A194

ASSEMBLY, No. 194

STATE OF NEW JERSEY

Introduced Pending Technical Review by Legislative Counsel

PRE-FILED FOR INTRODUCTION IN THE 1996 SESSION

By Assemblywoman WEINBERG

An Act concerning the withholding of life-sustaining treatment and supplementing Titles 26 and 45 of the Revised Statutes.

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

1. As used in sections 1 through 5 of P.L. , c. (C. ) (pending before the Legislature as this bill):

"Advanced life support" means an advanced level of pre-hospital, interhospital and emergency service care which includes basic life support functions, cardiac monitoring, cardiac defibrillation, telemetered electrocardiography, administration of antiarrhythmic agents, intravenous therapy, administration of specific medications, drugs and solutions, use of adjunctive ventilation devices, trauma care and other techniques and procedures authorized in writing by the commissioner pursuant to regulation and P.L.1984, c.146 (C.26:2K-7 et seq.).

"Basic life support" means a basic level of pre-hospital care which includes patient stabilization, airway clearance, cardiopulmonary resuscitation, hemorrhage control, initial wound care and fracture stabilization, and other techniques and procedures authorized by the commissioner.

"Cardiopulmonary resuscitation" means cardiac compression, endotracheal intubation and other advanced airway management, artificial ventilation, defibrillation and other related procedures as stipulated by the commissioner.

"Commissioner" means the Commissioner of Health.

"Do not resuscitate order" means a physician's written order not to attempt cardiopulmonary resuscitation in the event the patient suffers a cardiac or respiratory arrest.

"Emergency medical services personnel" means persons trained and certified or licensed to provide emergency medical care, whether on a paid or voluntary basis, as part of a basic life support or advanced life support pre-hospital emergency care service.

"Life-sustaining treatment" 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 a patient.

"Pre-hospital care" means the provision of emergency medical care or transportation by trained and certified or licensed emergency medical services personnel at the scene of an emergency and while transporting sick or injured persons to a medical care facility or provider.

"Terminal condition" means the terminal stage of an irreversibly fatal illness, disease or condition. A determination of a specific life expectancy is not required as a precondition for a diagnosis of a "terminal condition," but a prognosis of a life expectancy of six months or less, with or without the provision of life-sustaining treatment, based upon reasonable medical certainty, shall be deemed to constitute a terminal condition.

2. Emergency medical services personnel may withhold cardiopulmonary resuscitation or any other life-sustaining treatment from a patient in the event of cardiac or respiratory arrest if evidence of a do not resuscitate order is presented on a form and in a manner to be prescribed by the commissioner.

3. Emergency medical services personnel, a licensed physician, hospital or its board of trustees, officer or member of the medical staff, nurse or other employee of the hospital, or officer or member of a first aid, ambulance or rescue squad, who has not engaged in negligent or unprofessional conduct, shall not be liable for any civil or criminal damages as a result of the withholding or withdrawal of cardiopulmonary resuscitation or other life-sustaining treatment from a patient in accordance with the provisions of this act and any rules and regulations adopted by the commissioner.

4. Nothing in this act shall be construed to permit the withholding of medication, intravenous fluids, oxygen or other therapies, or the nonperformance of any medical procedure, deemed necessary to provide comfort care to a patient or to alleviate the patient's pain.

5. The commissioner, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) shall adopt rules and regulations to effectuate the purposes of sections 1 through 4 of P.L. , c. (C. )(pending before the Legislature as this bill).

6. As used in sections 6 through 10 of P.L. , c. (C. ) (pending before the Legislature as this bill):

"Board" means the New Jersey Board of Nursing.

7. A visiting or home care nurse licensed by the board may withhold cardiopulmonary resuscitation or any other life-sustaining treatment from a patient in the event of cardiac or respiratory arrest if evidence of a written order not to resuscitate by the attending physician is presented on a form and in a manner to be prescribed by the board.

8. A visiting or home care nurse, licensed physician, or employee of an agency, firm or other entity providing visiting or home care nurse services, who has not engaged in negligent or unprofessional conduct, shall not be liable for any civil or criminal damages as a result of the withholding or withdrawal of cardiopulmonary resuscitation or other life-sustaining treatment from a patient in accordance with the provisions of this act and any rules and regulations adopted by the board.

9. Nothing in this act shall be construed to permit the withholding of medication, intravenous fluids, oxygen or other therapies, or the nonperformance of any medical procedure, deemed necessary to provide comfort care to a patient or to alleviate the patient's pain.

10. The board, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) shall adopt rules and regulations to effectuate the purposes of sections 6 through 9 of P.L. , c. (C. )(pending before the Legislature as this bill).

11. This act shall take effect immediately.

STATEMENT

This bill would permit emergency medical services personnel to withhold or withdraw cardiopulmonary resuscitation or other life-sustaining treatment from a patient in an out-of-hospital setting, either at the scene of an emergency or while transporting the patient to a medical care facility or provider, based upon a physician's written do not resuscitate order. Evidence of this order shall be presented to the emergency medical services personnel on a form and in a manner to be prescribed by the Commissioner of Health.

The bill would also permit a visiting or home care nurse licensed by the New Jersey Board of Nursing to withhold or withdraw cardiopulmonary resuscitation or other life-sustaining treatment from a patient in the home, based upon a physician's written do not resuscitate order. Evidence of this order shall be presented to the nurse on a form and in a manner to be prescribed by the board.

This bill is intended to complement the "New Jersey Advance Directives for Health Care Act," P.L.1991, c.201 (C.26:2H-53 et seq.) which provides for "living wills" by which patients may specify the circumstances under which extraordinary means should be used to prolong their lives, but applies only to patients in hospitals and other health care facilities.

To date, seven states (Arizona, Colorado, Florida, Montana, New York, Rhode Island and Virginia) have enacted statutes which allow persons to refuse emergency resuscitation in out-of-hospital settings.

Permits withholding or withdrawal of life-sustaining treatment under certain circumstances.