“Dignity” Bill in in New Jersey OKs Starving Dementia Patients to Death

New Jersey lawmakers have introduced Senate Bill 4186, the “Dementia Dignity and Advance Care Planning Act.” It is wrong on many, many grounds.

Wesley J. Smith wrote about this legislation in National Review Online on May 18^th. He warns that “moves are afoot in bioethics” that could allow dementia advance directives to be used either to authorize euthanasia where legal or to require withholding food and water from patients who can no longer provide current consent, even when they may still appear willing to eat or drink.

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Supporters frame the bill around autonomy, quality of life, and reducing emotional and financial burdens. They argue that it allows individuals diagnosed with Alzheimer’s disease or other dementias to create “Dementia Specific Advance Directives” (DSADs) while they still have “decisional capacity.”

No one disputes the devastation of dementia. Many of us have watched helplessly as memory, speech, and independence faded in someone we loved. Legislators invoke that suffering to justify this bill.

What they do not advertise is that this creates a potential dangerous structure in which withdrawal of artificial nutrition and hydration becomes routine in certain cases.

The bill explicitly authorizes “comfort feeding only” orders. It defines this as 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.” [Emphasis added]

That phrase “if and as tolerated” is dangerously vague. Who determines tolerance on any given day? A patient with dementia may refuse a spoonful at breakfast yet eagerly accept the same food at lunch.

At what point does hand feeding shift from “comfort” to “burdensome”? Once the order is in place, the default risks becoming minimal care, while artificial nutrition and hydration are categorically prohibited.

These concerns are not merely theoretical. Smith warns that “comfort feeding only” approaches in advanced dementia care may, in practice, change how assisted eating and drinking are treated. Although presented as a focus on comfort and avoiding burdensome interventions, he cautions that in institutional settings such policies could lead to reduced hand feeding for patients who can no longer advocate for themselves.

Food and water are not “extraordinary medical interventions.” They are the baseline of human care.

When a competent patient refuses them, that choice must be respected. But we have to recognize that their desire may change from day to day.  By extending that logic to patients who can no longer consent and allowing “quality of life” determinations to drive the withdrawal of assisted feeding crosses an ethical line that should not become blurred.

The proposal compounds this concern with sweeping immunity provisions. Health care providers and institutions are shielded from civil or criminal liability if they act in “good faith” reliance on a Dementia Specific Advance Directives. Families who believe a directive is being applied too early, too rigidly, or inconsistently with a patient’s observable comfort will face an uphill battle to intervene.

In practice, these legal protections operate within already strained elder care environments. Caregivers are exhausted, nursing homes are understaffed, and long-term care facilities face constant staffing and financial pressures. In that environment, lowering expectations around assisted feeding risks creating a culture in which dependent elderly patients are treated more as “burdens” than as people still deserving basic care, patience, and dignity

The bill requires people diagnosed with dementia to spell out “feeding preferences, including comfort feeding only,” while they still supposedly have “decisional capacity.” But the legislation never actually defines what “decisional capacity” means or exactly who decides when a person has lost it. That matters because dementia is not a simple on-off switch.

Many patients have good days and bad days. Someone may be confused in the morning but alert later in the day, forget names yet still recognize family, enjoy meals, respond to conversation, or willingly accept food and water. Once someone is declared to have lost “decisional capacity,” decisions about feeding can be controlled by paperwork signed years earlier, even if the person in front of caregivers still appears comfortable, cooperative, and willing to eat.

Another underlying assumption behind this legislation is that people can accurately predict, years in advance, how they will feel living with advanced dementia. But reality is often more complicated. Many patients who once feared such a diagnosis still find comfort in familiar routines, enjoy time with family, respond to music or affection, and continue experiencing moments of connection and contentment.

New Jersey should instead be strengthening palliative care training, increasing staffing ratios in long term care facilities, expanding respite support for families, and reinforcing protections against neglect and abuse. Those reforms add care rather than subtracting it.

A person’s value and dignity do not disappear simply because memory and cognition decline.

S4186 deserves far more than routine passage. It is not “dignity” to grant broad legal authority to limit basic nutrition for those who can no longer object. Once safeguards protecting vulnerable patients are weakened, they are difficult and close to impossible to restore.

New Jersey residents need to stay informed and engaged as these proposals move through the legislative process. Legislation affecting vulnerable patients often receives limited public scrutiny, and informed civic participation is essential to ensure that such bills are fully understood and stopped before they become law.

New Jersey lawmakers should reject this legislation. Food and water are care, not optional treatment, and decisions about them should not be left to vague or untested assumptions about future incapacity.

LifeNews.com Note: Marie Tasy is the executive director of New Jersey Right to Life