New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 48B - DECISION-MAKING FOR THE TERMINALLY ILL
Subchapter 2 - DEFINITIONS
Section 10:48B-2.1 - Definitions

The following words and terms, as used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise:

"Advance directive" means a written document executed in accordance with the requirements of the New Jersey Advance Directive for Health Care Act, 26:2H-53 et seq. It is a written instruction stating the individual's general treatment philosophy and objectives, and/or the individual's specific wishes regarding the provision, withholding or withdrawal of any form of health care, including life sustaining medical treatment. It may also be used for the individual to name a health care representative to make medical decisions on behalf of the individual, if he or she loses capacity.

"Attending physician" means the physician selected by, or assigned to, the individual who has primary responsibility for the treatment and care of the individual.

"Bureau of Guardianship Services (BGS)" means the unit within the Department of Human Services, which has the responsibility and authority to provide guardianship of the person to individuals in need of such services (10:45-1.2) .

"Capacity" means an individual's ability to understand and appreciate the nature and consequences of health care decisions, including the benefits and risks of each, and alternatives to any proposed health care, and to reach an informed decision on his or her own behalf. An individual's decision-making capacity is evaluated relative to the demands of a particular health care decision.

"Disability Rights New Jersey (DRNJ)" means the organization designated by the Governor to be the agency to implement, on behalf of the State of New Jersey, the Protection and Advocacy System established under the Developmental Disabilities Assistance and Bill of Rights Act, 42 U.S.C. §§ 15041- 15045.

"Do Not Resuscitate (DNR) Order" means a physician's written order not to attempt cardiopulmonary resuscitation in a hospital or out-of-hospital situation in the event the individual suffers cardiac or respiratory arrest.

"Emergency care" means immediate treatment provided to a sudden, acute and unanticipated medical crisis in order to avoid injury, impairment or death.

"Ethics Committee" means a multi-disciplinary standing committee, which shall be recognized by the Assistant Commissioner of Legal, Regulatory and Guardianship Services, or his or her designee, pursuant to 10:48B-3.1, and shall have a consultative role, when the Bureau of Guardianship Services is the guardian, in reviewing a recommendation for a "Do Not Resuscitate Order" (DNR) or for withholding or withdrawing an individual's life-sustaining medical treatment.

"Health care facility" means a hospital, a residential health care facility or nursing home, an assisted living facility, a developmental center, or a private residential facility licensed under N.J.A.C. 10:47. Community residences licensed under N.J.A.C. 10:44A or 10:44B are not health care facilities.

"Hospice" means a program, which is licensed by the New Jersey Department of Health to provide palliative services to terminally ill individuals in the individual's home or place of residence, including medical, nursing, social work, volunteer, and counseling services.

"Immediate family" means spouse, civil union partner as defined in P.L. 2006, c. 103, children, parents and siblings. Immediate family may also include individuals less closely related to the individual by blood or marriage, but who have been interested and involved with the individual's welfare.

"Life sustaining medical treatment (LSMT)" means the use of any medical device or procedure, artificially provided fluids and nutrition, drugs, surgery, or therapy that uses mechanical or other artificial means to sustain, restore or supplant a vital bodily function and thereby increase the expected life span of the individual.

"Medical practitioner" means a person who is certified as an advanced practice nurse (APN) pursuant to N.J.S.A. 45:11-45 et seq., or a physician licensed to practice medicine and surgery pursuant to Chapter 9 of Title 45 of the New Jersey Revised Statutes.

"Medically contraindicated" means that to a reasonable degree of medical certainty, CPR will be unsuccessful in restoring cardiac and respiratory function, or that the individual will experience repeated arrest in a short time period before death occurs or that CPR would impose unwarranted physical trauma on the patient in light of the individual's medical condition and the expected outcome of resuscitation for the individual.

"Palliative care" means a holistic approach to individual care, integrating medical, psychosocial, and spiritual elements, in the presence of an incurable progressive illness that is expected to end in death. Designed to decrease the severity of pain, suffering, and other distressing symptoms, palliative care recognizes that dying is part of living. Palliative care is provided to the individual, the family, and others involved in the individual's illness by an interdisciplinary healthcare team, including nurses, social workers, chaplains, and physicians. The expected outcome of palliative care is to enable the individual to experience an improved quality of life.

"Permanently unconscious" means a medical condition that has been diagnosed in accordance with currently accepted medical standards, and with reasonable medical certainty, as total and irreversible loss of consciousness and capacity for interaction with the environment. The term "permanently unconscious" includes, but is not limited to, a persistent vegetative state or irreversible coma.

"Practitioners Order for Life Sustaining Treatment (POLST)" means a form of standardized medical order signed by a physician or advanced practice nurse that comports with New Jersey State laws and rules.

"Regional Long Term Care Ethics Committee" means a multi-disciplinary body of individuals, at least two of whom have completed the training program sponsored by the Office of the Ombudsman for the Institutionalized Elderly. Regional Long Term Care Ethics Committees provide to the long-term care community expertise of multi-disciplinary members who offer case consultation and support to residents and health care professionals who are facing ethical dilemmas (N.J.A.C. 8:39-5). Regional Long Term Care Ethics Committees also provide education for residents and families, health care professionals and the local community (8:39-13.4) . Regional Long Term Care Ethics Committees provide policy development to enhance facilities' ethical decision-making.

"Supportive care plan" means a plan of care to be developed by the health care facility for each individual for whom a Do Not Resuscitate (DNR) Order is proposed. The plan is individualized to meet the individual's needs and shall consider fluid/intravenous therapies, nutrition, symptom management/medication, invasive diagnostic and therapeutic procedures including, but not limited to, mechanical ventilation, kidney dialysis, pulmonary, arterial or venous catheters, transfusions, laboratory, x-ray and other tests. This plan shall also include non-medical interventions that address the individual's psychosocial and spiritual needs and may include complementary therapies, such as aromatherapy, music therapy, pet therapy, and the like.

"Terminally ill individual" means an individual receiving services from the Division, who is under medical care and has reached the terminal stage of an irreversibly fatal illness, disease, or condition and the prognosis of the treating practitioner and at least one other physician asserts that the medical prognosis indicates a life expectancy of one year or less if the irreversibly fatal illness, disease, or condition continues on its normal course of progression, based upon reasonable medical certainty.

"Treating practitioner" means the medical practitioner selected by, or assigned to, the individual who has primary responsibility for the treatment and care of the individual.