Medical Decisions: Advance Directives

An advance directive is a written document that lets you plan for your medical care when you can’t make decisions for yourself. Outside of Vermont, an advance directive is sometimes called a durable power of attorney for health care, a health care proxy, a living will or a terminal care document.

An advance directive lets you:

pick someone to make health care decisions for you (your “agent”)
write down what kind of medical care you want and don’t want
decide the kind of treatments you want for end of life care
list who you would want to be your guardian, if you need one
say how you would want your family to be involved in your care in the future
give burial or cremation instructions
decide to be an organ donor

Everyone should have an advance directive. An advance directive is not just for seniors or people at the end of life. An advance directive can help you any time you can't make medical decisions for yourself.

No Vermont law says that your spouse or other next of kin can make medical decisions for you. So if you want your spouse or next of kin to make medical decisions for you, you should name that person as your agent in an advance directive.

You have the right to make any medical decisions for yourself – as long as you are able to communicate your wishes. Your agent can make health care decisions for you only when you can't make medical decisions for yourself or when you say that you want your agent to start making the decisions.

All medical providers are required to follow your advance directive. Your agent should make decisions for you based on what you wrote down in your advance directive or what you have said you want. If you did not write down any treatment wishes, your agent should try to make the decisions that you would have made for yourself.

If you have a serious medical condition, you may need a DNR/COLST. That stands for Do Not Resuscitate Order and Clinician Orders for Life Sustaining Treatment. It is a document signed by your doctor or other medical clinician which sets out what life-sustaining treatment you want and whether you want a Do Not Resuscitate Order. It will be followed by other doctors and emergency medical personnel whether or not you are in a medical facility. It is one way to ensure that your advance directive is followed if you have a medical emergency.

How to prepare your advance directive

No specific form is required. You can have an attorney prepare an advance directive for you or you can do it yourself using one of these forms. We offer a long form and a short form. The short form is simpler, while the long form gives more detailed instructions.

Use our Advance Directive for Health Care short form (three pages).

Use the fillable PDF version of the Advance Directive short form.
Use the web page version of our Advance Directive short form.

Or use our Advance Directive for Health Care long form (11 pages).

Use the fillable PDF version of the Advance Directive long form.
Use the web page version of our Advance Directive long form.

Once your advance directive is drafted and you are satisfied with its contents, you must sign the advance directive in front of two witnesses who are not your agent or immediate family members. Your immediate family includes your spouse or partner, your parents, your siblings, your children or grandchildren.

Your witnesses must also sign the document. It does not need to be notarized.

Who can be my agent?

You can pick any adult who has the ability to make decisions about your care to be your agent, except your doctor or health care provider. You should pick someone you trust and who knows you well.

What can my agent do?

The person you appoint as your agent gets the authority to do a number of things on your behalf:

get copies of your medical and hospital records
agree to or refuse medical treatment for you
participate in any meetings about what health care you should get
consent to the disclosure of your medical records
file a complaint on your behalf if there is a problem with your treatment

What can’t my agent do?

A health care advance directive does not give your agent authority to handle your money or make sure your bills are paid. You need a different document if you want to give someone authority to handle your money. That document is called a Power of Attorney.

In addition, a health care agent can never agree for you to be sterilized.

What if my agent disagrees with me?

When you have an agent, you still have the right to make your own health care decisions. The agent is only allowed to help make sure your wishes are followed. If your agent disagrees with what you want, you win. As long as you are able to express your wishes, your doctors and medical providers must do what you say, not what your agent says.

There is one exception to this rule. Sometimes people with a mental illness or anticipating dementia want to lock in decisions for themselves now, when they are mentally healthy, even if they think they will want to make a different decision later. They can plan for this if they follow all the legal requirements. For more information on this possibility, see Part 6 of the Vermont Ethics Network’s Advance Directive (long form).

What to do with your advance directive

Give a copy of your advance directive to the person you picked as your agent. Talk with your agent about what you have written and what you want for medical treatment. You may also want to give a copy to other family members so they know about it.

Give a copy of your advance directive to your doctor and to any nursing home, hospital or other place you may get medical care.

If you have a serious medical condition, ask your doctor or other clinician whether you need a DNR/COLST. If you want, talk to your doctor about getting DNR identification such as a bracelet or necklace. Such IDs will be honored by medical personnel only if bought from a state approved seller.

The Vermont Department of Health can store your advance directive in an online registry. The registry is free. Doctors and hospitals are required to check the registry, so that is a good way to make sure that they will know about your advance directive. You can submit your advance directive to the registry by mail or fax. This is a free service for Vermonters.

Changing your advance directive

You may change or revoke (withdraw or cancel) your advance directive at any time. The best way to change it is to write a new advance directive. After you write the new advance directive, you should give it to all the people and organizations that have the old one. You should tell them that you revoked the old one.

Review your advance directive periodically (at least once a decade) and when things in your life change, such as divorce, death of a loved one, serious diagnosis or deterioration. These are sometimes referred to as the “5 D’s.”