Health Care Decisions & Advance Directives
Frequently Asked Questions: Health Care Decisions & Advance Directives
The answers to these questions are taken from the booklet "Taking Steps to Plan for Critical Health Care Decisions" published by the Vermont Ethics Network. For more information or to purchase this publication click here.
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. Advanced directives are a gift of communication and an assurance that your wishes will be honored.
You may write one if you are an adult (the Terminal Care Document specifies that you be at least 18) and are capable of understanding the nature and consequences of your health care decisions.
Advance directives are for every adult. No matter how young or old, how healthy or sick, you could have an accident or unexpected illness and suddenly be unable to speak for yourself.
Anyone 18 years of age, or older, can serve as your agent, with one exception. Under Vermont law, your health or residential care provider cannot be your agent and your provider at the same time - unless that person is a relative. Vermont law also allows for selection of an "alternate agent," in the event your agent is unavailable when a health care decision is required.
Your doctor is legally required to follow the directions in your advance directive as closely as possible. If your doctor disagrees with your wishes, he or she must help find another physician willing to follow your instructions. That applies to all doctors involved in your care.
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New Hampshire, for example, does not permit artificially supplied nutrition and fluids (tube feeding) to be withheld or withdrawn unless the patient has provided written instructions to that effect in an Advance Directive. New Hampshire requires that advance directives be notarized OR be witnessed by two people.
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 you are expecting to be treated out-of-state, check directly with the state or contact the National Hospice and Palliative Care Organization, 1700 Diagonal Road, Suite 625, Alexandria, VA, 22314 (telephone 1-800-658-8898 ), for more information or to view the forms of the other state. It is a good idea to take a photocopy of your advance directive with you when you travel. You may also carry a wallet card.
If you have a medical emergency outside of a hospital, the ambulance crew is required to give you life-prolonging care (unless you have a signed DNR/COLST order) until you can get to the hospital and are evaluated by a doctor. At the hospital, you, or your advance directive, can guide further decisions. If you do not want CPR (cardiopulmonary resuscitation) performed on you, you must have your doctor fill out and sign a Do Not Resuscitate (DNR) order and have it immediately available for ambulance crews arriving at your home. If you are terminally ill and wish to die at home, you should talk to your doctor, other caregivers and family members about situations in which you might or might not want the ambulance summoned.
Absolutely. You continue to make your own medical decisions as long as you are able to do so and can communicate your wishes. Your agent's authority begins only when you lack the capacity to make your own decisions, as certified in writing by your doctor. Even if your agent has already begun to make decisions on your behalf, treatment cannot be given or withheld if you object.
No. One of the strongest features of an advance directive is that it enables you to indicate the kind of care you do want as well as treatments you don't want.
You must fill out a new form if you want to change anything in your written advance directive. Writing a new advance directive automatically cancels the old one. You may also cancel an Advance Directive by tearing it up or telling others that it no longer applies. Be sure to notify everyone who has copies of your advance directive that you are canceling it and writing a new one.
It is also important to review your advance directive every few years, more often if your health is declining, to make sure it still reflects your wishes. Initial and date it each time.
There are no specific legal requirements, but copies should be given to your family, your doctor and your local hospital and mailed to the Vermont Advance Directive Registry. You may also carry a wallet card.
If you are at least 18 years of age, you may sign and carry a Uniform Donor Card. [download card here] You may also check and sign the appropriate lines on the back of your Vermont Drivers license. These cards authorize the removal and use of your organs and tissue after your death. Organs needed for transplantation are kidneys, lungs, heart, liver and pancreas. Tissues used for transplantation include eyes/corneas, bone and associated connective tissue, skin, heart valves and cardiovascular tissue. The new Vermont Advance Directive for Health Care Form has a special optional section for you to express your wishes about being an organ donor. [more details here].
It can if you wish. Part Four of the Vermont Advance Directive for Health Care allows you to share specific directions about your funeral wishes or other disposition of your remains, including who you wish to name as your agent for this purpose. It may be somebody other than your health care agent. Or, you may just want to indicate that your family will decide.