Care and Protection of Beth

The subject child was born in 1986 to two minor parents. Both the child and the mother (defendant) were shortly thereafter taken into the custody of the Department of Social Services (DSS) (defendant) following child protective proceedings. When the child was approximately three months old, the mother regained physical custody of the child, but both mother and child remained in the legal custody of DSS. Shortly thereafter, the mother and child were in a car accident that left the child in an irreversible coma, attached to a breathing tube and feeding tube. In July 1987, DSS and the mother jointly moved in the district court for the appointment of a guardian ad litem (plaintiff), given the child’s parents were both minors, and for entry of a substituted-judgment decision as to the child’s medical care. At a hearing, the director of the pediatric ICU where the child was hospitalized testified the child was irreversibly brain dead, had no possibility of recovery, and that entering a no-code order was ethically appropriate. The district court entered a do-not-resuscitate order (DNR) for the child, finding that the child would choose not to be resuscitated were she competent. The guardian ad litem appealed, arguing the district court’s substituted judgment had no basis in the record and that the state’s interest in the preservation of life outweighed any bodily dignity issues or interest a brain-dead child might have in the imposition of a DNR.