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Frequently Asked Questions about Advance Directives

What is the difference between advance care planning and an advance directive?

Advance care planning is the process of thinking about, planning, and communicating preferences and priorities for your future health care needs. An advance directive is a legal document that is signed in the presence of two witnesses that allows you to designate a decision maker(s) and document your goals and values for future care and treatment.

Why should I complete an advance directive?

There may come a time when you are seriously ill or injured and cannot make your own decisions about what kinds of treatments you would want under certain circumstances. Having discussion with family, friends and loved ones ahead of time about your values and wishes will help them to be able to speak on your behalf during a critical time. Advance directives are a gift of communication and an assurance that your wishes will be honored.

Who can complete an advance directive?

All adults 18 years of age or older who are capable of making their own decisions are encouraged to complete an advance directive for themselves.

What is the difference between a Living Will and an advance directive?

A Living Will is an older document that was designed to address a situation where a person has a terminal condition and only wants care directed at their comfort and no extraordinary measures taken to prolong their life.

An advance directive is a more contemporary version of the older living will. Advance directives allow an individual to specify the care and treatment they would and would not find acceptable if they were unable to speak for themselves, regardless of whether their condition is terminal.

Is an advance directive a legal document in Vermont?

Yes, properly signed and witnessed advance directives are legally recognized in Vermont.

Who can witness an advance directive?

Any adult can witness an advance directive as long as they are not your health care agent, spouse, parents, siblings, children or grandchildren. A health care provider may serve as a witness.

What is the difference between an advance directive and a DNR/COLST order?

An advance directive is completed by an individual who is capable of making their own decisions. These are preference based documents that guide care and treatment in the future if the individual is not able to speak for themselves. Advance directives are not recognized by emergency first responders.

A DNR/COLST order is a medical order created through a shared decision making process between a clinician (MD, DO, APRN, PA) and a patient. These documents require informed consent, will guide the current treatment plan, and are legally recognized by all medical providers, including emergency first responders. Consent for a DNR/COLST can be provided by someone other than the patient if the patient lacks capacity.

What is the difference between a Durable Power of Attorney for Health Care and a health care agent?

A Durable Power of Attorney for Health Care and a health care agent are both terms to describe an individual who has been appointed by a person who has capacity to make health care decisions on their behalf in the event that they are not able.

Vermont’s Durable Power of Attorney for Health Care statute was repealed in 2005. If a Durable Power of Attorney for Health Care document was executed prior to 2005 and was in accordance with the law at that time, it is still valid.

Who can serve as a health care agent?

Anyone 18 years of age or older can serve as your agent, with the following exception, per Vermont statute 18 VSA § 9702(18)(c):

“The principal’s health care provider may not be the principal’s agent. Unless related to the principal by blood, marriage, civil union, or adoption, an agent may not be an owner, operator, employee, agent, or contractor of a residential care facility, a health care facility, or a correctional facility in which the principal resides at the time of execution of an advance directive.”

Vermont law allows for appointment of co-agents, as well as an alternate agent, in the event your agent is unavailable when a health care decision is required.

Can my health care agent override my decisions?

A health care agent is obligated to make decisions by attempting to determine what the person would have wanted in that situation. To do this, they must consider the previously stated wishes, per their advance directive (to the degree that those apply), verbal statements (to the extent that they apply), and knowledge of their goals, values, religious and moral beliefs. They are not allowed to consider their own interests, values, wishes or beliefs when making decisions for someone else.

Will my advance directive be honored in an emergency?

If you have a medical emergency outside of a hospital, the first responders are required to provide maximal treatment (unless you have a signed DNR/COLST order) until you can get to a hospital and are evaluated by a doctor. At the hospital, you, your advance directive, or health care agent can guide further decisions.

If you do not want CPR (cardiopulmonary resuscitation) performed on you for any reason, you should talk to your clinician about completing a DNR/COLST so that first responders who come to your home will be able to honor your preference.

 

Will another state honor my advance directive?

Most states will honor an out-of-state advance directive, but some require that it conform to their laws. New Hampshire, for example, does not permit artificially supplied nutrition and fluids (tube feeding) to be withheld or withdrawn unless the patient has provided written instructions to that effect in an Advance Directive.

Some states will not honor an advance directive of a patient who is pregnant and permanently ill or comatose. While Vermont has no such law, women capable of becoming pregnant should consider including instructions relating to pregnancy on their advance directives.

If I live in another state but get my care in Vermont, what advance directive form should I be using?

You should use the advance directive form for the state in which you reside. To find the form for your state, click here.

What types of decisions can be communicated in an advance directive?

In general, any preferences related to your future health care needs can be communicated in an advance directive. Many advance directives include information related to:

  • The individual(s) who can and cannot not be involved in decision making
  • Situations that you would and would not find acceptable
  • Trade-offs that you would or would not be willing to make in order to have more time
  • Trial courses of treatment to see if you will get better
  • Invasive procedures that you may or may not want at the end of life, i.e. use of CPR, artificial feeding, breathing machines, etc.
  • Organ and tissue donation
  • Funeral or burial arrangements
  • Spiritual or religious preferences
Can I still make my own health care decisions if I have signed an advance directive?

You make your own medical decisions as long as you are able to do so. In general, your agent’s authority begins when you lack the capacity to make your own decisions, as determined by a clinician.

What if I change my mind about the kind of treatment I want?

A person can change their mind at any time about their treatment decisions. If your advance directive no longer reflects your current decisions, you should complete a new document. The most current advance directive will guide the care plan if you are unable to speak for yourself. If you update your advance directive, be sure to notify and provide updated copies to everyone who has old copies.

Can I indicate my preference for organ donation on my advance directive?

Yes, you can. For more information about organ donation and registering to become an organ donor, click here.

Can I authorize my agent to pursue Vermont’s law on physician assisted death in my advance directive once I no longer have capacity?

No, Vermont law requires that only individuals with decision making capacity can request medical aid in dying.

Does my advance directive authorize my agent to make funeral arrangements for me?

It can if you wish. Part Four of the Short Form Vermont Advance Directive allows you to share specific instructions about your funeral wishes and/or disposition of your remains.

If I don't have an advance directive, who will make my decisions?

In Vermont, there is no law that outlines who will make decisions for you if you lack capacity, do not have an advance directive, and do not have a medical guardian appointed through the courts.

Health care providers will seek out people with a known close relationship to you to try to determine what you would want in the situation. If no one knows what you would want, care will be provided that is in your best interest.

What should I do with my advance directive document after I have signed it?

It is recommended that you keep the original and that copies be given to your agent(s), any family/friends who you think would benefit from knowing your wishes, your doctor, the hospital where you receive your care, and the Vermont Advance Directive Registry.

Where can I find the statutory and regulatory requirements for advance directives?