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When considering the future and planning for unexpected medical circumstances, individuals often turn to legal documents that ensure their healthcare wishes are respected. Among these, the Vermont Living Will form emerges as a critical tool, designed to communicate preferences regarding end-of-life care. This document, legally binding in Vermont, empowers individuals to make decisions about the types of medical treatment they wish to receive or refuse, in the event they become incapacitated and can no longer express their desires. It outlines specific instructions for healthcare providers, including decisions related to life-sustaining treatments and pain management. Importantly, the Vermont Living Will ensures that personal values and healthcare preferences are honored, providing peace of mind for both the individual and their loved ones. In its preparation, clear communication and legal guidance are essential to accurately convey the person's directives, illustrating the profound impact and significance of this document in safeguarding personal healthcare choices.

Vermont Living Will Preview

Vermont Living Will Template

This Living Will is designed to be in compliance with the Vermont Patient's Bill of Rights Act. It allows you to guide and direct your medical treatment in advance in the event that you are unable to communicate your wishes. Ensure the following document accurately reflects your decisions and conforms with Vermont state law.

Personal Information

  • Full Name: ___________________________________
  • Date of Birth: ________________________________
  • Address: ______________________________________
  • City: _________________________________________
  • State: Vermont
  • Zip Code: ____________________________________

Living Will Declarations

I, ___________________________, being of sound mind, intentionally and voluntarily declare my wish that my dying shall not be artificially prolonged under the circumstances set forth below. I understand that this may apply if I am in any of the following conditions:

  1. A terminal condition where the application of life-sustaining treatment would only serve to artificially prolong the process of dying;
  2. In a permanent unconscious condition that is irreversible, in which I am completely unaware of myself and my surroundings;
  3. In a condition where I am expected to die without the use of life-sustaining treatment;
  4. Or in any other conditions specified by the laws of Vermont.

Should I be in any state mentioned, I request the following treatments and decisions:

  • Life-sustaining treatment: _____________________________________________________________
  • Do not resuscitate (DNR) orders: ________________________________________________________
  • Artificial nutrition (feeding tubes) desires: _____________________________________________
  • Pain relief preferences even if they hasten death: ________________________________________

Designation of Health Care Agent

In the event that I am incapable of making my own healthcare decisions, I designate the following individual as my Health Care Agent:

  • Name: ________________________________________________
  • Relationship: _________________________________________
  • Phone Number: ________________________________________
  • Address: _____________________________________________

This Health Care Agent shall have the authority to make all health care decisions on my behalf, including decisions about life-sustaining treatments, in accordance with what I have stated in this living will or as they believe I would have wanted.

Signature

I understand the contents of this document and the effect of this declaration to withhold or withdraw life-sustaining treatment. My signature below affirms that I am of sound mind and fully understand my right to determine the course of my medical treatment.

Date: ___________________________

Signature: ________________________

State of Vermont, County of __________________:

This document was signed in my presence by _______________________________ (name of declarant), who is personally known to me or proved to me on the basis of satisfactory evidence. This living will is signed voluntarily as the declarant's own free act and deed.

Date: ___________________________

Witness Signature: ___________________________

Printed Name: _______________________________

Address: ____________________________________

File Attributes

Fact Name Description
Purpose A Vermont Living Will lets people make decisions about their future medical care in case they can't speak for themselves.
Also Known As In Vermont, it's also called an "Advance Directive."
Governing Law The Vermont Patient Choice at End of Life Act (Title 18, Chapter 113 of the Vermont Statutes) governs Living Wills.
Who Can Make One Any adult who can make their own decisions can make a Living Will in Vermont.
Requirements It must be signed by the person making it and witnessed by either two people or a notary public.
Revocation The person can change their mind and cancel (revoke) their Living Will at any time.

Guidelines on Filling in Vermont Living Will

Creating a Vermont Living Will is a pivotal step in managing your healthcare preferences. This essential document communicates your desires regarding medical treatment in situations where you might not be able to express your wishes yourself. It ensures that your healthcare team knows your preferences about life-sustaining treatments, including resuscitation, mechanical ventilation, and feeding tubes, among others. Filling out this document carefully will assure that your healthcare preferences are understood and respected by your family and healthcare providers. The instructions below guide you through the necessary steps to accurately complete the Vermont Living John Will form.

  1. Begin by entering your full legal name at the top of the form to affirm the document's ownership.
  2. State your date of birth clearly to avoid any confusion regarding your identity.
  3. In the sections concerning medical treatments, clearly indicate which treatments you would accept or refuse in case you are in a condition where you cannot communicate your wishes. Be specific to ensure your healthcare team understands your directives.
  4. If you have strong feelings about receiving or not receiving life-sustaining treatment under certain conditions, such as permanent unconsciousness or terminal illness, make sure to articulate these preferences clearly on the form.
  5. Appointment of a healthcare agent is an important step. If you wish to designate someone to make healthcare decisions on your behalf, provide the person’s full name, relation to you, and contact information. Ensure this individual agrees to your appointment and understands your healthcare preferences.
  6. Discuss your living will with the healthcare agent you've designated, your family, and your primary healthcare provider to ensure everyone is informed of your wishes. This discussion can help prevent future conflicts or confusion.After completing the form, sign and date it in the presence of two adult witnesses, who also must sign and date the document. Ensure these witnesses are not your healthcare provider or a potential heir to avoid conflicts of interest.
  7. Finally, keep the original document in a safe but accessible place. Inform your healthcare agent, family members, and healthcare providers of where your living will is stored, and consider giving copies to your healthcare agent and primary healthcare provider.

Once your Vermont Living Will is fully completed and signed, it serves as a legally binding document that conveys your healthcare preferences. Remember, you can revise or revoke your living will at any time, should your wishes or circumstances change. It's also a good idea to review this document periodically to ensure it still reflects your current healthcare desires.

More About Vermont Living Will

What is a Vermont Living Will?

A Vermont Living Will is a legal document that outlines an individual's preferences regarding medical treatment in the event they become unable to make or communicate decisions for themselves due to incapacity. This document is also often referred to as an advance directive. It allows a person to provide specific instructions about the health care they wish to receive or not receive, including decisions on the use of life-sustaining treatment, when they are in a condition where recovery is not expected.

How do I create a Vermont Living Will?

Creating a Vermont Living Will involves several steps:

  1. Fill out the form: Complete the Vermont Living Will form by providing detailed instructions about your healthcare preferences.
  2. Choose a health care agent: Designate a trusted person to act as your health care agent, who will make decisions on your behalf based on your living will's instructions.
  3. Signatures: The Living Will must be signed in the presence of two witnesses, neither of whom should be the health care agent, a close relative, or a potential inheritor of your estate. Some choose to have the document notarized for additional legal fortification.
  4. Share the document: Provide copies of the completed Living Will to your health care agent, family members, and healthcare providers to ensure your wishes are known and can be followed.

Who should have a copy of my Vermont Living Will?

It's important to distribute copies of your Vermont Living Will to several key individuals to ensure your medical wishes are honored:

  • Your health care agent
  • Family members or close friends you trust
  • Your primary care physician and any specialists you see regularly
  • Your attorney, if you have one
Keeping a copy in an accessible but secure place at home is also prudent. You might also consider sharing a copy or instructions on where to find one with your legal representative.

Can I change my Vermont Living Will once it's been created?

Yes, you can change your Vermont Living Will at any time. To make changes, it is best practice to create a new document that reflects your current wishes and go through the proper execution process again, including having your signatures witnessed accordingly. Upon creating a new Living Will, destroy all copies of the old one to prevent confusion and ensure your health care decisions are based on your most recent wishes.

Is a Vermont Living Will the same as a Durable Power of Attorney for Health Care?

No, a Vermont Living Will and a Durable Power of Attorney for Health Care are not the same, although they both serve as advance directives. A Living Will specifically outlines your preferences regarding medical treatment and care, particularly about end-of-life decisions. A Durable Power of Attorney for Health Care, on the other hand, designates a person (health care agent) to make health care decisions on your behalf should you become unable to make them yourself. While a Living Will provides specific directives, a Durable Power of Attorney for Health Care gives someone else the authority to make decisions based on their understanding of your wishes or best interests when your wishes are not specifically known.

Common mistakes

When filling out the Vermont Living Will form, it's important to be as accurate and thorough as possible. However, many people run into a few common mistakes that can hinder the document's effectiveness. Identifying and avoiding these errors can ensure your wishes are clearly understood and followed.

  1. Not Specifying Detailed Preferences: A significant mistake is not being specific about medical treatments you do or do not want. This vagueness can create confusion among those trying to follow your instructions.

  2. Forgetting to Update the Document: People often forget to update their Living Will after major life changes, such as a new diagnosis or a change in marital status. An outdated document may not reflect your current wishes.

  3. Failing to Discuss with Healthcare Provider: Not communicating your wishes to your healthcare provider can lead to a lack of alignment between your Living Will and medical records, potentially causing issues in an emergency.

  4. Ignoring State Requirements for Witnesses: Each state has its own laws about who can act as a witness. In Vermont, not adhering to these requirements can invalidate the document.

  5. Not Distributing Copies: Keeping your Living Will in a safe place is good, but not if nobody knows where it is or what it says. Make sure key people, such as family members and healthcare providers, have copies.

By being aware of these mistakes, you can take proactive steps to ensure your Vermont Living Will clearly communicates your healthcare wishes and is legally sound.

Documents used along the form

When preparing a Vermont Living Will, individuals often find it beneficial to include additional forms and documents that complement their living will and ensure a comprehensive approach to end-of-life planning. These documents can provide detailed guidelines on personal wishes, healthcare decisions, and legal matters. Together, they form a robust legal framework that respects the individual's preferences and simplifies decision-making processes for families and healthcare providers. Below is a list of documents frequently used alongside the Vermont Living Will form.

  • Advance Directive for Health Care: This legal document allows individuals to designate a health care agent to make medical decisions on their behalf if they are unable to do so and outlines specific wishes regarding medical treatment.
  • Durable Power of Attorney: This appoints a trusted person to handle financial and legal affairs if the individual becomes incapacitated or unable to manage them personally.
  • Do Not Resuscitate (DNR) Order: A medical order that tells health care providers not to perform CPR if breathing stops or if the heart stops beating.
  • Organ and Tissue Donation Form: Specifies an individual's wishes regarding organ and tissue donation at the time of death.
  • HIPAA Release Form: This authorizes healthcare providers to share an individual's medical information with designated persons, such as family members or a healthcare agent.
  • Emergency Medical Information Card: A card that contains critical health information, such as allergies and medications, which can be carried in a wallet for emergencies.
  • Personal Property Memorandum: Often attached to a will, this document allows individuals to specify how they wish their personal property to be distributed.
  • Last Will and Testament: States how an individual's assets and estate will be distributed among beneficiaries after their death.
  • Guardianship Designation: Allows parents or guardians to appoint someone to care for their dependents if they become unable to do so.
  • Funeral Planning Declaration: Provides instructions for one's funeral arrangements and the disposition of their remains, easing the burden on family members to make these decisions.

Together, these documents complement the Vermont Living Will by covering a broad spectrum of personal, healthcare, and financial decisions. Creating a comprehensive plan with these documents can help ensure that individual wishes are respected and that loved ones are provided with clear guidance during difficult times. It is advisable to consult with a legal professional when preparing these documents to ensure they meet all legal requirements and accurately reflect the individual's wishes.

Similar forms

The Vermont Living Will form is similar to several other pivotal legal documents that allow individuals to document their wishes regarding medical treatment and end-of-life care. These documents serve as vital guides for loved ones and healthcare providers in situations where the individual cannot communicate their preferences directly. Each document, while serving a complementary role to the Vermont Living Will, has distinctive features and applications.

Health Care Power of Attorney (HCPOA): This document appoints a trusted person to make health care decisions on behalf of an individual, should they become unable to do so themselves. The Vermont Living Will and the HCPOA are similar in that both deal with medical directives. However, while the Living Will specifies the individual's wishes regarding life-sustaining treatments, the HCPOA designates another person to make health care decisions, not limited to end-of-life choices.

Advance Directive: Often encompassing elements of both the Living Will and HCPOA, an Advance Directive is a broader document. It typically includes a Living Will section that details wishes regarding treatment preferences under specific conditions, and a section that appoints a health care agent. The Vermont Living Will is similar to the part of the Advance Directive that specifies treatment preferences. The key difference is that Advance Directives may offer a more comprehensive approach, covering a broader range of scenarios and decisions.

Do Not Resuscitate (DNR) Order: A DNR is a medical order signed by a physician that instructs health care providers not to perform CPR (cardiopulmonary resuscitation) if a patient's breathing stops or if the heart stops beating. The Vermont Living Will is similar to a DNR in that it can include wishes about not receiving certain life-sustaining treatments. The major difference is that a DNR is strictly about CPR and does not address other treatments or interventions.

Medical Orders for Life-Sustaining Treatment (MOLST): Like a DNR, MOLST or similar forms (such as POLST, Physician Orders for Life-Sustaining Treatment) are medical orders that apply to a range of critical care decisions. They are more comprehensive than a simple DNR, detailing wishes regarding intubation, mechanical ventilation, and other life-sustaining interventions. While similar to the Vermont Living Will in guiding emergency medical personnel and health care providers, MOLST forms are actually signed by a physician based on the patient's wishes and medical conditions.

Dos and Don'ts

When filling out the Vermont Living Will form, it's crucial to approach the document with thoughtfulness and detail. A Living Will allows you to make decisions about your medical care in advance, in case you are unable to communicate your wishes in the future. Below are eight essential do's and don'ts to consider during the process:

  • Do: Read the instructions carefully before you begin to ensure you understand the requirements and implications of your choices.
  • Do: Use a pen with black or blue ink for clarity and to ensure the document can be easily copied or scanned.
  • Do: Be specific about your medical care preferences, including treatments you do or do not want, to help guide your healthcare providers.
  • Do: Discuss your wishes with your family, loved ones, and healthcare providers to ensure they are aware of your preferences.
  • Do: Designate a trusted person as your healthcare agent to make decisions on your behalf if you're unable to do so, and ensure they are willing and able to take on this responsibility.
  • Don't: Leave any sections incomplete. If a section does not apply to you, mark it accordingly to show that you have reviewed it.
  • Don't: Sign the document without having the required witnesses or notary public present, as per Vermont state requirements.
  • Don't: Forget to review and update your Living Will periodically, especially after significant life events or changes in your health condition.

Taking the time to carefully prepare your Vermont Living Will form ensures your healthcare wishes are known and can be respected. Remember, this document is an important part of your healthcare planning and provides peace of mind for both you and your loved ones.

Misconceptions

When it comes to planning for future healthcare decisions, the Vermont Living Will form is an instrumental document. However, there are common misconceptions surrounding it that can hinder its effective use. Understanding these can ensure individuals make informed decisions about their healthcare.

  • It's only for the elderly: A prevalent misconception is that living wills are only for older adults, but adults of all ages can face medical emergencies or conditions that leave them unable to communicate their healthcare preferences.
  • It covers all health decisions: Some believe a living will addresses every possible health decision. In reality, it primarily focuses on end-of-life care, such as the use of life-sustaining treatments when one is terminally ill or permanently unconscious.
  • You don't need a lawyer to create one: While legal advice can be beneficial, especially in complex situations, Vermont allows individuals to complete a living will without a lawyer. The form must be witnessed correctly to be legally valid.
  • It takes effect as soon as it's signed: This is not the case. A living will only comes into effect under specific conditions, such as when a person is terminally ill or in a persistent vegetative state and cannot make decisions themselves.
  • The same document works nationwide: While many states have reciprocity laws recognizing living wills made in other states, there are variations in law. It’s prudent to create a living will that complies with the laws of the state where you primarily reside, or consult legal advice when moving to a different state.
  • A living will is irrevocable: People often think once a living will is signed, it cannot be changed. However, individuals can revise or completely revoke their living will at any time, as long as they are mentally competent to do so.
  • If you change your mind, you just need to tell your doctor: While verbally expressing wishes to change a living will to healthcare providers is important, formal changes require updating the document itself to reflect new decisions and ensuring it is properly witnessed.
  • Doctors can override a living will: There's a misconception that doctors can easily override the wishes stated in a living will. In fact, healthcare providers are legally bound to follow the directives, unless they are not consistent with standard medical practice or the healthcare provider's moral beliefs—in which case, they generally are required to transfer care to another provider who will comply.
  • It only applies if you're in a hospital: This isn't true. A living will applies in any setting where you receive medical care, whether it’s in a hospital, at a nursing home, or even in your own home, as long as the conditions specified in the document are met.

Understanding the specifics of Vermont's Living Will form is crucial for making informed decisions about end-of-life care. Dispelling these misconceptions ensures individuals create a document that accurately reflects their healthcare preferences and gives them peace of mind.

Key takeaways

When preparing to fill out a Vermont Living Will form, it's essential to approach the process with care and diligence. This legal document is your voice when you cannot speak for yourself regarding medical treatments and end-of-life care. Here are four critical takeaways to keep in mind:

  • Understand the Purpose: A Living Will in Vermont allows you to express your preferences about medical treatments, including life-sustaining procedures, in the event you are unable to communicate your decisions due to illness or incapacity. It ensures that your healthcare providers and loved ones understand your wishes, providing clarity during difficult times.
  • Legal Requirements: Vermont has specific legal requirements for a Living Will to be considered valid. These include the necessity for the document to be signed by the person creating it (the principal) and witnessed by two individuals who are not related to the principal by blood, marriage, or adoption, and who do not stand to inherit from the principal. Ensuring these requirements are met is crucial for the document's enforceability.
  • Consider Including a Durable Power of Attorney for Health Care: While the Living Will speaks to specific health care preferences, pairing it with a Durable Power of Attorney for Health Care, where you name an agent to make healthcare decisions on your behalf if you're unable, provides a comprehensive approach to your future healthcare planning. This ensures someone you trust is legally appointed to uphold your wishes.
  • Review and Update Regularly: Life changes, such as new medical diagnoses, changing relationships, or simply altering your wishes, necessitate revisiting and potentially updating your Living Will. Regularly reviewing and updating your document ensures it accurately reflects your current preferences.

Filling out a Vermont Living Will form is a step towards ensuring your healthcare preferences are known and respected. Taking the time to accurately complete and regularly review this document can provide peace of mind for you and your loved ones.

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