HEALTH DECISIONS
A Publication of the Vermont Ethics Network
( 64 Main St. , Room 25, Montpelier , VT 05602-2951
Telephone: 802 828-2909, Fax: 802 828-6558
Email: VEN@vtethicsnetwork.org , Website: http://www.vtethicsnetwork.org
Vol. 13 No. 3 February 2007
Vermont Advance Directive Registry Open for Business
A Reader Responds: “I Know What I Want!”
DON’T Buy this Book!
“Death with Dignity” Bill re-introduced in the current legislative Session
VENnotesEditor’s Note: To print this newsletter go to the File menu of your browser and click “Print”.
Vermont Advance Directive Registry Open for Business
With the formal announcement by the Acting Commissioner of the Vermont Department of Health, Sharon Moffatt, the Vermont Advance Directive Registry was formally launched in early February 2007. Vermonters who wish to send a copy of their current Advance Directive for Health Care for inclusion in the Registry can now do so. They will have to sign a copy of a Registration Agreement to send along with their document. This is available at the VDH website: www.healthvermont.gov/vadr Both of these documents are then to be sent to:
Vermont Advance Directive Registry (VADR)
523 Westfield Ave., P.O. Box 2789
Westfield, NJ 07091-2789
Or they may be FAXed to (908) 654-1919This is a free service to Vermonters who want to avail themselves of this opportunity. Why would one do it? For the security and peace of mind of having your Advance Directive form, including specific wishes for having or not having life-sustaining treatment in a critical care situation, immediately available to your health care providers when you no longer can communicate your wishes directly to them. The hospitals and other health care providers can access the documents with their own code numbers or by using your Registration ID # on a wallet card that will be sent back to you. Especially in the first six months of the program, we are encouraging people to share their ID # with both their primary care physician and their local regional hospital. This will facilitate access to the new system.
All information you share with the Registry will be confidential and secure and only available to users with authorization from you (through sharing your ID #) or providers who need your Advance Directive to guide decisions about your care. For those who may be still uncertain or afraid to share the contents of their actual Advance Directive document, they can file a cover sheet listing where copies can be found. This is called an Advance Directive Locator. It’s the next best thing to immediate access to the document.
The Vermont Advance Directive Registry documents and procedures are explained on the VT Dept. of Health website: www.healthvermont.gov/vadr
VEN will be working with the Health Department and local partners – hospitals and other co-sponsors – in hosting public information sessions around the state in the next six months. These can be solely about the Registry (for those who have already completed their Advance Directive documents) or about both the Advance Care Planning process of completing Advance Directives and the final, recommended step of registering documents in the Vermont Advance Directive Registry. There should be more information about dates and locations in our Spring newsletter or on our website: www.vtethicsnetwork.org as these are scheduled. If you would like to host one of these local information workshops, contact John Campbell at VEN at (802) 828-2909.
A Reader Responds: “I Know What I Want!”
In the July VEN Health Decisions newsletter a short article by Gail Cashman, RN entitled “Is What I Wanted Then What I Want Now?” described one approach to analyzing patient wishes over time. (Her article can be viewed online at www.vtethicsnetwork.org or a copy requested from VEN.) As we have done in the past, we invited readers to respond. Here is a response from Meredith Babbott of Burlington to that article.
In the July ’06 issue of “Health Decisions” the lead article was entitled, “Is What I Wanted Then What I Want Now?” It was an interesting account of someone who had end-stage renal disease, was on dialysis three times a week, and was experiencing rapidly progressing dementia and physical instability. The last of his numerous falls required a rescue squad to take him to a hospital. When he healed of broken ribs, it was no longer possible to take care of him at home. His diminished mental capabilities necessitated going to a nursing home – although he had stated numerous times he never wanted to go to one.
The decision about a person’s future should depend on the previous expressions of his or her directives for health care, either verbally to family, friends and physician or written down. If none of these communications has taken place, the decisions are left to the conclusions of others.
Personally I would not want to exist as a “contented demented,” a characterization attributed to Dr. Robert Orr, former Director of Clinical Ethics at Fletcher Allen, Such a label is in my opinion demeaning, dehumanizing and disrespectful of an intellectually impaired patient. If I could “look ahead” and know that this was in my health future I would not choose to live in this condition.
The purpose of a completed Advance Directive is to put into writing one’s personal choices in the event that a time might come when verbal communication is no longer possible. Those who have completed an Advance Directive and have given copies to family, close friends and their doctor expect and trust that guidelines will be honored in accordance with the law.
To the questions raised by Ms Cashman’s article in Health Decisions, “Is What I wanted Then What I Want Now?” my answer is “Yes!” How I have personally lived my life of 78 years has been with enthusiasm, involvement in the various communities in which I have lived and mostly happy interaction with friends, family and with problems and issues worked out. I hope my life will continue to be healthy, interactive and happy. When it no longer is positive, my Advance Directive will be available to speak for me and help guide those then involved in my life. These are my wishes now – and will be valid until the end. (Meredith B. Babbott letter to VEN, January 2007)
DON’T Buy this Book!
It isn’t often that I suggest to people that they NOT consider buying a good book, but here’s one: Art Buchwald’s Too Soon to Say Goodbye (Ransom House, 2006, $17.95 – it’s not the price!). In the frigid cold of a Montpelier February it is always a good excuse to trundle over the Bear Pond Books store to take a few minutes to scan the latest best sellers on the table by the door. (Or at Barnes and Noble in S. Burlington, or anywhere). Inevitably you open a book to the center or toward the end to get it’s flavor. At least, I do. Well, having enjoyed Buchwald for years, it’s like the butterscotch brownies my mother started baking “just for me” when I was little. First a smile, then a laugh, then somebody trying to get by has to say “Excuse me!” Minutes pass. The Epilogue and the Afterword, then somewhere in the middle again. As Buchwald, a hospice escapee (or “graduate”) muses upon his release back to Martha’s Vineyard last summer, “I never realized dying could be so much fun!” So … don’t buy this book. It could embarrass you to be picking another one of what my daughters call “those death books”. Or, better yet, use it as an excuse to block the doorway of the shoppers at Bear Pond while you chuckle and forget the cold outside.
“Death with Dignity” Bill re-introduced in the current legislative Session
The Legislation that “died” in Committee last year has been resurrected and reintroduced with new bill numbers by its sponsors. The new bills are: H.44 and S.63 both Titled “An ACT Relating to Patient Choice and Control at the End of Life.” We hope that people will continue to discuss and have a dialogue about the issues involved regardless of their personal positions for or against this proposed legislation that is patterned after the Oregon “Death With Dignity” Law. We have an excerpt of a special VEN program from 1997 called: “Physician Assisted Suicide: A Challenge for Society” introduced by Moderator and former VEN Board member Dr. James Bernat and featuring a debate between Rev. Ralph Mero (founder of Compassion in Dying, a Washington state-based organization) and Attorney Diane Coleman (founder of the Disability Rights Advocacy organization “Not Dead Yet”). We had the VHS tape converted into several copies of DVD format – total running time just under one half hour. If you would like to borrow or purchase one of these for a local discussion, please call us at (802) 828-2909.
VENnotes
New Ethicist Joins FAHC Staff
Marcia Bosek, DNSc, RN, recently joined Fletcher Allen as a Clinical Ethicist, with a joint appointment at UVM's College of Nursing. Prior to coming to Vermont, Marcia spent seventeen years on the faculty of Rush University in Chicago, teaching both nursing and ethics, and doing clinical ethics consultations. In addition to modeling a more collaborative approach to ethics consultation, this new position is designed to support other ethics efforts throughout Vermont. Along with Dr. Bob Macauley, Marcia is happy to be a sounding board for challenging cases, facilitate discussions, give presentations, and interact with interdisciplinary healthcare teams regarding clinical or professional ethical issues. She can be reached at 847-2000.
New NH Advance Directive Law Restricts Agent’s Authority
New Hampshire’s new Advance Directive Law, RSA chapter 139, went into effect on January 1, 2007. One of the interesting features is the option for NH residents to have their documents witnessed by two non-related, disinterested witnesses or have the Advance Directive signed by a Notary. Removal of the Notary requirement may assist in having more completed and also alleviate some confusion about the difference in witnessing requirements from Vermont that never has required a Notary. Another feature, however, would make it impossible for an agent to withhold or withdraw artificial feeding and hydration and other life sustaining treatment without express direction in the Advance Directive document or a court order. This could be even more troublesome for Vermonters who find themselves in critical care situations across the river if they do not have a detailed Advance Directive measuring up to NH standards.
(Student intern Ruofan Yao will be assisting VEN in researching this area of concern.)Check out website for up to date calendar listings. www.vtethicsnetwork.org
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Health Decision and VEN InformationBOARD OF DIRECTORS: Patrick McCoy, chair; M.Teena Flood; Cathy Frank, Judy Cohen, RN PhD; Betsy Davis, RN MPH; Christine Graham, Marilyn J. Hart, MD; Robert Johnson; Steve LaRose; Daria Mason; Rev. Denise Niemira, MD; Robert Opel; Louise Rauh; Kevin Veller
HONORARY BOARD MEMBERS: Arnold Golodetz, MD; Michelle Champoux; James L. Bernat, MD; Jean Mallary; Marge Trautz
STAFF: John Campbell, Executive Director; Jim Mullally, Staff Assistant
Health Decisions is a publication of the Vermont Ethics Network, Inc., a non-profit, tax-exempt organization
dedicated to promoting public dialogue about ethical issues and choices in health care.Vermont Ethics Network
64 Main St., Room 25
Montpelier, VT 05602-2951
Telephone: 802 828-2909, Fax: 802 828-6558
Email: VEN@vtethicsnetwork.org
Website: www.vtethicsnetwork.org
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