A 1352 — "Dementia Dignity and Advance Care Planning Act."

A1352 1R [First Reprint] ASSEMBLY, No.

MURPHY District 7 (Burlington)  Assemblyman   ROBERT  J.   SYNOPSIS      "Dementia Dignity and Advance Care Planning Act."   CURRENT VERSION OF TEXT      Introduced Pending Technical Review by Legislative Counsel.

KARABINCHAK District 18 (Middlesex)   Co-Sponsored by:

Assemblywoman Speight         SYNOPSIS      "Dementia Dignity and Advance Care Planning Act."   CURRENT VERSION OF TEXT      As reported by the Assembly Health Committee on March 9, 2026, with amendments.

       1.    This act shall be known and may be cited as the “Dementia Dignity and Advance Care Planning Act.”        2.2.    The Legislature finds and declares that:

The     Legislaturea.     findsAlzheimer’s disease and declaresrelated that:dementias are among the leading causes of death in New Jersey, imposing profound emotional and financial burdens on patients and families.

     a.b.    Current State law recognizes the right of competent adults to make advance decisions regarding health care, but does not adequately provide for dementia-specific directives tailored to the unique challenges of progressive cognitive decline.

Alzheimer’s     diseasec.     andMany relatedindividuals dementiaswish areto amongavoid theburdensome leadinginterventions, causesforced offeeding, deathor inrepeated Newhospitalizations Jersey,once imposingthey profoundreach emotionaladvanced andstages financialof burdensdementia, onwhen patientsquality andof families.life has irreversibly diminished.

     b.d.    It is the public policy of this State to respect the dignity, autonomy, and previously expressed wishes of individuals living with dementia by authorizing Dementia-Specific Advance Directives (DSADs), establishing clear standards for “comfort feeding only,” and ensuring that such directives are honored across all care settings.

Current  State     law3.    recognizes1[“Advanced dementia” means a stage of progressive neurodegenerative disease in which the rightindividual is permanently unable to communicate meaningfully, recognize loved ones, or perform basic activities of competentdaily adultsliving without total assistance.]1      “Comfort feeding only” means an order that directs caregivers to makeoffer advanceoral decisionsfood regardingand healthfluids care,by buthand, doesif notand adequatelyas providetolerated, for dementia-specificcomfort directivespurposes, tailoredand toprohibits theartificial uniquenutrition challengesor ofhydration progressivethrough cognitivefeeding decline.tubes or intravenous means.

     c.

Many individuals wish to avoid burdensome interventions, forced feeding, or repeated hospitalizations once they reach advanced stages of dementia, when quality of life has irreversibly diminished.

     d.

It is the public policy of this State to respect the dignity, autonomy, and previously expressed wishes of individuals living with dementia by authorizing Dementia-Specific Advance Directives (DSADs), establishing clear standards for “comfort feeding only,” and ensuring that such directives are honored across all care settings.

       3.

As used in this act:

     “Advanced dementia” means a stage of progressive neurodegenerative disease in which the individual is permanently unable to communicate meaningfully, recognize loved ones, or perform basic activities of daily living without total assistance.

     “Comfort feeding only” means an order that directs caregivers to offer oral food and fluids by hand, if and as tolerated, for comfort purposes, and prohibits artificial nutrition or hydration through feeding tubes or intravenous means.

     b.b.    The DSAD shall:

The     DSAD(1)   shall:be signed and dated by the declarant while having decisional capacity;

     (1)(2)   be signedwitnessed andby datedtwo byadults, theat declarantleast whileone havingof decisionalwhom capacity;is not a relative, health care provider, or entitled to any portion of the declarant’s estate or notarized;

     (2)(3)   bespecify witnessed by two adults, at least one of whom is not a relative, health care provider, or entitled to any portion of the declarant’sindividual’s estatewishes orregarding: notarized;

     (3)(a)   specifyfeeding thepreferences, individual’sincluding wishescomfort regarding:feeding only;

     (a)(b)   feedinghospitalization, preferences,resuscitation, includingartificial comfortnutrition feedingand only;hydration, intravenous fluids, antibiotics, and other life-prolonging measures;

     (b) hospitalization, resuscitation, artificial nutrition and hydration,     intravenous(c)   fluids,conditions antibiotics,that andwill othertrigger life-prolongingcomfort-only measures;care.

and      (c)c.     conditionsThe thatdeclarant willshall triggerbe comfort-onlypermitted care.to revoke his or her DSAD at any time while retaining decisional capacity.

       c.15.   a.  A dementia-specific advance directive executed pursuant to section 4 of this act shall be deemed a form of instruction directive under P.L.1991, c.201 (C.26:2H-53 et seq.) and shall be subject to all rights, duties, and protections afforded therein.

The     declarantb.    Nothing in this act shall be permittedconstrued to revokeinvalidate, hisreplace, or hersupersede DSADa atpreviously anyexecuted timeadvance whiledirective retainingunless decisionalexpressly capacity.stated by the declarant.

       5.   6.    a.a.  In the event a declarant has executed multiple advance directives, including a dementia-specific advance directive, the directive most recently executed shall control unless the declarant expressly provides otherwise.

The     departmentb.    A dementia-specific advance directive shall establishgovern anddecisions maintainarising from a secure,diagnosis electronicof Dementiadementia Advanceor Directiverelated Registryneurodegenerative tocondition storeand DSADsshall executednot pursuantcontrol medical decisions unrelated to sectionsuch 4condition ofunless thisexpressly act.stated.

     b.c.     A dementia-specific advance directive shall not preclude the consideration of other diagnosed medical conditions.  Health care decisions shall be made consistent with the declarant’s expressed wishes and applicable medical standards.

Licensed     d.    In the event of an irreconcilable conflict between directives, the declarant’s designated health care professionalsrepresentative shall haveinterpret real-timethe accessdirectives toconsistent with the registrydeclarant’s forknown patientswishes underand theirbest careinterest whopursuant haveto executedP.L.1991, c.201 (C.26:2H-53 et seq.).1        1[5.] 7.1     a.         The department shall establish and maintain a DSAD.secure, electronic Dementia Advance Directive Registry to store DSADs executed pursuant to section 4 of this act.

       6.   b.    EveryLicensed licensedhealth hospital,care nursingprofessionals home,shall assistedhave livingreal-time facility,access hospice,to andthe healthregistry for patients under their care professionalwho shall:have executed a DSAD.

     1[6.] 8.1     Every licensed hospital, nursing home, assisted living facility, hospice, and health care professional shall:

not not be compelled to perform a treatment decision contrary to one’s conscience, provided that the timely transfer of care shall be arranged to ensure the patient’s wishes are respected.

       7.   1[7.] a.9.1     a.  The department shall develop training programs for health care professionals and long-term care staff on dementia-specific advance care planning, execution 1,1 and recognition of DSADs, and comfort feeding practices.

The     departmentb.    shall1[Every developlicensed traininghospital, programsnursing forhome, healthassisted careliving professionalsfacility, and long-termhospice careshall staffincorporate onDSAD dementia-specificeducation advanceinto patient intake and care planning,planning executionprocesses] andThe recognitiontraining ofprograms DSADs,developed andpursuant comfortto feedingsubsection practices.a.

    of b.this section shall constitute optional training for health care professionals and long-term care staff, for which clinicians who provide dementia care may secure continuing medical education credits1.

Every  licensed     hospital,1[8.] nursing10.1   home,The assisteddepartment livingshall facility,collect and hospicepublish shallannually incorporateon DSADits educationInternet intowebsite, patientde-identified intakedata andon carethe planningnumber processes.of DSADs filed, honored, and revoked.

       8.   1[9.] 11.1 The departmentCommissioner of Health shall collectadopt rules and publishregulations, annuallyin onaccordance itswith Internetthe website,“Administrative de-identifiedProcedure dataAct,” onP.L.1968, c.410 (C.52:14B-1 et seq.), as are necessary to effectuate the numberprovisions of DSADsthis filed,act, honored,including rules and revoked.regulations concerning the submission, storage, and retrieval of DSADs.