Coronavirus Update: Ethics Considerations, Guidance and Resources.
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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.
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.
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.
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.
Yes, properly signed and witnessed advance directives are legally recognized in Vermont.
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.
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.
You should use the advance directive form for the state in which you reside. To find the form for your state, click here.
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.
To access a list of regional contacts who are available to provide advance care planning support, please click here.
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:
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.
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.
If you created a document using remote witnesses between February 15, 2020 and June 15, 2020, you need to complete a replacement advance directive either with in-person witnesses (if it is safe to do so) or following the steps outlined above.
Yes, you can. For more information about organ donation and registering to become an organ donor, click here.
No, Vermont law requires that only individuals with decision making capacity can request medical aid in dying.
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.
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.
(Please bear in mind that if you have never been a patient/received care at your local hospital, they will not have a way to store your document without first having established a medical record.)
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.
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.
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.
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.
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.
Please see our page on Making Medical Decisions for Someone Else.
Still have questions? Contact us.