## Facts

- Donna Piazzi was admitted to University Hospital in Augusta, Georgia, a hospital operated by University Health Services, Inc. (UHS), while unconscious and approximately 20 weeks pregnant.
- Donna’s condition worsened, and physicians determined she was brain-dead; her bodily functions were being maintained through mechanical life-support systems.
- By the time of the expedited hearing, the fetus had reached “quickening” (fetal movement) but was not viable and could not survive outside the womb at that time.
- Medical testimony indicated that withdrawing life support would make fetal death medically certain at that stage.
- Medical testimony also indicated there was a reasonable possibility that continued somatic support could keep Donna’s body functioning long enough for the fetus to reach viability and be delivered with a reasonable possibility of survival.
- Physicians also described uncertainty about neonatal outcome: there was a possibility of serious abnormalities, but it was impossible to determine those outcomes before birth, and there was also a reasonable possibility the child could be normal.
- Robert Piazzi, Donna’s lawful husband, asked UHS to terminate life support, understanding that doing so would result in fetal death.
- David Hadden, Donna’s boyfriend, claimed to be the fetus’s biological father (a claim not disputed by Robert Piazzi) and asked that life support continue to give the fetus an opportunity to develop and survive.
- UHS filed a petition for declaratory judgment seeking a court order declaring the parties’ rights and directing whether life support should be maintained to allow fetal development.
- The court appointed a guardian ad litem to represent the interests of the unborn child; the guardian ad litem supported continued life support.
- The Georgia Division of Family and Children Services (DFCS) moved to dismiss, arguing that the question of maintaining life support to protect an unborn fetus was beyond the court’s jurisdiction and was a medical decision for physicians.

## Issues

1. Whether the Superior Court had jurisdiction under Georgia’s Declaratory Judgment Act to decide UHS’s request for direction about continuing life support for a brain-dead pregnant patient in the face of conflicting demands.
2. If the controversy was justiciable, whether the court should order continued life support when there was a reasonable possibility the fetus could be maintained to viability and delivered with a reasonable possibility of survival, despite the husband’s request to withdraw support.

## Decision

- The court denied DFCS’s motion to dismiss, finding a real and immediate controversy appropriate for declaratory relief because UHS faced conflicting demands and legal uncertainty about its obligations.
- The court granted UHS’s petition for declaratory relief.
- The court ordered UHS to continue life-support systems for Donna Piazzi to give the fetus the opportunity to develop to viability and be delivered, based on medical evidence showing a reasonable possibility of survival if support continued.
- The court contemplated continued medical evaluation of whether ongoing support continued to offer a reasonable possibility of achieving viability and delivery.

## Legal Principles

- Declaratory judgment is available when an actual controversy exists and a party requires judicial direction to avoid acting at legal risk under conflicting demands.
- A trial court may exercise declaratory-judgment authority in an urgent medical dispute when the parties’ rights and requested conduct are concrete and immediate, not hypothetical.
- In resolving conflicts about continued somatic support for a brain-dead pregnant patient, the court may consider the interests of the unborn child and may appoint a guardian ad litem to represent those interests.
- Where medical evidence shows a reasonable possibility that continued life support will allow a nonviable but quickened fetus to reach viability and be delivered with a reasonable possibility of survival, the court may order continued support even over the objection of the patient’s spouse.
- The possibility of fetal abnormality does not automatically defeat an order to continue support when survival to delivery remains reasonably possible and outcomes cannot be reliably determined before birth.

## Conclusion

The Superior Court of Richmond County held that UHS presented a justiciable declaratory-judgment controversy, denied DFCS’s motion to dismiss, and ordered continued life support for Donna Piazzi because medical testimony showed a reasonable possibility that continued somatic support could allow the quickened but nonviable fetus to reach viability and be delivered with a reasonable possibility of survival, notwithstanding the husband’s request to terminate support.


University Health Services, Inc. v. Piazzi, 1986 WL 1167470 (1986)