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Printable Vermont Living Will Template

The Vermont Living Will form is a legal document that allows individuals to outline their preferences for medical care in the event they become unable to communicate their wishes themselves. It provides a way for people to ensure that their healthcare decisions are respected, even when they cannot express them directly. By completing this form, individuals can clearly state what medical actions should or should not be taken, thereby guiding family members and healthcare professionals through difficult decisions.

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Article Guide

Among the myriad considerations individuals face when planning for the future, the creation of a Living Will stands out for its profound importance. In Vermont, the Living Will form emerges as a crucial document that allows people to articulate their wishes concerning medical treatment, should they become incapacitated and unable to communicate their preferences directly. This form covers a range of decisions, from the refusal of certain types of life-sustaining treatment to the conditions under which one would prefer to accept or decline nutrition and hydration provided artificially. Furthermore, it empowers individuals to appoint a health care agent, entrusted with the responsibility to ensure that the stipulated wishes are respected and adhered to by medical professionals. The Vermont Living Will serves not only as a testament to one’s personal convictions about end-of-life care but also as a legal tool that provides peace of mind to both the document's creator and their loved ones, ensuring that medical treatment aligns with the individual’s values and desires during critical moments when they cannot speak for themselves.

Form Sample

Vermont Living Will Template

This Vermont Living Will template is designed to help individuals make known their wishes regarding medical treatment in situations where they are unable to communicate their decisions. It is compliant with the Vermont Patient Choice at End of Life Act (Act 39) and other relevant Vermont state laws. Completing this living will ensures your healthcare preferences are respected by family members and medical professionals.

Personal Details

Full Legal Name: __________________________
Date of Birth: __________________________
Address: __________________________
City: __________________________, State: Vermont, Zip Code: __________________________
Social Security Number: __________________________

Designation of Health Care Agent

I hereby appoint the following individual as my Health Care Agent to make healthcare decisions for me if I become unable to make my own decisions:

Name: __________________________
Relationship to me: __________________________
Primary Telephone: __________________________ Alternative Telephone: __________________________
Address: __________________________

Living Will Instructions

I direct that my healthcare providers and others involved in my care provide, withhold, or withdraw treatment in accordance with my directions below:

  • If I am in a condition where I am unable to communicate and there is no reasonable expectation of my recovery, I direct that:
    • Life-sustaining treatments should / should not be provided, including artificially-administered nutrition and hydration.
  • I do / do not want to receive pain relief medication, even if it may hasten my death.

Other specific wishes (if any):
______________________________________________________________________

Declaration

I declare that this living will reflects my personal wishes. I understand the full import of this declaration and am emotionally and mentally competent to make this decision. I am aware that I can revoke this directive at any time.

Signature: __________________________ Date: __________________________

State of Vermont )
County of __________________________ ) ss.
On this day of __________________________, before me, a Notary Public in and for said county and state, personally appeared __________________________, known to me or satisfactorily proven to be the person whose name is subscribed to the foregoing instrument, and acknowledged that they executed the same for the purposes therein contained.

In Witness Whereof, I have hereunto set my hand and official seal.

Notary Public Signature: __________________________
My commission expires: __________________________

Document Attributes

Fact Name Description
Form Title Vermont Living Will
Purpose To allow individuals to outline their healthcare preferences in the event they are unable to communicate.
Governing Laws Vermont's Advance Directive Law, 18 V.S.A. Chapter 231.
Who Can Make One? Any competent individual 18 years of age or older.
Requirements Must be signed by the declarant and either witnessed by two individuals or notarized.
Witness Restrictions Witnesses cannot be the agent appointed in the Living Will, related to the declarant by blood, marriage, or adoption, or directly financially responsible for the declarant’s medical care.
Revocation Can be revoked at any time by the declarant through a signed and dated writing, destroying the document, or verbally expressing the intent to revoke.
Validity Outside Vermont May be recognized by other states if it complies with their laws, or if their laws recognize documents validly executed in another state.
Where to File Not formally filed with the state but should be provided to the individual’s physician and/or healthcare facility and included in medical records.

Instructions on How to Fill Out Vermont Living Will

Filling out a Vermont Living Will is a responsible step in planning for future health care decisions. This document gives instructions on how you want to be treated if you can't make decisions for yourself. The process involves providing personal information, specifying your health care preferences, designating a health care agent, and making the document legally binding. Here's a guide to help you through each step, ensuring your wishes are clearly documented.

  1. Start by writing your full legal name at the top of the form. This identifies you as the person creating the Living Will.
  2. Enter your date of birth next to your name, establishing your identity and age.
  3. Specify your wishes regarding life-sustaining treatment. This may include instructions on whether you want treatments that can prolong your life under certain conditions.
  4. Choose a health care agent. This is someone who will make health care decisions for you if you're unable to do so. Write their full name, address, and contact details in the designated section.
  5. If desired, appoint an alternate health care agent. Provide the same information for them as you did for your primary agent. This person will step in if the primary agent is unavailable or unwilling to make decisions.
  6. Include any additional instructions. This section is for specifying anything not covered elsewhere in the Living Will, such as preferences for pain management or other treatments.
  7. Sign and date the form in the presence of two witnesses, who must also sign and date the form. These witnesses confirm that you are willingly and competently making these decisions.
  8. Consider having the form notarized, although this is not a requirement in Vermont. A notary public can further attest to the validity of your signature and the document.

Once completed, your Vermont Living Will is an official document reflecting your health care preferences. Share a copy with your health care agent, your family, and your primary care provider to ensure your wishes are known and can be followed. Remember, you can revise or revoke this document at any time should your wishes or circumstances change, just ensure to distribute the updated copies accordingly.

FAQ

  1. What is a Vermont Living Will?

    A Vermont Living Will is a legal document that lets individuals outline their preferences for medical treatment in situations where they can no longer communicate their wishes due to illness or incapacity. It provides clear guidance to healthcare providers and family members about the person's end-of-life care preferences.

  2. Who should have a Living Will?

    Any adult in Vermont who wishes to have control over their medical treatment when they are incapacitated should consider creating a Living Will. It's particularly important for those with strong views about specific treatments or end-of-life care, or individuals with chronic illnesses.

  3. How do I create a Living Will in Vermont?

    To create a Living Will in Vermont, you must complete a form that specifies your healthcare preferences. This form must be signed in the presence of two witnesses who are not related to you by blood, marriage, or adoption and who do not stand to inherit from you. You can also have the form notarized.

  4. Are there restrictions on who can be a witness?

    Yes, witnesses to a Vermont Living Will must be adults and cannot be related to you by blood, marriage, or adoption. Additionally, they should not stand to inherit anything from you, either through your will or by law, and they should not be your healthcare provider or an employee of a healthcare provider treating you.

  5. What should be included in a Living Will?

    A Living Will should include specific instructions about the types of medical treatments you would like to receive or refuse under certain conditions. This may involve decisions about life support, artificial nutrition and hydration, and pain management. You can also specify your preferences regarding organ donation.

  6. Can I update my Living Will?

    Yes, you can update your Living Will at any time. It's recommended to review it periodically, or after a major life event such as a divorce, the birth of a child, or a significant change in health status. To update your Living Will, you should complete a new form and ensure it is properly witnessed and/or notarized, then inform your healthcare provider and family of the updated document.

  7. How does a Living Will differ from a Health Care Proxy?

    A Living Will specifies your wishes regarding medical treatment, while a Health Care Proxy, also known as a Durable Power of Attorney for Health Care, appoints someone else (a proxy) to make medical decisions for you if you are unable. Vermont residents may choose to have both, ensuring their treatment preferences are known and that there is someone designated to make decisions on their behalf.

  8. What happens if I don't have a Living Will?

    If you don't have a Living Will and become unable to communicate your healthcare preferences, decisions about your treatment will generally be made by your spouse, adult children, parents, or next of kin, in that order. Having a Living Will ensures that your specific wishes are known and followed, preventing potential conflicts or uncertainty among your loved ones and healthcare providers.

Common mistakes

Filling out a Vermont Living Will form is a crucial step in making sure your healthcare wishes are respected. However, mistakes can be made during this process. Here's a list of 10 common mistakes people often make:

  1. Not reading the instructions carefully. It's important to understand every part of the form to ensure it's filled out correctly.
  2. Using unclear language. Be as specific as possible with your healthcare wishes to avoid any confusion.
  3. Forgetting to update the form. Life changes, such as new diagnoses or changes in your healthcare preferences, should be reflected in your Living Will.
  4. Not discussing the details with your healthcare proxy. Your appointed proxy should understand your wishes thoroughly.
  5. Leaving blank spaces. If a section doesn't apply, it's better to indicate this clearly rather than leaving it empty.
  6. Skipping the signature and date. This is a legal document, and these elements are crucial for its validity.
  7. Ignoring state requirements. Make sure the form complies with Vermont's specific legal requirements.
  8. Failing to notify key people. Once completed, it's crucial to inform family members and healthcare providers about the existence of your Living Will.
  9. Losing the only copy. Keep the original in a safe place and distribute copies to your healthcare proxy and other pertinent individuals.
  10. Overlooking the need for witnesses or a notary. Depending on Vermont's current laws, having your signature witnessed or notarized may be necessary.

Remember, taking the time to accurately fill out your Vermont Living Will form is an act of care for yourself and your loved ones. Avoiding these common mistakes can help ensure your healthcare wishes are clearly understood and respected.

Documents used along the form

In preparation for end-of-life decisions or severe health incapacitations, individuals often consider a Vermont Living Will as a foundation for their healthcare directives. However, pairing a living will with other essential forms and documents can ensure a more comprehensive approach to personal and medical affairs. Each of these documents serves a unique purpose, complementing the Living Will in safeguarding an individual's healthcare preferences and legal rights.

  • Durable Power of Attorney for Health Care: This legal document appoints a trusted person to make healthcare decisions on an individual’s behalf if they become unable to do so themselves. It’s crucial in scenarios where medical decisions need to be made beyond the scope of a living will.
  • Advance Directive: While similar to a Living Will, an Advance Directive can include specific wishes about the types of medical treatment the individual does or does not want to receive at the end-of-life. It often encompasses the Durable Power of Attorney for Health Care within the same document, creating a comprehensive directive.
  • Do Not Resuscitate (DNR) Order: A DNR order is a medical directive that prevents the use of CPR or advanced cardiac life support if an individual’s heart stops or if they stop breathing. This document is created in consultation with a healthcare provider and is designed to be respected across healthcare settings.
  • HIPAA Release Form: This form allows healthcare providers to disclose health information to designated individuals, such as family members or the person holding Durable Power of Attorney for Health Care. It’s essential for facilitating communication among healthcare professionals and loved ones.
  • Organ and Tissue Donation Form: Individuals can specify their wish to donate their organs and tissues after death through this consent form. It’s a gift of life that can save or significantly improve others' lives and can be included in the registry through the Department of Motor Vehicles (DMV) or via an online registry.
  • Funeral Planning Declaration: This document outlines an individual's preferences for their funeral arrangements and the disposition of their remains. Such declarations can alleviate the emotional strain on family members by making one's final wishes known.
  • Financial Power of Attorney: This grants a trusted individual the authority to handle financial affairs and decisions on behalf of the person. It ensures that bills, taxes, and other financial matters are attended to, even if the individual becomes incapacitated.

Each of these documents plays a pivotal role in creating a thorough and executable plan that reflects an individual’s healthcare and personal wishes comprehensively. A Vermont Living Will, when used in concert with these supplementary forms and documents, offers peace of mind to both the individual and their loved ones, ensuring that their desires are respected and followed. Services of legal and healthcare professionals can provide guidance in preparing these crucial documents accurately and in accordance with Vermont laws.

Similar forms

The Vermont Living Will shares similarities with an Advance Directive, a document that allows individuals to state their wishes for medical treatment in the event they become unable to communicate those preferences themselves. Both documents are designed to guide healthcare providers and loved ones in making decisions that align with the individual’s values and desires regarding end-of-life care or life-sustaining treatments.

Similar to the Medical Power of Attorney, the Vermont Living Will enables an individual to appoint a healthcare agent. This agent makes medical decisions on their behalf, should they become incapacitated. The key function of both documents is to ensure that medical decisions are made according to the individual's preferences, even when they can't communicate those preferences themselves due to medical reasons.

The Durable Power of Attorney for Healthcare is another document akin to the Vermont Living Will. It specifically focuses on allowing individuals to designate someone to make healthcare decisions for them, covering a broad range of medical decisions beyond the scope of life-sustaining treatments. While the Vermont Living Will might focus more on end-of-life decisions, a Durable Power of Attorney for Healthcare encompasses all medical decisions when the person is incapacitated.

The Do Not Resuscitate Order (DNR) shares a specific common purpose with the Vermont Living Will: both aim to guide healthcare providers regarding the use of life-sustaining treatments. A Vermont Living Will can include instructions to refrain from the use of extraordinary measures in terminal conditions, similar to how a DNR specifically instructs healthcare providers not to perform CPR if the patient's breathing or heart stops.

The Five Wishes Document is another advance care planning tool that, like the Vermont Living Will, addresses an individual’s personal, emotional, and spiritual needs in addition to their medical and legal wishes at the end of life. It allows people to specify their desires in areas such as comfort care, how they want to be treated, and what they want their loved ones to know, offering a more holistic approach to end-of-life planning.

A Health Care Proxy is similar to portions of the Vermont Living Will because it also allows an individual to appoint a representative to make healthcare decisions on their behalf in case they become unable to do so. The primary function of both documents is to ensure that healthcare decisions reflect the incapacitated individual’s preferences and values.

The POLST (Physician Orders for Life-Sustaining Treatment) form, while more immediate in its application compared to the Vermont Living Will, serves a similar purpose by specifying the types of medical treatment patients prefer in their current health state. Both documents are used to communicate a patient’s preferences regarding life-sustaining treatments, but the POLST is typically for individuals with serious health conditions and is filled out in consultation with a healthcare provider.

A Living Trust, although primarily used for financial and estate planning, shares the concept of appointing a responsible party to manage affairs, similar to a healthcare agent in a Vermont Living Living. While the focus differs — one is on financial affairs and the other on health care decisions — both involve designating a trusted individual to act on the grantor's behalf when they are unable to do so themselves.

The Last Will and Testament, while distinct in its focus on post-death affairs, such as the distribution of assets and care of dependents, intersects with the Vermont Living Will in its fundamental purpose of documenting an individual’s preferences to be executed when they are no longer able to make decisions or communicate. Both are preemptive, legally binding documents that ensure an individual's wishes are respected and followed.

Dos and Don'ts

Filling out a Vermont Living Will form is an important step in ensuring your healthcare wishes are honored. Here are some essential do's and don'ts to consider when completing this document:

Do's:

  1. Read the entire form carefully before you start filling it out to understand all the sections and instructions.

  2. Use clear and precise language to ensure your wishes are understood exactly as you intend.

  3. Discuss your wishes with your healthcare provider to ensure they are realistic and can be followed under Vermont law.

  4. Choose a healthcare agent who is trustworthy and willing to advocate for your healthcare preferences.

  5. Inform your family and loved ones about your Living Will to prepare them and reduce potential conflicts.

  6. Sign and date the form in the presence of two witnesses, as required by Vermont law to make it legally binding.

  7. Keep the original document in a safe but accessible place, and inform your healthcare agent and family where it is.

  8. Provide copies of the signed form to your healthcare agent, primary doctor, and possibly a lawyer.

  9. Review and update your Living Will periodically, especially after major life changes or changes in your health condition.

  10. Consider consulting with a legal professional specializing in estate planning or healthcare directives to ensure your form meets all legal requirements.

Don'ts:

  • Don’t fill out the form in a hurry. Take the time to consider your healthcare decisions carefully.

  • Don’t use ambiguous language that could be open to interpretation or confusion.

  • Don’t assume your doctors and healthcare providers will automatically know your wishes without a discussion.

  • Don’t choose a healthcare agent without discussing your wishes with them first.

  • Don’t forget to consider alternative scenarios where your wishes may need to adjust, such as advancements in medical treatments.

  • Don’t leave your Living Will form unsigned or unwitnessed, as this could make it non-valid.

  • Don’t keep your Living Will a secret from those who might need to know your healthcare preferences.

  • Don’t fail to give a copy of your Living Will to your healthcare agent and relevant healthcare providers.

  • Don’t assume once your Living Will is completed that it never needs to be revised or looked at again.

  • Don’t overlook the assistance of a lawyer, especially if your situation involves complex health or family dynamics.

Misconceptions

Understanding a Living Will, especially within specific states like Vermont, can be tricky. There are several misconceptions that can make navigating end-of-life decisions more challenging than necessary. Here’s a list to help shed light on common misunderstandings.

  • Only the Elderly Need a Living Will: This is not accurate. Anyone over the age of 18 can benefit from having a Living Will. It's about preparing for unforeseen circumstances, regardless of age.

  • It's Too Complicated to Create: While the thought of creating a Living Will might seem daunting, Vermont has made the process relatively straightforward. Resources and forms are available to guide individuals through the process.

  • A Lawyer is Needed to Complete It: It's a common belief that you need a lawyer to create a Living Will, but this isn’t the case. While legal advice can be beneficial, especially for complex situations, Vermont allows you to complete a Living Will without one.

  • It Covers All End-of-Life Decisions: A Living Will is crucial for making known your wishes regarding medical treatment, but it doesn’t cover all aspects of end-of-life planning. For example, it doesn’t appoint someone to manage your finances.

  • Once Signed, It’s Final: This is a misconception. A Living Will can be updated or revoked at any time by the person who created it, as long as they are mentally competent to do so.

  • It’s the Same Thing as a Durable Power of Attorney for Health Care: These are two distinct documents. The former outlines your wishes regarding medical treatment, while the latter designates an individual to make healthcare decisions on your behalf if you’re unable to do so.

  • A Living Will is Only About Life Support: While decisions about life-sustaining measures are a significant aspect, a Living Will can also include your preferences on pain management, organ donation, and other medical procedures.

  • My Family Knows My Wishes, So I Don’t Need One: Relying on family members to make decisions without a Living Will can place them in a difficult position. Documenting your wishes helps to ensure they’re carried out precisely as you want without putting unnecessary stress on your loved ones.

  • It's Too Early to Think About It: It’s never too early to start planning for the future. A Living Will is an essential part of that, ensuring your wishes are respected, no matter what happens.

  • It Costs a Lot to Create a Living Will: The cost of creating a Living Will in Vermont doesn’t have to be prohibitive. There are many affordable resources and some services offer assistance for free or at a reduced cost.

Clearing up these misconceptions can empower individuals to take control of their healthcare decisions. Creating a Living Will is a thoughtful act, not just for oneself but for one's family as well. Vermont residents have support and resources at their disposal to navigate this important task with confidence.

Key takeaways

In Vermont, a Living Will is a legal document that allows individuals to state their wishes regarding medical treatment in the event that they are unable to communicate their decisions due to illness or incapacity. Below are key takeaways for filling out and using the Vermont Living Will form:

  • Before filling out the form, it is essential to have a thorough discussion with family members and healthcare providers about your wishes concerning end-of-life care. This ensures that your decisions are made with understanding and support.
  • The Vermont Living Will form must be completed with accuracy to ensure that your healthcare wishes are clearly understood and followed. Be as specific as possible about the types of treatments you do or do not want to receive.
  • It is recommended to review the form periodically. Life changes such as a diagnosis, marriage, divorce, or the birth of a child might influence your decisions regarding healthcare preferences.
  • For the Living Will to be legally binding in Vermont, it must be signed in the presence of two witnesses who are not related to you, will not inherit anything from you, and are not involved in your healthcare. Alternatively, the document can be notarized.
  • Once the Living Will form is completed and signed, it is crucial to inform your healthcare proxy (if you have designated one), family, close friends, and your healthcare providers about the document and its contents.
  • Keep the original copy of your Living Will in a safe but accessible place. Copies should be given to your healthcare proxy, your primary care provider, and possibly a lawyer.
  • In situations where you wish to revoke or change your Living Will, it is important to inform all relevant parties, destroy all copies of the old document, and create a new one reflecting your current wishes.
  • The Vermont Living Will form does not expire, but revising it periodically ensures it reflects your current healthcare preferences.
  • If you travel or spend a considerable amount of time in another state, consider filling out the equivalently legal document in that jurisdiction since laws and forms vary by state.

By meticulously preparing your Vermont Living Will, you ensure that your healthcare wishes are known and can be honored, providing peace of mind for yourself and your loved ones.

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