Vermont COLST Form: What It Is and How It Works

Emergency responders arriving at a Vermont home are legally required to begin life-saving treatment — CPR, intubation, defibrillation — unless a valid written medical order tells them not to. A standard advance directive or living will does not qualify. In Vermont, the document that gives emergency responders immediate, portable legal authorization is the COLST form.

Understanding what a COLST is, and what it is not, matters both for people planning their own end-of-life care and for executors who discover one among a decedent's papers.

What COLST Stands For

COLST stands for Clinician Orders for Life-Sustaining Treatment. Vermont uses this term where many other states use POLST (Physician Orders for Life-Sustaining Treatment). The two forms serve the same purpose and share the same national framework, but Vermont's version has specific local requirements. Do not assume that a POLST from another state carries legal weight in Vermont — it does not function as a Vermont COLST.

What a COLST Covers

A COLST is a set of actionable medical orders — not a statement of preferences, but actual physician-signed orders — that address four categories of treatment:

Cardiopulmonary resuscitation (CPR). The COLST specifies whether the patient wants CPR attempted in the event of cardiac or respiratory arrest. If it says "Do Not Attempt Resuscitation," emergency responders must honor that instruction if the form is present and valid.

Medical interventions. The form specifies the extent of medical treatment beyond CPR: full treatment (intensive care, hospitalization, all interventions), limited interventions (hospital care but avoiding intensive care if possible), or comfort-focused care (symptom management and avoiding hospitalization when possible).

Artificial nutrition. The COLST addresses whether the patient consents to long-term tube feeding or IV nutrition if they cannot eat independently.

Antibiotics and other disease-directed treatments. The form documents preferences for treating infections and other conditions when the patient cannot express their wishes.

How a COLST Differs from an Advance Directive

Vermont residents often confuse the COLST with a standard advance directive or healthcare power of attorney. The distinction is important:

An advance directive (also called a living will or healthcare directive) is a legal document expressing a person's general wishes about medical treatment and naming a healthcare agent to make decisions. It requires two witnesses and registration with the Vermont Advance Directive Registry is optional but encouraged. An advance directive does not, by itself, authorize emergency responders to withhold CPR.

A COLST is a physician-signed medical order. It requires a conversation between a clinician and the patient (or their healthcare agent), and the treating clinician must sign it. This is why it has immediate force with emergency responders: it is an actual medical order in the patient's chart, not just a personal statement of wishes. Emergency personnel are trained to look for a COLST form — typically posted on a refrigerator door or kept with other medical papers — and to honor it as they would any physician order.

Who Typically Has a COLST

COLST forms are most relevant for people with serious, chronic, or terminal illness; residents of nursing facilities or assisted living; and patients receiving hospice care. A healthy 50-year-old without significant medical history does not typically have a COLST. An 80-year-old with advanced heart failure, dementia, or a terminal cancer diagnosis very likely does.

The conversation about a COLST is initiated by the treating physician or advanced practice nurse. The patient (or their healthcare agent, if the patient lacks decision-making capacity) participates in the discussion and then either signs the form or has their agent sign it. The clinician countersigns, making it a valid medical order.

What to Do When You Find a COLST Among a Decedent's Papers

If you are settling an estate and discover a COLST among the decedent's papers, it has no ongoing legal effect after death — it governed treatment decisions made while the person was alive. You do not need to file it with the Probate Division. You can keep it with other personal medical records or discard it at your discretion.

However, a COLST found post-death is meaningful for one reason: it tells you that the decedent had documented end-of-life preferences and likely had serious illness planning conversations with their physician. This may indicate:

• The decedent also had an advance directive naming a healthcare agent (look for it in the same folder)
• There may be hospice or palliative care providers who should be notified of the death
• The cause of death may have been a known terminal illness, which can affect how you communicate with insurance companies and creditors

COLST and Vermont's Medical Aid in Dying Law

Vermont is one of only a handful of states with a medical aid in dying law. The COLST and the Patient Choice and Control at End of Life Act (18 V.S.A. Chapter 113) are separate legal instruments — one governs emergency medical interventions, the other permits a terminally ill, mentally capable adult to request a prescription for life-ending medication. They can coexist: a person may have both a COLST limiting resuscitation and a prescription under the Aid in Dying Act. As executor, you need to understand what each document means for the estate administration process, particularly for the death certificate and any insurance claims.

Practical Note for Executors

The most common administrative issue executors face with COLST forms is confusion about whether the form needs to be submitted anywhere during probate. It does not. The COLST is a medical record, not a legal instrument that transfers property or triggers court filings. Your probate obligations begin with the death certificate, the original will (if any), and the petition to open the estate.

For a full chronological checklist of Vermont probate obligations — from the death certificate through the final accounting — see the Vermont Probate Process Guide at /us/vermont/probate/.

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