Vermont Advance Directive and COLST Form: What Families Need to Know

If you have just lost someone in Vermont, or you are helping an aging parent prepare for end-of-life care, the paperwork around medical directives in this state is genuinely different from what most people expect. Vermont does not use the POLST form that most other states have adopted. It has its own version called the COLST, it maintains a statewide registry where residents can store their directives, and its progressive medical aid in dying law — Act 39 — creates specific implications for how death certificates are completed and how life insurance claims are handled.

This is what you need to understand.

What Is a Vermont Advance Directive?

An advance directive in Vermont is a legal document in which a person records their wishes about future medical treatment — particularly what interventions they do or do not want if they become incapacitated and cannot speak for themselves. Vermont advance directives typically cover:

• Healthcare agent designation: Appointing a person (a durable power of attorney for healthcare) to make medical decisions if the person cannot make them independently.
• Instructions for care: Specific wishes about life-sustaining treatment, resuscitation, artificial nutrition, and palliative care.
• Organ and tissue donation preferences.
• Disposition of remains: Some people use advance directives to record burial or cremation wishes.

Vermont recognizes two forms of documents in this space: the traditional advance directive (which functions like a living will combined with a healthcare proxy), and the COLST form, which is a separate, more immediate clinical order.

The COLST Form: Vermont's Version of POLST

If you search online for end-of-life medical orders in Vermont, you will find references to "POLST" — the Physician Orders for Life-Sustaining Treatment used widely across the United States. Vermont does not use the POLST framework. Instead, Vermont uses the COLST — Clinician Orders for Life-Sustaining Treatment.

The practical difference matters mainly to healthcare providers, but families should understand it:

• The COLST is a physician order, not just an expression of wishes. It carries immediate legal and clinical weight in any healthcare setting in Vermont.
• It is typically completed for patients with advanced illness or frailty — it is not intended as a planning document for healthy individuals, which is where an advance directive is more appropriate.
• Vermont COLST forms are recognized across healthcare settings — emergency responders, hospitals, nursing homes, and hospice programs — within the state.
• If the decedent had a COLST form in place, the treating facility or hospice should have it in the medical record. Family members or the executor do not typically need to take action on the COLST form itself after death; it is a care instruction that ceases to be relevant once the person has died.

The confusion between COLST and POLST matters mainly when families are dealing with out-of-state providers or when research turns up generic national information. In Vermont, the applicable document is the COLST.

The Vermont Advance Directive Registry (VADR)

Vermont operates a statewide database called the Vermont Advance Directive Registry (VADR), maintained in conjunction with the Vermont Ethics Network. Registration is free for Vermont residents.

The registry allows individuals to securely store their advance directive so that authorized parties — including healthcare facilities, licensed funeral directors, and emergency responders — can retrieve the document without having to locate a paper copy.

For families managing a recent death, the registry is relevant in two situations:

1. Confirming end-of-life wishes were honored. If there is any question about whether the decedent's medical wishes were followed in their final days, the VADR is the first place to check. Healthcare providers with appropriate authorization can access the registry to retrieve the document.

2. Disposition of remains. If the advance directive recorded specific burial or cremation instructions, or designated a particular person to control the disposition of remains, that instruction in the VADR has legal significance. Under Vermont law, a registered advance directive or a designated healthcare agent can legally supersede the default hierarchy of next-of-kin decision-making regarding the disposition of the decedent's body. This matters when family members disagree about burial versus cremation, or when the deceased had a specific request that the family might not honor without a formal document backing it up.

Licensed funeral directors and authorized healthcare facilities can retrieve documents from the VADR directly. The registry is accessible at VTEthicsNetwork.org.

Act 39: Vermont's Medical Aid in Dying Law

Vermont was among the earliest states to legalize medical aid in dying. Under Act 39 — formally the Patient Choice and Control at End of Life Act — a terminally ill, mentally capable adult can request a prescription for medication to self-administer to hasten death.

The law has three specific implications that families and executors need to understand after a death:

Death certificates are completed differently. Vermont law requires that when someone dies under Act 39, the official death certificate must list the underlying terminal illness as the cause of death and must record the manner of death as "natural." The death is not recorded as a suicide, assisted suicide, or homicide under Vermont law.

Life insurance claims are protected. Most life insurance policies contain a contestability clause that allows the insurer to deny claims if the insured died by suicide within a specified window — often two years from the policy issue date. Because Vermont law explicitly states that Act 39 deaths are not suicide for any legal purpose, these contestability clauses cannot be used to deny a payout to the beneficiary. If an insurer attempts to deny a claim on these grounds, that denial is contrary to Vermont law.

The executor should verify the death certificate. If the decedent utilized Act 39, confirm before submitting the death certificate to any institution that the cause of death is listed as the underlying illness and the manner of death is listed as natural. A certificate that does not conform to this standard can create unnecessary delays or disputes with insurance companies — disputes the law does not require you to have.

After the Death: What the Executor Needs to Do with These Documents

The practical role of advance directives and the COLST form in estate administration is limited — these are medical documents, and their function ends at death. However, three tasks are worth confirming:

• Check the VADR to confirm whether the decedent registered any document that affects the disposition of remains. If so, ensure that the registered wishes are being followed.
• If the decedent used Act 39, verify the death certificate format before using it with any financial institution or insurance company.
• Preserve the original advance directive in the estate records even after the death. It may be relevant if anyone later contests decisions made about the decedent's care, or if a healthcare facility requires confirmation of an agent's authority during the final hospitalization.

The advance directive and COLST questions are typically resolved in the first week after death. The longer-running administrative work — probate, property transfers, tax clearance — extends over the following months.

Getting the Full Estate Administration Sequence in Order

Vermont estate administration involves multiple agencies that most people have never heard of before a family death. The VADR and the COLST system are early-stage concerns; the probate court, the Vermont Department of Taxes, the DMV, and the local town clerk's office all come into play over the weeks and months that follow. The Vermont Estate Settlement Guide provides a chronological checklist that covers the medical directive questions as well as the full administrative sequence that follows — including the state-specific forms, filing fees, and deadlines that Vermont's decentralized system requires.

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