This section contains the nature of the case and procedural background.

Baby K was born with anencephaly, a congenital malformation in which a major portion of the brain, skull, and scalp are missing. Because Baby K lacks a cerebrum, she is permanently unconscious. Thus, she has no cognitive abilities or awareness. She cannot see, hear, or otherwise interact with her environment. When Baby K had difficulty breathing on her own at birth, Hospital physicians placed her on a mechanical ventilator. The physicians explained to Ms. H (D) that most anencephalic infants die within a few days of birth due to breathing difficulties and other complications. Because aggressive treatment would serve no therapeutic or palliative purpose, they recommended that Baby K only be provided with supportive care in the form of nutrition, hydration, and warmth. D insisted that Baby K be provided with mechanical breathing assistance whenever the infant developed difficulty breathing on her own, while the physicians maintained that such care was inappropriate. P sought to transfer Baby K to another hospital. This attempt failed when all of the hospitals in the area with pediatric intensive care units declined to accept the infant. In November of 1992, when Baby K no longer needed the services of an acute-care hospital, she was transferred to a nearby nursing home. Baby K has been readmitted to P three times due to breathing difficulties. Each time she has been provided with breathing assistance and, after stabilization, has been discharged to the nursing home. P filed this action to resolve the issue of whether it is obligated to provide emergency medical treatment to Baby K that it deems medically and ethically inappropriate. Baby K's guardian ad litem and her father, Mr. K, joined in P's request for a declaration that the Hospital is not required to provide respiratory support or other aggressive treatments. D contested the request for declaratory relief. The court denied the requested relief. P, Mr. K, and Baby K's guardian ad litem appealed.

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