Source: https://legislature.vermont.gov/statutes/fullchapter/18/231
Timestamp: 2019-06-18 23:19:57
Document Index: 628440630

Matched Legal Cases: ['§ 1', '§ 1', '§ 7501', '§ 1', '§ 332', '§ 13', '§ 4', '§ 238', '§ 9', '§ 30', '§ 4', '§ 17', '§ 47', '§ 1', '§ 112', '§ 1', '§ 1', '§ 1', '§ 19', '§ 2', '§ 1', '§ 10', '§ 1', '§ 2', '§ 1', '§ 3', '§ 9709', '§ 1', '§ 12', '§ 4', '§ 9710', '§ 1', '§ 9712', '§ 1', '§ 335', '§ 1', '§ 336', '§ 13', '§ 1', '§ 9714', '§ 1', '§ 337', '§ 1481', '§ 1', '§ 6', '§ 1', '§ 1', '§ 1', '§ 9718', '§ 1', '§ 338', '§ 238', '§ 21', '§ 52', '§ 4', '§ 1', '§ 339', '§ 14', '§ 1', '§ 9731', '§ 3061', '§ 1']

Chapter 231: ADVANCE DIRECTIVES FOR HEALTH CARE, DISPOSITION OF REMAINS, AND SURROGATE DECISION MAKING
The State of Vermont recognizes the fundamental right of an adult to determine the extent of health care the individual will receive, including treatment provided during periods of incapacity and at the end of life. This chapter enables adults to retain control over their own health care through the use of advance directives, including appointment of an agent and directions regarding health care and disposition of remains. During periods of incapacity, the decisions by the agent shall be based on the express instructions, wishes, or beliefs of the individual, to the extent those can be determined. This chapter also allows, in limited circumstances in which a patient without capacity has neither an agent nor a guardian, for a surrogate to provide or withhold consent on the patient's behalf for a do-not-resuscitate order or clinician order for life-sustaining treatment. (Added 2005, No. 55, § 1; eff. Sept. 1, 2005; amended 2015, No. 136 (Adj. Sess.), § 1, eff. Jan. 1, 2018.)
(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.
(4) "Capacity" means an individual's ability to make and communicate a decision regarding the issue that needs to be decided.
(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.
(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.
(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.
(A) the principal's or patient's spouse, adult child, parent, adult sibling, adult grandchild, or clergy person; or
(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.
(21) "Ombudsman" means:
(A) the State Long-Term Care Ombudsman or a representative of the Ombudsman's Office, as defined in 33 V.S.A. § 7501; or
(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.
(24) "Principal's clinician" means a clinician who currently has responsibility for providing health care to the principal.
(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.
(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.
(34) "Mental health patient representative" means the mental health patient representative established by section 7253 of this title. (Added 2005, No. 55, § 1, eff. Sept. 1, 2005; amended 2005, No. 215 (Adj. Sess.), § 332; 2009, No. 25, § 13; 2009, No. 119 (Adj. Sess.), § 4; 2009, No. 154 (Adj. Sess.), § 238a, eff. Feb. 1, 2011; 2011, No. 60, § 9, eff. June 1, 2011; 2013, No. 34, § 30a; 2013, No. 127 (Adj. Sess.), § 4, eff. May 10, 2014; 2013, No. 192 (Adj. Sess.), § 17; 2015, No. 23, § 47; 2015, No. 136 (Adj. Sess.), § 1, eff. Jan. 1, 2018; 2017, No. 113 (Adj. Sess.), § 112; 2017, No. 121 (Adj. Sess.), § 1, eff. May 3, 2018.)
Subchapter 001: ADVANCE DIRECTIVES AND DISPOSITION OF REMAINS
An individual possessing a duly executed advance directive to whom it becomes known that the terms of the advance directive may be applicable shall deliver the advance directive to the principal's clinician, other health care provider, health care facility, or residential care facility, unless the individual knows that another copy has previously been delivered and is available. (Added 2005, No. 55, § 1, eff. Sept. 1, 2005.)
(1) when a principal's clinician:
(A) determines, after speaking with an interested individual if one is reasonably available, that the principal lacks capacity, and makes specific findings regarding the cause, nature, and projected duration of the principal's lack of capacity;
(C) has made reasonable efforts to notify the principal's agent or guardian of the determination; or
(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.
(e) An advance directive regarding disposition of the principal's remains shall become effective upon the death of the principal. (Added 2005, No. 55, § 1, eff. Sept. 1, 2005; amended 2013, No. 192 (Adj. Sess.), § 19; 2017, No. 121 (Adj. Sess.), § 2a, eff. May 3, 2018.)
(a) As used in this section, "clinician" shall have the same meaning as in section 9701 of this title and shall also include a duly licensed medical doctor, osteopathic physician, advanced practice registered nurse or nurse practitioner, or physician assistant who treated the patient outside Vermont and held a valid license to practice in the state in which the patient was located at the time the DNR/COLST was issued.
(l) A DNR order precludes efforts to resuscitate only in the event of cardiopulmonary arrest and does not affect other therapeutic interventions that may be appropriate for the patient. (Added 2005, No. 55, § 1, eff. Sept. 1, 2005; amended 2011, No. 60, § 10, eff. June 1, 2011; 2011, No. 76 (Adj. Sess.), § 1, eff. March 7, 2012; 2013, No. 50, § E.312.3; 2013, No. 127 (Adj. Sess.), §§ 2, 5, eff. May 10, 2014; 2015, No. 136 (Adj. Sess.), § 1, eff. Jan. 1, 2018; 2017, No. 121 (Adj. Sess.), § 3, eff. May 3, 2018.)
§ 9709. Obligations of health care providers, health care facilities, residential care facilities, and health insurers regarding protocols and nondiscrimination
(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.
(b) Every health care provider, health care facility, and residential care facility shall develop protocols:
(1) to ensure that a principal's advance directive, including any amendment, suspension, or revocation thereof, and DNR/COLST order, if any, are promptly available when services are to be provided, including that the existence of the advance directive, amendment, suspension, revocation, or DNR/COLST order is prominently noted on any file jacket or folder, and that a note is entered into any electronic database of the provider or facility;
(2) for maintaining advance directives received from individuals who anticipate future care but are not yet patients of that provider or facility;
(3) to ensure that the provider or facility checks the registry at the time any individual without capacity is admitted or provided services to determine whether the individual has an advance directive;
(i) request, review, receive, and copy any oral or written information regarding the principal's physical or mental health, including medical and hospital records;
(iv) file a complaint on behalf of the principal regarding a health care provider, health care facility, or residential care facility;
(B) the exercise of rights under this subdivision shall not be construed to waive any privilege provided by law;
(c) Every health care facility and residential care facility shall develop written protocols to ensure that:
(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.
(B) The review of a patient's advance directive required by this subdivision shall occur:
(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.
(e) No health care provider, health care facility, residential care facility, health insurer as defined in section 9402 of this title, insurer issuing disability insurance, or self-insured employee welfare benefit plan shall charge an individual a different rate or require any individual to execute an advance directive or to obtain a DNR/COLST order or DNR identification as a condition of admission to a facility or as a condition of being insured for or receiving health care or residential care. No health care shall be refused except as provided herein because an individual is known to have executed an advance directive. (Added 2005, No. 55, § 1, eff. Sept. 1, 2005; amended 2011, No. 60, § 12, eff. June 1, 2011; 2017, No. 121 (Adj. Sess.), § 4, eff. May 3, 2018.)
§ 9710. Consent for hospice care
(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.
(b) As used in this section, "hospice care" means a program of care and support provided by a Medicare-certified hospice provider to help an individual with a terminal condition to live comfortably by providing palliative care, including effective pain and symptom management. Hospice care may include services provided by an interdisciplinary team that are intended to address the physical, emotional, psychosocial, and spiritual needs of the individual and his or her family. (Added 2013, No. 127 (Adj. Sess.), § 1, eff. May 10, 2014.)
§ 9712. Obligations of funeral directors, crematory operators, cemetery officials, procurement organizations, and individuals appointed to arrange for the disposition of the principal's remains
(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.
(b) Any funeral director, crematory operator, or cemetery official having knowledge of a principal's advance directive shall follow the advance directive and any instructions of the individual appointed in an advance directive to arrange for the disposition of the principal's remains, except:
(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.
(d) Every funeral director, crematory operator, cemetery official, and procurement organization shall develop systems:
(1) to ensure that a principal's advance directive is promptly available when services are to be provided, including that the existence of an advance directive is prominently noted on any file jacket or folder, and that a note is entered into any electronic database of the director, operator, official, or organization;
(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.
(e) In the event the principal's instructions in an advance directive regarding disposition of remains or for funeral goods and services are in apparent conflict with a contract entered into by the principal for the disposition of remains, funeral goods, or services, the most recent document created by the principal shall be followed to the extent of the conflict. Nothing in this subsection shall be construed as limiting any other available remedies. (Added 2005, No. 55, § 1, eff. Sept. 1, 2005; amended 2005, No. 215 (Adj. Sess.), § 335.)
(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)(1) No health care provider, health care facility, residential care facility, or any other person acting for or under such person's control shall, if the provider or facility has complied with the provisions of this chapter, be subject to civil or criminal liability for:
(A) 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 a principal or patient with capacity or of the principal's or patient's agent, guardian, or surrogate, or a decision or objection of a principal or patient; or
(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.
(3) Providing notice to the employer of a moral or other conflict pursuant to subdivision 9707(b)(3) of this title, so long as the employee has provided ongoing health care until a new employee or provider has been found to provide the services. (Added 2005, No. 55, § 1, eff. Sept. 1, 2005; amended 2005, No. 215 (Adj. Sess.), § 336; 2011, No. 60, § 13, eff. June 1, 2011; 2015, No. 136 (Adj. Sess.), § 1, eff. Jan. 1, 2018.)
§ 9714. Failure to follow advance directive; unauthorized access of registry; administrative penalties
(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.
(d) Liability for the cost of health care, disposition of remains, anatomical gifts, or funeral goods and services provided pursuant to an advance directive or pursuant to an instruction of the agent, guardian, or individual designated in an advance directive to make decisions regarding disposition of remains shall be the same as if the services were provided pursuant to the principal's decision. (Added 2005, No. 55, § 1, eff. Sept. 1, 2005; amended 2005, No. 215 (Adj. Sess.), § 337.)
(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.
(d) Nothing in this chapter shall be construed to limit the effect of a DD Form 93 (Record of Emergency Data) properly executed by a current or former member of the armed forces of the United States described in 10 U.S.C. § 1481(a). (Added 2005, No. 55, § 1, eff. Sept. 1, 2005; amended 2009, No. 119 (Adj. Sess.), § 6; 2011, No. 80 (Adj. Sess.), § 1, eff. April 13, 2012.)
Nothing in this chapter limits the enforceability of an advance directive or similar instrument executed in another state or jurisdiction in compliance with the law of that state or jurisdiction. To the extent possible under conflicts of law doctrine, an advance directive executed in Vermont shall be interpreted according to Vermont law. (Added 2005, No. 55, § 1, eff. Sept. 1, 2005.)
An advance directive executed as provided in this chapter shall be presumed valid. No third party shall require an additional or different form of advance directive. A photocopy or facsimile of a duly executed original advance directive shall be relied upon to the same extent as the original. (Added 2005, No. 55, § 1, eff. Sept. 1, 2005.)
§ 9718. Petition for review by the Probate Division of the Superior Court
(a) A petition may be filed in the Probate Division of the Superior Court under this section by:
(1) a principal, guardian, agent, ombudsman, a mental health patient representative, or interested individual other than one identified in an advance directive, pursuant to subdivision 9702(a)(10) of this title, as not authorized to bring an action under this section;
(3) the Defender General if the principal is in the custody of the Department of Corrections;
(4) a representative of the State-designated protection and advocacy system if the principal is in the custody of the Department of Mental Health; or
(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.
(b) A petition filed in the Probate Division of the Superior Court under this section shall include a supporting affidavit and may request:
(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.
(d) The principal or an agent may file an petition in the Probate Division of the Superior Court challenging a determination under subdivision 9706(a)(1) or subsection (c) of this title if:
(1) the petitioner provides notice to any agent, the principal, an interested individual, or a person entitled to notification of a determination of capacity under subdivision 9706(a)(1) or subsection (c) of this title prior to filing;
(2) the petition includes a supporting affidavit setting forth specific facts challenging a capacity determination under subdivision 9706(a)(1) or subsection (c) of this title;
(3)(A) prior to filing, the petitioner obtains a determination from a clinician that the principal's capacity is not as the principal's clinician has determined; or
(B) if the petitioner is unable to obtain the determination required by subdivision (A) of this subdivision (3), the petitioner includes in the supporting affidavit the facts regarding the attempts to obtain a second determination of capacity and supporting the challenge to the capacity determination by the petitioner's clinician; and
(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.
(g) A petitioner filing under subsection (b), (c), or (d) of this section shall, if doing so would be consistent with any obligations the petitioner has under HIPAA, provide notice to the following persons if known: the principal, an agent, a guardian, and interested individuals. (Added 2005, No. 55, § 1, eff. Sept. 1, 2005; amended 2005, No. 215 (Adj. Sess.), § 338; 2009, No. 154 (Adj. Sess.), § 238a, eff. Feb. 1, 2011; 2013, No. 192 (Adj. Sess.), § 21; 2015, No. 23, § 52; 2017, No. 121 (Adj. Sess.), § 4a, eff. May 3, 2018.)
(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.
(2) Within one year of the effective date of this chapter, the Commissioner of Motor Vehicles shall provide motor vehicle licenses and identity cards, as soon as existing licenses or cards have been depleted, which allow the license holder or card holder to indicate that he or she has an advance directive and whether it is in the registry. (Added 2005, No. 55, § 1, eff. Sept. 1, 2005; amended 2005, No. 215 (Adj. Sess.), § 339; 2011, No. 60, § 14, eff. June 1, 2011.)
If any provisions of this chapter or its application to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of this chapter which can be given effect without the invalid provision or application, and, to this end, provisions of this chapter are severable. (Added 2005, No. 55, § 1, eff. Sept. 1, 2005.)
Subchapter 002: SURROGATE CONSENT
§ 9731. Informed consent by surrogate for DNR/COLST order
(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.
(b) A surrogate may provide or withhold informed consent only if all of the following conditions are met:
(1) the patient's clinician determines that the patient lacks capacity to provide informed consent;
(2) the patient has not appointed an agent through an advance directive;
(3) the patient has not indicated in an advance directive that the interested individual or individuals seeking to serve as surrogate should not be consulted on health care decisions or otherwise provided instructions in an advance directive contrary to allowing such individual or individuals to serve as surrogate;
(4) the patient does not have a guardian who is authorized to make health care decisions; and
(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.
(2) If the patient has not designated a surrogate pursuant to subdivision (1) of this subsection, or if the surrogate designated by the patient is not reasonably available or is unwilling to serve, then the patient's clinician shall make a reasonable attempt to notify all reasonably available interested individuals of the need for a surrogate to make a decision regarding whether to provide or withhold consent for a DNR/COLST order. A surrogate shall be an interested individual who is:
(A) willing to provide or withhold informed consent for a DNR/COLST order for the patient in accordance with the patient's wishes and values, if known; and
(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.
(d) The patient's clinician, health care provider, or residential care provider may rely on the decision of a surrogate identified pursuant to this section as long as the clinician or provider documents in the patient's medical record that the surrogate has confirmed that one of the following circumstances applies:
(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.
(h) A surrogate shall have the same rights as a patient with capacity would have to the following, to the extent that it is related to providing or withholding informed consent for a DNR/COLST order:
(1) request, receive, review, and copy any oral or written information regarding the patient's physical or mental health, including medical and hospital records;
(2) participate in any meetings, discussions, or conferences concerning health care decisions related to the patient;
(4) file a complaint on behalf of the patient regarding a health care provider, health care facility, or residential care facility. (Added 2015, No. 136 (Adj. Sess.), § 1, eff. Jan. 1, 2018.)