Living will requirements in Vermont

Which document is this, really

Vermont’s law never uses the words “living will.” The Advance Directive for Health Care Act, 18 V.S.A. chapter 231, creates one document, called simply the Advance Directive, and lets you build it out of whichever pieces you need: naming an agent, naming a preferred primary clinician, writing down your health care wishes or treatment goals, an anatomical gift, wishes about disposition of remains, and funeral goods and services. There is no separate living-will form and no separate agent-appointment form the way some states split the two apart. You fill in as much of the one document as you want, sign it once, and it covers all of that at once.

No specific form is required to make a Vermont Advance Directive valid. The Department of Health does publish a suggested form on its own website, and most people use it rather than starting from a blank page, but nothing in the law requires that particular paper. Myend’s Healthcare Directive is built the same way this document is meant to work: one document that carries your wishes and names the person who speaks for you when you cannot.

Who can make a Vermont Advance Directive

Vermont sets the line at 18. Section 9702 opens with “An adult may do any or all of the following,” and Vermont’s general age of majority is 18, so you need to be 18 or older to sign your own Advance Directive. What matters at the moment you sign, past that age line, is capacity: that you understand you are creating an Advance Directive, what it can do, and what naming an agent means. That is a judgment made in the room at signing, not a certificate you produce beforehand.

Signing it so it counts

1. 1You sign

   You sign the Advance Directive yourself. If you are physically unable to sign, someone else may sign it for you, at your express direction and in your presence.

2. 2Two witnesses sign too

   Two witnesses, each at least 18, watch you sign and sign the document themselves, affirming that you appeared to understand what you were doing and were free from duress or undue influence at the time.

3. 3In a facility, someone else explains it too

   If you are being admitted to, or are already in, a hospital, a nursing home, or a residential care facility when you sign, Vermont adds a step that decides whether the document works at all: your Advance Directive is not effective unless one of a named group explains what it is and what it does, and signs a statement confirming they did. In a hospital that means an ombudsman, a member of the clergy, a Vermont-licensed attorney, a Probate Division designee, an individual the hospital has designated for this, or a mental health patient representative; in a nursing home or residential care facility, the same names plus a trained volunteer at the facility and a clinician who is not employed there. That person may explain it in the room, or over a live video connection or the telephone.

Vermont bars a specific list of people from witnessing: your named agent, your spouse, your parent, an adult sibling, an adult child, or an adult grandchild; the state’s own form adds a reciprocal beneficiary to that list too. What Vermont does not bar is unusual among states that regulate this closely: your own health care or residential care provider, and their staff, are allowed to witness your Advance Directive.

Vermont has also written remote witnessing directly into its signing law. A witness does not have to be in the room with you, as long as you and that witness already know each other: the witness can attest over a live audio-video connection, or by telephone, that you appeared to understand the document and were free from duress, and your Advance Directive has to include that witness’s name, contact information, and their relationship to you. The person who explains the document in a hospital, nursing home, or residential care facility can do the same thing remotely. Vermont also allows the principal, the witnesses, and that explaining person to sign the Advance Directive with a digital signature, as long as any remote witness meets the conditions above.

Vermont does not ask for a notary anywhere in this process. Two witnesses, whether in the room with you or attesting from a screen, are what make an Advance Directive valid here, not a notary’s seal.

Naming your agent

The Advance Directive is also where you name your agent, Vermont’s term for the person who can make health care decisions for you once your Advance Directive takes effect.

Vermont disqualifies two groups. Your own health care provider cannot serve as your agent. And unless the person is related to you by blood, marriage, civil union, or adoption, they also cannot be an owner, operator, employee, agent, or contractor of the residential care facility, health care facility, or correctional facility where you live. Outside those two rules, Vermont’s law does not hand you a longer list to work through, so anyone else you trust can serve.

Once your Advance Directive is effective, your agent can make any health care decision you could have made yourself, within the limits you wrote into it. Vermont also tells them how to decide: work out what you would have wanted, from your instructions, from what you said to them, or from what they know of your values and beliefs, and fall back on your best interests only when none of that answers the question. They may not weigh their own wishes, and may not decide on the basis of your economic status or a long-standing disability.

When it takes effect

Vermont gives you three separate switches, and you choose which one your document uses. The usual one is capacity: your Advance Directive becomes effective when your clinician determines that you lack capacity, after speaking with an interested individual if one is reasonably available, and makes specific findings about the cause, the nature, and the likely duration of it. That clinician then has to make reasonable efforts to tell you and to tell your agent or guardian, and to certify in your medical record the facts that made the directive effective.

The other two switches are yours to set in the document: a circumstance or condition of your choosing, which need not be about capacity at all, or a statement that the directive takes effect the moment you sign it. Either way, while you still have capacity you keep deciding. Your agent holds authority alongside you, not instead of you, and if you disagree, your decision governs.

If you are pregnant

Vermont does not decide this one for you, in either direction. Section 9702(a)(8) lets you “direct which life sustaining treatment the principal would desire or not desire” if you turn out to be pregnant once your Advance Directive becomes effective, and the state’s own long form turns that permission into an actual choice on the page: a box for wanting every life-sustaining treatment continued, or a box for naming only the treatments you list yourself.

If you leave the pregnancy section blank, Vermont’s law supplies no automatic rule either way. Your other instructions, and whatever your agent knows of your wishes, are what guide the decision instead.

Changing or cancelling it

Vermont draws a line between your agent and everything else, and it is the line most people get wrong. To suspend or revoke your agent’s appointment you have to do one of three things: sign a statement saying so, tell your own clinician in person, who then writes it into your medical record, or burn, tear or obliterate the document yourself, or have someone do it in front of you at your direction. Any other part of the Advance Directive can be suspended or revoked more loosely, orally, in writing, or by any other act that shows you specifically mean to. Neither route asks you to have capacity: Vermont lets you revoke with it or without it. The one exception is a provision letting your agent act over your objection, which can only be suspended or revoked while you have capacity.

You can also amend by writing a new one, which does take capacity. A provision in a later Advance Directive amends a conflicting provision in an earlier one, to the extent they conflict. And filing for annulment, divorce, dissolution of a civil union, legal separation, or an order of relief from abuse suspends a spouse or other opposing party you had named as agent, unless the directive or the court order says otherwise; the suspension lifts if the action is withdrawn and becomes permanent once the decree is final.

Whatever route you use, tell your agent and the providers holding a copy. Vermont makes clinicians and facilities who learn of a revocation record it, flag it, notify you and your agent, and pass it to the registry, but none of that starts until somebody knows.

Making sure it is found

Vermont runs an actual registry for this, the Vermont Advance Directive Registry, VADR. Filing your Advance Directive with VADR is voluntary and free, but it is not a filing cabinet nobody opens. Providers and facilities have to keep a protocol for checking the registry when someone without capacity is admitted or treated, and information obtained from VADR is presumed current and accurate unless something shows otherwise. The registry is created by statute and run by the Vermont Department of Health.

Filing with VADR is not a substitute for handing a signed copy to your agent and your physician directly, and keeping another copy somewhere obvious in your own home. A photocopy of a properly signed original carries the same weight as the original, and no third party may insist you use a different form of advance directive instead.

A directive you signed in another state still holds here: nothing in Vermont’s chapter limits the enforceability of an advance directive executed elsewhere in compliance with that place’s law.

This is not a POLST

Vermont’s version of this is called COLST, Clinician Orders for Life-Sustaining Treatment: a clinician’s own order for things like intubation, mechanical ventilation, transfer to a hospital, antibiotics, or artificially administered nutrition, signed together with someone who is already facing a serious illness. Vermont also runs a companion DNR order and DNR-identification system alongside it. An Advance Directive is something you put in place well before any of that, on your own, without a clinician in the room. Myend prepares the Advance Directive. It does not, and cannot, produce a COLST order, because that has to come from your own treating clinician.

What is different about Vermont

Vermont hands the pregnancy question back to you instead of answering it for you, and lets a witness attest from another room entirely.

Most states either suspend a directive during pregnancy or say nothing about it at all. Vermont does neither. Its Advance Directive Act gives you a specific election, continue every life-sustaining treatment, or only the ones you name, and puts an actual checkbox for it on the state’s own form. Leaving it blank does not fall back to a state-supplied default; it simply leaves the question to your other instructions and your agent.

Vermont is also unusually open about how a witness can watch you sign. A live audio-video connection or a phone call is enough, as long as you and the witness already know each other and your directive records who they are and how you know them, and the same option extends to a digital signature and to the person who has to explain the document if you are signing in a hospital or care facility. Layered on top of that, Vermont affirmatively allows your own care providers and their staff to serve as witnesses, which is the opposite of the rule in many other states.

Put together, that is a state that builds one flexible document rather than several rigid ones: one form for your wishes and your agent, a pregnancy question it asks you to answer rather than answering for you, and a signing process that can follow you outside the room if it needs to.

Common questions

Sources and review