"Dementia Dignity and Advance Care Planning Act."

S4186

SENATE, No. 4186

STATE OF NEW JERSEY

222nd LEGISLATURE

�

INTRODUCED MAY 11, 2026

Sponsored by:

Senator� ANGELA V. MCKNIGHT

District 31 (Hudson)

SYNOPSIS

���� �Dementia Dignity and Advance Care Planning Act.�

CURRENT VERSION OF TEXT

���� As introduced.

��

An Act
concerning dementia and advance care planning, and
supplementing Title 26 of the Revised Statutes.

����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:

���� 1.��� This act shall be known
and may be cited as the �Dementia Dignity and Advance Care Planning Act.�

���� 2. The Legislature finds and
declares that:

���� a. Alzheimer�s disease and
related dementias are among the leading causes of death in New Jersey, imposing
profound emotional and financial burdens on patients and families.

���� 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.

���� 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.

���� �Dementia-Specific Advance
Directive� or �DSAD� means a written document executed pursuant to this act by
an individual with decisional capacity, specifying health care preferences to
apply in the event the individual later enters advanced stages of dementia.

���� �Department� means the
Department of Health.

���� 4.��� a. Any competent adult
diagnosed with Alzheimer�s disease or another neurodegenerative dementia shall
be permitted to execute a Dementia-Specific Advance Directive.

���� b. The DSAD shall:

���� (1) be signed and dated by the
declarant while having decisional capacity;

���� (2) be witnessed by two
adults, at least one of whom is not a relative, health care provider, or
entitled to any portion of the declarant�s estate or notarized;

���� (3) specify the individual�s
wishes regarding:

���� (a) feeding preferences,
including comfort feeding only;

���� (b) hospitalization,
resuscitation, artificial nutrition and hydration, intravenous fluids,
antibiotics, and other life-prolonging measures; and

���� (c) conditions that will
trigger comfort-only care.

���� c. The declarant shall be
permitted to revoke his or her DSAD at any time while retaining decisional
capacity.

���� 5.��� a. The department shall
establish and maintain a secure, electronic Dementia Advance Directive Registry
to store DSADs executed pursuant to section 4 of this act.

���� b. Licensed health care
professionals shall have real-time access to the registry for patients under
their care who have executed a DSAD.

���� 6.��� Every licensed hospital,
nursing home, assisted living facility, hospice, and health care professional
shall:

���� a. honor a valid DSAD executed
under this act;

���� b.��� offer patients and
families the option of comfort feeding only orders consistent with a DSAD;

���� c.���� be immune from civil
and criminal liability and from discipline by the department or professional
licensing boards if acting in good faith reliance on a DSAD; and

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

���� b. Every licensed hospital,
nursing home, assisted living facility, and hospice shall incorporate DSAD
education into patient intake and care planning processes.

���� 8.��� The department shall
collect and publish annually on its Internet website, de-identified data on the
number of DSADs filed, honored, and revoked.

���� 9. The Commissioner of Health
shall adopt rules and regulations, in accordance with the �Administrative
Procedure Act,� P.L.1968, c.410 (C.52:14B-1 et seq.), as are necessary to
effectuate the provisions of this act, including rules and regulations concerning
the submission, storage, and retrieval of DSADs.

���� 10. This act shall take effect
one year following enactment, except that the department may take anticipatory
administrative action in advance thereof.

STATEMENT

���� This bill establishes the �Dementia
Dignity and Advance Care Planning Act.�

���� Under the bill, any competent
adult diagnosed with Alzheimer�s disease or another neurodegenerative dementia
is to be permitted to execute a �Dementia-Specific Advance Directive� (DSAD),
which is a written document executed pursuant to this bill by an individual
with decisional capacity, specifying health care preferences to apply in the
event the individual later enters advanced stages of dementia.

���� The DSAD is to:� (1) be signed
and dated by the declarant while having decisional capacity; (2) be witnessed
by two adults, at least one of whom is not a relative, health care provider, or
entitled to any portion of the declarant�s estate or notarized; (3) specify the
individual�s wishes regarding: feeding preferences, including comfort feeding
only; hospitalization, resuscitation, artificial nutrition and hydration,
intravenous fluids, antibiotics, and other life-prolonging measures; and
conditions that will trigger comfort-only care.� The declarant is to be
permitted to revoke his or her DSAD at any time while retaining decisional
capacity.

���� Under the bill, the Department
of Health (department) is to establish and maintain a secure, electronic
Dementia Advance Directive Registry to store DSADs; develop training programs
for health care professionals and long-term care staff on dementia-specific
advance care planning, execution and recognition of DSADs, and comfort feeding
practices; and collect and publish annually on its Internet website,
de-identified data on the number of DSADs filed, honored, and revoked.

���� The bill provides that every
licensed hospital, nursing home, assisted living facility, hospice, and health
care professional is to:� (1) honor a valid DSAD executed under this bill; (2)
offer patients and families the option of comfort feeding only orders
consistent with a DSAD; (3) be immune from civil and criminal liability and
from discipline by the department or professional licensing boards if acting in
good faith reliance on a DSAD; and (4) not be compelled to perform a treatment
decision contrary to one�s conscience, provided that the timely transfer of
care will be arranged to ensure the patient�s wishes are respected.