"Dementia Dignity and Advance Care Planning Act."
S4186, the “Dementia Dignity and Advance Care Planning Act,” would create a new framework in New Jersey for people diagnosed with Alzheimer’s disease or another neurodegenerative dementia to complete a Dementia-Specific Advance Directive (DSAD). The bill is designed for individuals who still have decisional capacity at the time of execution, allowing them to state in advance their preferences for care if they later reach advanced dementia. Those preferences may address feeding, hospitalization, resuscitation, artificial nutrition and hydration, intravenous fluids, antibiotics, and other life-prolonging treatment, as well as when comfort-only care should begin.
The bill also directs the Department of Health to establish a secure electronic registry for DSADs, make them accessible to licensed health care professionals in real time, and develop training for health care and long-term care staff on recognizing and implementing these directives. It further requires hospitals, nursing homes, assisted living facilities, hospices, and health care professionals to honor valid DSADs, offer comfort-feeding-only options consistent with them, and include DSAD education in intake and care-planning processes. The department would also publish annual de-identified data on how many directives are filed, honored, and revoked.
If enacted, the bill would supplement Title 26 of the Revised Statutes by creating a dementia-specific advance care planning regime distinct from existing general advance directive law. It would establish legal recognition for DSADs, impose compliance duties on hospitals, nursing homes, assisted living facilities, hospices, and health care professionals, and provide immunity from civil, criminal, and disciplinary liability for good-faith reliance on a valid directive. The measure would also require the Department of Health to build and maintain a registry, issue regulations, and oversee training and reporting, thereby expanding state administrative responsibilities and affecting end-of-life decision-making practices across the health care system.
The bill’s stated purpose and structure suggest generally supportive sentiment toward patient autonomy, dignity, and clearer end-of-life planning for people with dementia. The legislative findings emphasize respecting previously expressed wishes and avoiding burdensome interventions in advanced stages of disease, indicating a policy approach framed as compassionate and rights-based. No committee transcript or vote record was provided, so there is no documented opposition or recorded floor/committee sentiment in the materials supplied.
The main points of potential contention are likely to involve how the bill balances patient autonomy with clinical judgment, institutional conscience protections, and implementation burdens. Health care providers and facilities may be concerned about the operational demands of a new registry, training requirements, and the obligation to recognize and honor DSADs across care settings. Another possible area of debate is the scope of the comfort-feeding-only concept and the bill’s treatment of artificial nutrition, hydration, and other life-prolonging measures, especially in cases where family members, providers, or facilities disagree about whether the directive applies. The bill attempts to address some of these concerns by allowing conscientious objection so long as timely transfer of care is arranged.