Coronavirus Update: Ethics Considerations, Guidance and Resources.
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As we practice social distancing to prevent the spread of coronavirus, staying connected and having conversations with loved ones about what matters most is of equal importance. Take some time to share your hopes and fears for the future with those closest to you. Review your advance directive if you have one to make sure it represents your preferences and priorities. If you’ve never completed an advance directive, now is the perfect time to:
|Addison County||End of Life Services||Laurie Borden||Program Director||(802) 388-4111||Phones are staffed from 12pm-2pm, M-F, for questions, information requests, or to schedule a Zoom appointment for one-on-one support.|
|Chittenden County||BAYADA||Nick Parrish||Psychosocial Manager||(802) 448-1610|
|Chittenden County||UVMMC Office of Community Health Improvement||Community Health Team||(802) 847-1601||Support is available for patients of Chittenden County UVM Health Network providers. Please call the number listed to verify whether your provider is part of the network.|
|Chittenden County||UVM Health Network Home Health & Hospice||Holly Thompson||Volunteer Coordinator, Who's Your Person... What's Your Plan?||(802) 734-5531||Email is the preferred mode of contact.|
|Orleans County||North Country Hospital||Neely Bryant, MSW||Inpatient Case Management Department||(802) 334-3261|
|Washington County||Central Vermont Home Health & Hospice||Jim Budis, RN||Hospice & Palliative Care Manager||(802) 224-2240|
|Washington County||Central Vermont Medical Center||Elaine Hafter, MSW||Care Coordinator, Palliative and Spiritual Care Department||(802) 371-5375||Voicemail will be checked between 8am-4:30pm, M-F. Also available by pager at (802) 452-7949 during this timeframe.|
|Windham County||Brattleboro Area Hospice||Don Freeman||Taking Steps Brattleboro Advance Care Planning Program Coordinator||(802) 257-0775, ext 101|
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At this time of increased social isolation, we understand that it may be challenging for some to identify an appropriate individual to serve as their health care agent, especially in the absence of close family and friends. While someone may not come to mind immediately, keep in mind that your agent doesn’t have to be a family member. According to Vermont law, anyone 18 years of age or older can serve as your agent, with the following exceptions:
“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.”
This leaves ample room for a creative approach. We encourage you to think outside the box for someone trustworthy that you could communicate your wishes to and who is willing and able to communicate your wishes to the health care team in the event that you are unable to speak for yourself. It could be a friend, more distant relative, neighbor, or someone from your place of worship.
Even if you may not have someone you wish to name as your health care agent, it is still important to share what is important to you in terms of any future health care needs. If your doctor or the medical team can’t speak to you directly, they will still want to know about your health care priorities and preferences. Use the short form advance directive, draw a line through the section(s) in Part 1 for appointing a health care agent so it is clear that you did not forget to fill this out but have intentionally left it blank, and complete sections 2 – 5 of the form. You can also attach any additional information that you want health care providers to know. Just be sure that you write your name, date of birth, and the date you are completing the document at the top of any additional pages so it is clear that these pages are to be included with the entire signed and witnessed document. It’s also a good idea to make note on the form itself to “see attached pages” to direct the reader of the document to look for them.
When the COVID social distancing recommendations and requirements began, VEN received many inquiries about how to safely engage in advance care planning and complete advance directive documents without being in the physical presence of witnesses and/or explainers. At that time, we recommended (and provided information on our website) that people utilize telephone and virtual forms of communication to have conversations and document “virtual” witnessing and explaining. Keeping in mind that while this did not meet existing legal requirements for properly executed advance directives, such documents carried moral weight and would still be considered when making medical decisions for a patient who lacked capacity. We also recommended that people be prepared to complete a replacement document with in-person witnessing as soon as it was safe to do so.
Since providing this initial guidance, we shared that a bill (H.950) addressing remote witnessing and explaining of advance directives was making its way through the legislative process. We are happy to report that H.950 passed and was signed by Governor Scott on June 15, 2020 as Act Number 107. This Act addresses the legal status of advance directives completed using remote witnesses and/or explainers during two time-frames:
In the case of documents completed using remote witnesses between February 15 and June 15 of 2020—these documents are considered valid if: the remote witnesses were known to the principal (a principal is the person completing their advance directive), the remote witnesses were informed about their role in witnessing the advance directive, and the principal included the name and contact information of the remote witnesses. Documents completed during this time frame will be considered valid ONLY UNTIL June 30, 2021 unless amended, revoked or suspended by the principal prior to that date.
In the case of documents completed using remote witnesses between June 15, 2020 and June 30, 2021—these documents are considered valid if: the remote witnesses were known to the principal, the witnesses attested that the principal seemed to understand the nature of the document and was free from duress or undue influence at the time the advance directive was signed, and the principal included the name, contact information and relationship of the witnesses to the principal. Documents completed during this time shall remain valid unless amended, revoked or suspended by the principal.
Detailed instructions on how to complete an advance directive using remote witnessing are as follows:
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.
We recommend that you give copies of your document to your loved ones, doctor, hospital where you are most likely to receive care, and the Vermont Advance Directive Registry. Instructions for how to register your document with the Registry are available here. We have also been in recent communication with a number of hospitals in the state to obtain mailing instructions for completed advance directives. This information is available below and will be updated as additional listings are received:
|Hospital Name||Department||Mailing Address||Attention:||Fax (if applicable)||Email (if applicable)|
|Brattleboro Memorial Hospital||Health Information Department||17 Belmont Ave, Brattleboro, VT 05301||Jon O'Brien|
|Central Vermont Medical Center||Medical Records||PO Box 547, Barre, VT 05641||(802) 371-5351|
|Mt. Ascutney Hospital and Health Center||Health Information||289 County Rd, Windsor, VT 05089||(802) 674-7152||or|
|North Country Hospital||Health Information Management (HIM)||189 Prouty Drive, Newport, VT 05855|
|The University of Vermont Medical Center||Medical Records||111 Colchester Ave, Burlington, VT 05401||(802) 847-5531|
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Hospice and palliative care agencies across the state are continuing to offer services during the COVID-19 pandemic. Below are overviews by agency of the services each are delivering (we will continue to add more as they become available):