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

Current through Register Vol. 56, No. 14, July 15, 2024
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.