TEXAS SUPREME COURT UPHOLDS EMERGENCY RESUSCITATION OVER PARENTAL OBJECTION.

Deciding a closely watched case, the Texas Supreme Court on September 30 ruled that when emergency medical treatment is needed to save the life of a newborn infant, that treatment can be provided without parental consent when there is no time to conduct court proceedings to determine whether a parental decision to withhold treatment should be accepted or overruled.

In August 1990, Karla Miller's life-threatening infection forced doctors to induce delivery of her premature child. Some physicians told her and her husband the child had little chance to live and, if the baby did so, would probably have significant disabilities. The parents then told the doctors they wanted no resuscitation or life support to preserve the child's life after delivery, and the obstetrician directed that no neonatologist be present to care for the child after delivery.

Protests by nurses led to a series of meetings among hospital personnel, at the conclusion of which the Millers were told that a neonatologist would have to be present to evaluate the infant's condition before a decision could be made about life-preserving measures. The Millers protested and refused to consent to any resuscitation.

Subsequently, Sidney Miller was born at 23 weeks and 1 day gestation, weighing 615 grams, alive. The neonatologist provided her lifesaving treatment, and she initially responded well.

A few days later, however, she had a brain hemorrhage that did cause significant disabilities, including mental retardation and cerebral palsy. The Millers sued the corporation owning the hospital, and a jury awarded over $60 million in damages on the theory that Sidney would not have lived had the hospital not provided treatment against her parents' wishes.

The intermediate appellate court reversed, holding that a court cannot decide between life with disabilities and no life at all. The Texas Supreme Court agreed with that result, but with a refined rationale.

The court noted that parents have broad authority as decision-makers for their infant children, including decisions whether to consent to medical treatment. However, in circumstances such as child abuse and neglect, the state may override a parental refusal to consent. Normally this requires a hearing and a court order.