Source: https://legislature.vermont.gov/statutes/fullchapter/18/231
Timestamp: 2019-04-21 16:33:31+00:00

Document:
(1) "Advance directive" means a written record executed pursuant to section 9703 of this title, which may include appointment of an agent, identification of a preferred primary care clinician, instructions on health care desires or treatment goals, an anatomical gift, disposition of remains, and funeral goods and services. The term includes documents designated under prior law as a durable power of attorney for health care or a terminal care document.
(2) "Agent" means an adult with capacity to whom authority to make health care decisions is delegated under an advance directive, including an alternate agent if the agent is not reasonably available.
(3) "Anatomical gift" shall have the same meaning as provided in subdivision 5250b(3) of this title.
(4) "Capacity" means an individual's ability to make and communicate a decision regarding the issue that needs to be decided.
(A) An individual shall be deemed to have capacity to appoint an agent if the individual has a basic understanding of what it means to have another individual make health care decisions for oneself and of who would be an appropriate individual to make those decisions, and can identify whom the individual wants to make health care decisions for the individual.
(B) An individual shall be deemed to have capacity to make a health care decision if the individual has a basic understanding of the diagnosed condition and the benefits, risks, and alternatives to the proposed health care.
(5) "Clinician" means a medical doctor licensed to practice under 26 V.S.A. chapter 23, an osteopathic physician licensed pursuant to 26 V.S.A. chapter 33, an advanced practice registered nurse licensed pursuant to 26 V.S.A. chapter 28, subchapter 2, and a physician assistant licensed pursuant to 26 V.S.A. chapter 31 acting within the scope of the license under which the clinician is practicing.
(6) "Clinician orders for life-sustaining treatment" or "COLST" means a clinician's order or orders for treatment such as intubation, mechanical ventilation, transfer to hospital, antibiotics, artificially administered nutrition, or another medical intervention. A COLST order is designed for use in outpatient settings and health care facilities and may include a DNR order that meets the requirements of section 9708 of this title.
(7) "Commissioner" means the Commissioner of Health.
(8) "Do-not-resuscitate order" or "DNR order" means a written order of the patient's clinician directing health care providers not to attempt resuscitation.
(9) "DNR identification" means a necklace, bracelet, or anklet identifying the patient as an individual who has a DNR order.
(10) "Emergency medical personnel" shall have the same meaning as provided in 24 V.S.A. § 2651.
(11) "Guardian" means a person appointed by the Probate Division of the Superior Court who has the authority to make medical decisions pursuant to 14 V.S.A. § 3069(c).
(12) "Health care" means any treatment, service, or procedure to maintain, diagnose, or treat an individual's physical or mental condition, including services provided pursuant to a clinician's order, and services to assist in activities of daily living provided by a health care provider or in a health care facility or residential care facility.
(13) "Health care decision" means consent, refusal to consent, or withdrawal of consent to any health care.
(14) "Health care facility" shall have the same meaning as provided in section 9432 of this title.
(15) "Health care provider" shall have the same meaning as provided in section 9432 of this title and shall include emergency medical personnel.
(16) "HIPAA" means the Health Insurance Portability and Accountability Act of 1996, codified at 42 U.S.C. § 1320d and 45 C.F.R. §§ 160-164.
(17) "Informed consent" means the consent given voluntarily by an individual with capacity, on his or her own behalf or on behalf of another in the role of an agent, guardian, or surrogate, after being fully informed of the nature, benefits, risks, and consequences of the proposed health care, alternative health care, and no health care.
(B) any adult who has exhibited special care and concern for the principal or patient and who is personally familiar with the principal's or patient's values.
(19) "Life sustaining treatment" means any medical intervention, including nutrition and hydration administered by medical means and antibiotics, which is intended to extend life and without which the principal or patient is likely to die.
(20) "Nutrition and hydration administered by medical means" means the provision of food and water by means other than the natural ingestion of food or fluids by eating or drinking. Natural ingestion includes spoon feeding or similar means of assistance.
(B) a representative of the agency designated as the Office of the Mental Health Care Ombudsman pursuant to section 7259 of this title.
(22) "Patient's clinician" means the clinician who currently has responsibility for providing health care to the patient.
(23) "Principal" means an adult who has executed an advance directive.
(24) "Principal's clinician" means a clinician who currently has responsibility for providing health care to the principal.
(25) "Probate Division of the Superior Court designee" means a responsible, knowledgeable individual independent of a health care facility designated by the Probate Division of the Superior Court in the district where the principal resides or the county where the facility is located.
(26) "Procurement organization" shall have the same meaning as in subdivision 5250b(22) of this title.
(27) "Reasonably available" means able to be contacted with a level of diligence appropriate to the seriousness and urgency of a principal's health care needs, and willing and able to act in a timely manner considering the urgency of the principal's health care needs.
(28) "Registry" means a secure, web-based database created by the Commissioner to which individuals may submit an advance directive or information regarding the location of an advance directive that is accessible to principals and agents and, as needed, to individuals appointed to arrange for the disposition of remains, procurement organizations, health care providers, health care facilities, residential care facilities, funeral directors, crematory operators, cemetery officials, Probate Division of the Superior Court officials, and the employees thereof.
(29) "Residential care facility" means a residential care home or an assisted living residence as those terms are defined in 33 V.S.A. § 7102.
(30) "Resuscitate" or "resuscitation" includes chest compressions and mask ventilation; intubation and ventilation; defibrillation or cardioversion; and emergency cardiac medications provided according to the guidelines of the American Heart Association's Cardiac Life Support program.
(31) "DNR/COLST" means a do-not-resuscitate order (DNR) or a clinician order for life-sustaining treatment (COLST), or both.
(32) "Surrogate" means an interested individual who provides or withholds, pursuant to subchapter 2 of this chapter, informed consent for a do-not-resuscitate order or a clinician order for life-sustaining treatment.
(33) "Suspend" means to terminate the applicability of all or part of an advance directive for a specific period of time or while a specific condition exists.
(18) except as provided in subsection (d) of this section, appoint an individual to make or refuse to make an anatomical gift, and to arrange for the disposition of the principal's remains, including funeral goods and services.
(b) The absence of an advance directive or of any specific instruction in an advance directive shall have no effect on determining the principal's intent or wishes regarding health care or any other matter.
(c) The principal's health care provider may not be the principal's agent. Unless related to the principal by blood, marriage, civil union, or adoption, an agent may not be an owner, operator, employee, agent, or contractor of a residential care facility, a health care facility, or a correctional facility in which the principal resides at the time of execution of an advance directive.
(a) An adult with capacity may execute an advance directive at any time.
(b) The advance directive shall be dated, executed by the principal or by another individual in the principal's presence at the principal's express direction if the principal is physically unable to do so, and signed in the presence of two or more witnesses at least 18 years of age, who shall sign and affirm that the principal appeared to understand the nature of the document and to be free from duress or undue influence at the time the advance directive was signed. A health care provider may serve as a witness to the principal's execution of the advance directive under this subsection. If the principal is being admitted to or is a resident of a nursing home or residential care facility or is being admitted to or is a patient in a hospital at the time of execution, the individual who explained the nature and effect of the advance directive to the principal pursuant to subsection (d) or (e) of this section may also serve as one of the witnesses to the principal's execution of the advance directive under this subsection.
(c) Neither the agent appointed by the principal nor the principal's spouse, parent, adult sibling, adult child, or adult grandchild may witness the advance directive.
(H) a clinician, as long as the clinician is not employed by the nursing home or residential care facility at the time of the explanation.
(2) It is the intent of this subsection to ensure that residents of nursing homes and residential care facilities are willingly and voluntarily executing advance directives.
(6) a mental health patient representative.
(a)(1) A principal with capacity may amend, suspend, or revoke an advance directive or any specific instruction in an advance directive by executing a new advance directive or instruction pursuant to section 9703 of this title.
(2) A provision in a subsequently executed advance directive amends an earlier provision in an advance directive to the extent of any conflict between them.
(C) by burning, tearing, or obliterating the advance directive, either by the principal personally or by another person at the principal's express direction and in the presence of the principal.
(2) Except as provided in subdivision (3) of this subsection, a principal with or without capacity may suspend or revoke any provision other than the designation of an agent, orally, in writing, or by any other act evidencing a specific intent to suspend or revoke.
(3) A provision in an advance directive executed pursuant to subsection 9707(h) of this title may be suspended or revoked only if the principal has capacity.
(4) To the extent possible, the principal shall communicate any suspension or revocation to the agent or other interested individual.
(E) inform the registry of the amendment, suspension, or revocation.
(B) on request, assist the principal in notifying agents, guardians, interested individuals, and the registry.
(3) A health care provider, health care facility, or residential care facility not currently providing health or residential care to a principal who becomes aware of an amendment, suspension, or revocation shall ensure that the amendment, suspension, or revocation is recorded and flagged in the principal's medical record and is submitted to the registry.
(iv) the registry, if the principal's advance directive has been submitted to the registry.
(d)(1) The filing of an action or motion for annulment, divorce, dissolution of a civil union, legal separation, or an order for relief from abuse under 15 V.S.A. chapter 21 or 33 V.S.A. chapter 69, subchapter 2 by, on behalf of, or against the principal suspends a previous designation of the spouse or other party opposing the principal in the action as agent unless otherwise specified in the advance directive, decree, or order of the court.
(2) A designation of agent suspended under subdivision (1) of this subsection shall no longer be in effect, and the agent shall be reinstated, upon the withdrawal of the action or motion for annulment, divorce, dissolution of civil union, legal separation, or order for relief from abuse, or upon the expiration of a temporary order for relief from abuse.
(3) A designation of agent suspended under subdivision (1) of this subsection shall become permanent when the annulment, divorce, dissolution of civil union, or legal separation becomes final, or when the motion for relief from abuse is granted.
(3) upon execution, if specified pursuant to subdivision 9702(a)(4) of this title.
(b) When a principal has a clinician, the clinician shall certify in the principal's medical record the facts that have caused an advance directive to become effective.
(c) Upon a determination of need by the principal's clinician, or upon the request of the principal, agent, guardian, ombudsman, a mental health patient representative, health care provider, or any interested individual, the principal's clinician, another clinician, or a clinician's designee shall reexamine the principal to determine whether the principal has capacity. The clinician shall document the results of the reexamination in the principal's medical record and shall make reasonable efforts to notify the principal and the agent or guardian, as well as the individual who initiated the new determination of capacity, of the results of the reexamination, if providing such notice is consistent with the requirements of HIPAA.
(d) The authority of an agent to make health care decisions for a principal shall cease in accordance with subsection 9711(c) of this title.
(a) A health care provider, health care facility, and residential care facility shall not provide health care to a patient without capacity, except on an emergency basis, without first attempting to determine whether the patient has an advance directive in effect.
(D) document in the principal's medical record the conflict, the steps taken to resolve the conflict, and the resolution of the conflict.
(2) document in the principal's medical record the refusal, the reasons for the refusal, who was notified of the refusal, and any other steps taken to resolve the refusal.
(d) An employee with a conflict under subdivision (b)(3) of this section shall be required only to inform the employee's employer. The employer shall be responsible for otherwise complying with the requirements of that subdivision.
(3) the other agent or agents are not reasonably available.
(f) The health care provider shall make reasonable efforts to inform the principal of any proposed health care or of any proposal to withhold or withdraw health care.
(ii) the agent or advance directive authorizes providing or withholding the health care.
(2) The health care provider shall notify the agent or guardian if a principal requests or declines health care which the agent appears to have the authority to authorize or withhold under the principal's advance directive.
(A) An agent shall be named in the provision.
(B) The agent shall accept in writing the responsibility of authorizing or withholding health care over the principal's objection in the event the principal lacks capacity.
(C) A clinician for the principal shall sign the provision and affirm that the principal appeared to understand the benefits, risks, and alternatives to the health care being authorized or rejected by the principal in the provision.
(D)(i) An ombudsman, a mental health patient representative, attorney licensed to practice law in this State, or the Probate Division of the Superior Court designee shall sign a statement affirming that he or she has explained the nature and effect of the provision to the principal, and that the principal appeared to understand the explanation and be free from duress or undue influence.
(ii) If the principal is a patient in a hospital when the provision is executed, the ombudsman, mental health patient representative, attorney, or Probate Division of the Superior Court designee shall be independent of the hospital and not an interested individual.
(E) The provision shall specify the treatments to which it applies, and shall include an explicit statement that the principal desires or does not desire the proposed treatments even over the principal's objection at the time treatment is being offered or withheld. The provision may include a statement expressly granting to the health care agent the authority to consent to the principal's voluntary hospitalization.
(F) The provision shall include an acknowledgment that the principal is knowingly and voluntarily waiving the right to refuse or receive treatment at a time of incapacity, and that the principal understands that a clinician will determine capacity.
(2) A provision executed in compliance with subdivision (1) of this subsection shall be effective when the principal's clinician and a second clinician have determined pursuant to subdivision 9706(a)(1) of this title that the principal lacks capacity.
(A) The agent may, in the event the principal lacks capacity, make health care decisions over the principal's objection, provided that the decisions are made in compliance with subsection 9711(d) of this title.
(a) As used in this section, "DNR/COLST" shall mean do-not-resuscitate orders (DNR) and clinician orders for life sustaining treatment (COLST) as defined in section 9701 of this title.
(5) to ensure that the provider or facility complies with its obligations under the Patient Self-Determination Act, 42 U.S.C. § 1395cc(a), and the regulations issued thereunder.
(C) periodically while at the facility.
(2)(A) A patient's advance directive is reviewed to determine whether the facility would decline to follow any of the advance directive's instructions pursuant to subsection 9707(b) of this title, in which case the facility shall comply with the requirements of subsection 9707(c) or subdivision 9707(b)(3) of this title.
(iii) when a patient executes an advance directive or an amendment to an advance directive.
(3) A patient with an advance directive is encouraged and helped to submit the advance directive or a notice of the advance directive to the registry.
(4) DNR/COLST orders are issued, revoked, and handled pursuant to the same process and standards that are used for each patient receiving health care.
(5) Upon transfer or discharge to another facility, a copy of any advance directive, DNR order, or COLST order shall be transmitted with the principal or patient. If the transfer is to a health care facility or residential care facility, any advance directive, DNR order, or COLST order shall be promptly transmitted to the subsequent facility, unless the sending facility has confirmed that the receiving facility has a copy of the advance directive, DNR order, or COLST order.
(6) For a patient for whom DNR/COLST orders are documented in a facility-specific manner, any DNR/COLST orders to be continued upon discharge, during transport, or in another setting shall be documented on the Vermont DNR/COLST form issued pursuant to subsection 9708(b) of this title or on the form as prescribed by the patient's state of residence.
(d)(1) Each nursing home and residential care facility that chooses to use volunteers to explain to residents the nature and effect of an advance directive as required by subsection 9703(d) of this title shall ensure that the volunteers have received appropriate training regarding the explanation of advance directives.
(2) Every hospital shall designate an adequate number of individuals to explain the nature and effect of an advance directive to patients as required by subsection 9703(e) of this title.
(a) A family member of a patient or a person with a known close relationship to the patient may elect hospice care on behalf of the patient if the patient does not have an agent or guardian or the patient's agent or guardian, or both, if applicable, are unavailable. Decisions made by the family member or person with a known close relationship shall protect the patient's own wishes in the same manner as decisions made by an agent as described in subsection 9711(d) of this title.
(a) When the requirements of subsection 9706(a) of this title are met, and subject to the provisions of this chapter, other applicable law, and any express instructions regarding the agent's authority set forth in an advance directive or a court order, an agent shall have the authority to make any health care decisions on the principal's behalf that the principal could make if the principal had capacity.
(b) A principal with capacity retains concurrent authority with the principal's agent to make health care decisions. In the event the principal and the agent disagree on a decision regarding the principal's health care, the decision of the principal shall be controlling.
(2) when the circumstance or condition specified pursuant to subdivision 9702(a)(3) of this title no longer is met.
(C) the agent's knowledge of the principal's values or religious or moral beliefs.
(2) If the agent cannot determine what the principal would have wanted under the circumstances, the agent shall make the determination through an assessment of the principal's best interests. When making a decision for the principal on this basis, the agent shall not authorize the provision or withholding of health care on the basis of the principal's economic status or preexisting, long-term mental or physical disability.
(3) When making a determination under this subsection, the agent shall not consider the agent's own interests, wishes, values, or beliefs.
(B) notify the principal, alternate agent, health care provider, and residential care provider of the recusal or resignation.
(4) file a complaint on behalf of the principal regarding a health care provider, health care facility, or residential care facility.
(f) Nothing in this chapter shall be construed to give an agent authority to consent to voluntary sterilization.
(a) An individual appointed to arrange for the disposition of the principal's remains shall make those decisions based upon the principal's specific instructions contained in an advance directive or pre-need contract entered into with a funeral director, crematory operator, or cemetery official, or, if there are no such instructions, in accordance with the principal's wishes expressed orally or the knowledge of the agent or guardian of the principal's values or religious or moral beliefs.
(2) if the principal's estate is without sufficient funds to dispose of the remains or provide funeral goods and services in accordance with the advance directive, the disposition shall occur in a manner approximating the principal's wishes to the extent it is financially possible.
(c) Any procurement organization having knowledge of a principal's advance directive shall follow the advance directive and any instructions of the individual appointed in the advance directive to arrange for the recovery of the principal's anatomical gifts unless the procurement organization determines such gifts are unsuitable for the purposes for which they are made or if recovery of such gifts would cause the procurement organization to violate standards of professional conduct or any applicable regulation or law.
(2) within 120 days of the Commissioner's announcing the availability of the registry, to ensure that the director, operator, official, or organization checks the registry at the time services are to be provided to determine whether the decedent has an advance directive.
(a) No individual acting as an agent, guardian, or surrogate shall be subjected to criminal or civil liability for making a decision in good faith pursuant to the terms of an advance directive, or DNR order, or COLST order and the provisions of this chapter.
(B) relying in good faith on a suspended or revoked advance directive, suspended or revoked DNR order, or suspended or revoked COLST order, unless the provider or facility knew or should have known of the suspension, or revocation.
(2) A funeral director, crematory operator, cemetery official, procurement organization, or any other person acting for or under such person's control, shall, if the director, operator, official, or organization has complied with the provisions of this chapter, not be subject to civil or criminal liability for providing or withholding its services in good faith pursuant to the provisions of an advance directive, whether or not the advance directive has been suspended or revoked.
(3) Nothing in this subsection shall be construed to establish immunity for the failure to follow standards of professional conduct and to exercise due care in the provision of services.
(1) Providing or withholding treatment or services in good faith pursuant to the direction of a principal or patient, the provisions of an advance directive, a DNR order, a COLST order, a DNR identification, the consent of the principal or patient with capacity or principal's or patient's agent, guardian, or surrogate, a decision or objection of a principal or patient, or the provisions of this chapter. This subdivision shall not be construed to establish a defense for the failure to follow standards of professional conduct and to exercise due care in the provision of services.
(2) Relying on an amended, suspended, or revoked advance directive, unless the employee knew or should have known of the amendment, suspension, or revocation.
(a) A health care provider, health care facility, residential care facility, funeral director, crematory operator, or cemetery official, or an employee of any of them having actual knowledge of an advance directive or an instruction of the principal, agent, or guardian is subject to review and disciplinary action by the appropriate licensing entity for failing to act in accordance with the advance directive or instruction or with subsection 9707(b) of this title.
(b) A health care provider, health care facility, residential care facility, funeral home director, crematory operator, cemetery official, probate division official, or procurement organization, or an employee of any of them, who accesses the registry without authority or when authority has been denied specifically by the principal, agent, or guardian is subject to review and disciplinary action by the appropriate licensing, accreditation, or approving entity.
(c) Nothing in this section shall be construed as limiting any other available remedies.
(a) The withholding or withdrawal of life sustaining treatment from a principal who has executed an advance directive limiting the provision of life sustaining treatment shall not be construed as a suicide.
(b) Nothing in this chapter shall be construed to limit or abrogate an individual's ability to create a document of anatomical gift pursuant to chapter 110 of this title.
(c) Nothing in this chapter shall be interpreted to affect the statutory or common law in existence at the time of enactment applicable to death intentionally hastened through the use of prescription medication. Professionally appropriate use of medication to relieve suffering which may have the unintended effect of hastening death is not death intentionally hastened through the use of prescription medication.
(5) an individual or entity identified in an advance directive, pursuant to subdivision 9702(a)(10) of this title, as authorized to bring an action under this section.
(4) an order for disposition of the remains of the principal.
(c) A principal, agent, or interested individual may file an petition in the Probate Division of the Superior Court with a supporting affidavit challenging a determination that the condition specified pursuant to subdivision 9702(a)(3) of this title is met.
(4) the petitioner notifies the principal's clinician that an petition challenging the determination of capacity has been filed and provides the supporting determination or affidavit to the principal's clinician.
(e) The Probate Division of the Superior Court may limit the frequency of a capacity redetermination pursuant to subsection (d) of this section upon a finding that there have been multiple requests for redetermination, and that those requests have been frivolous or requested in bad faith.
(f) The agent, if any, shall have the opportunity to appear in any action brought under subdivision (b)(1), (2), or (3) of this section or subsection (c) or (d) of this section.
(a) No later than March 1, 2012, and from time to time thereafter, the Commissioner, in consultation with all appropriate agencies and organizations, shall adopt rules pursuant to 3 V.S.A. chapter 25 to effectuate the intent of this chapter. The rules shall cover at least one optional form of an advance directive with an accompanying form providing an explanation of choices and responsibilities, the Vermont DNR/COLST form as outlined in subsection 9708(b) of this title, the use of experimental treatments, a DNR identification, revocation of a DNR identification, and consistent statewide emergency medical standards for DNR/COLST orders and advance directives for patients and principals in all settings. The Commissioner shall also provide, but without the obligation to adopt a rule, optional forms for advance directives for individuals with disabilities, limited English proficiency, and cognitive translation needs.
(b)(1) Within one year of the effective date of this chapter, the Commissioner shall develop and maintain a registry to which a principal may submit his or her advance directive, including a terminal care document and a durable power of attorney. The rules shall describe when health care providers, health care facilities, and residential care facilities may access an advance directive in the registry. In no event shall the information in the registry be accessed or used for any purpose unrelated to decision making for health care or disposition of remains, except that the information may be used for statistical or analytical purposes as long as the individual's identifying information remains confidential.
(2)(A) Within one year of the effective date of this chapter, the Commissioner shall adopt rules pursuant to 3 V.S.A. chapter 25 on the process for securely submitting, revoking, amending, replacing, and accessing the information contained in the registry. The rules shall provide for incorporation into the registry of notifications of amendment, suspension, or revocation under subsection 9704(c) of this title and revocations of appointment under subsection 9704(d) of this title.
(B) The Commissioner shall provide to any individual who submits an advance directive to the registry a sticker that can be placed on a driver's license or identification card indicating that the holder has an advance directive in the registry.
(c)(1) Within one year of the effective date of this chapter, the Commissioner shall provide on the Department's public website information on advance directives and the registry to appropriate State offices. The Commissioner shall also include information on advance directives, and on the registry and the optional forms of an advance directive.
(a)(1) One or more interested individuals may be eligible to act as the surrogate for an adult without capacity in order to provide or withhold informed consent for a do-not-resuscitate order or clinician order for life-sustaining treatment pursuant to this subchapter. Only one interested individual may act as a surrogate at a time.
(2)(A) A patient's health care provider shall not be considered an interested individual and shall not serve as a patient's surrogate to provide or withhold informed consent for a DNR/COLST order pursuant to this chapter unless related to the patient by blood, marriage, civil union, or adoption.
(B) The owner, operator, employee, agent, or contractor of a residential care facility, health care facility, or correctional facility in which the patient resides at the time the DNR/COLST order is written shall not be considered an interested individual and shall not act as the patient's surrogate to provide or withhold consent for a DNR/COLST order pursuant to this chapter unless related to the patient by blood, marriage, civil union, or adoption.
(5) the patient does not object to the surrogate providing or withholding consent for a DNR/COLST order or to the treatment proposed to be provided or withdrawn pursuant to a DNR/COLST order, even if the patient lacks capacity.
(c)(1) A surrogate shall be an interested individual who is designated by the patient by personally informing the patient's clinician. If the patient designates a surrogate to the clinician orally, the clinician shall document the designation in the patient's medical record at the time the designation is made.
(B) willing and available to consult with the patient's clinician.
(3) Notwithstanding the provisions of subdivisions (1) and (2) of this subsection, an individual shall not serve as a surrogate over the patient's objection, even if the patient lacks capacity.
(1)(A) All interested individuals agree on the decision to provide or withhold consent for a DNR/COLST order, in which case they shall designate one surrogate, as well as an alternate, if available, who is authorized to provide or withhold consent and whose name will be identified on the DNR/COLST form and in the patient's medical record.
(B) All interested individuals agree that a specific interested individual may make the decision regarding whether to provide or withhold consent for a DNR/COLST order, in which case they shall designate the individual as the surrogate, as well as an alternate, if available, who is authorized to provide or withhold consent and whose name will be identified on the DNR/COLST form and in the patient's medical record.
(C) The surrogate or alternate, if applicable, is not reasonably available, in which case the clinician shall consult the interested individuals to request designation of another surrogate and alternate.
(2) If at any time the interested individuals are unable to agree on the designation of a surrogate, an interested person, as defined in 14 V.S.A. § 3061, may file a petition for guardianship in the Probate Division of the Superior Court.
(e) A surrogate providing informed consent for a DNR/COLST order shall use substituted judgment consistent with the patient's wishes and values and consistent with the parameters described in subsection 9711(d) of this title. The surrogate shall consult with the patient to the extent possible, and with the patient's clinician and any other appropriate health care providers and shall provide or withhold informed consent for a DNR/COLST order by attempting to determine what the patient would have wanted under the circumstances.
(f) The patient's clinician shall make reasonable efforts to inform the patient of any proposed treatment, or of any proposal to withhold or withdraw treatment, based on the decisions made by the surrogate.
(g) If the patient's clinician determines that the patient no longer lacks capacity and the DNR/COLST order was based on informed consent provided by a surrogate, the clinician shall seek the informed consent of the patient for any DNR/COLST order, which shall supersede the surrogate's consent.

References: § 2651
 § 3069
 § 1320
 § 7102
 § 1395
 § 3061