Vermont Healthcare Proxy: Advance Directives, COLST, and DNR Orders

Vermont has three overlapping documents that control what happens if you can't speak for yourself during a medical crisis: an advance directive (which includes your healthcare proxy designation), a COLST form, and a DNR order. Each serves a different purpose at a different stage, and confusing them — or completing only one — leaves gaps that can result in medical treatment you never wanted.

The Advance Directive: Your Foundation Document

Vermont's advance directive is a single document that combines two functions:

1. Healthcare proxy designation — you name a person (your "agent") who has the legal authority to make medical decisions on your behalf if you become incapacitated
2. Living will — you state your preferences for end-of-life care, including whether you want life-sustaining treatment if you're terminally ill or permanently unconscious

You complete this document yourself — no doctor's involvement is required. It must be signed and witnessed by two adults, and it takes effect only when a physician determines you lack the capacity to make your own medical decisions.

Registering with VADR

The Vermont Advance Directive Registry (VADR) is a free, secure digital registry maintained by the state. After completing your advance directive, you can register it so that hospitals, clinics, and emergency departments across Vermont can access your documented wishes electronically.

Registration is optional but strongly recommended. If you're brought to an emergency room unconscious, the treating physician can pull up your directive from VADR rather than relying on your family to produce a paper copy. You can register online, and you can update or revoke your directive through the registry at any time.

COLST: The Medical Order That Travels With You

The Clinician Orders for Life-Sustaining Treatment (COLST) is Vermont's version of what most states call POLST. It's fundamentally different from an advance directive in one critical way: a COLST is a medical order, not a planning document. It must be signed by a licensed clinician (MD, DO, PA, or APRN) based on a conversation about your current medical condition and treatment goals.

A COLST gives emergency medical technicians immediate, actionable instructions. It covers:

• Whether to attempt CPR
• Whether to use mechanical ventilation
• Whether to transfer to a hospital or provide comfort measures only
• Whether to provide antibiotics, IV fluids, or artificial nutrition

When You Need a COLST

A COLST is appropriate when you have a serious illness, advanced frailty, or any condition where a medical crisis requiring emergency intervention is realistically possible. It's most commonly used by:

• People with terminal diagnoses
• Nursing home and assisted living residents
• People with advanced dementia or progressive neurological conditions
• Frail elderly individuals who want to ensure their wishes about CPR and hospitalization are followed

The original COLST form should be kept on your refrigerator — this is where first responders are trained to look for it. Photocopies are legally valid in Vermont.

COLST vs. Advance Directive: The Key Difference

Your advance directive tells your healthcare proxy what you would want — it's a guide for someone else to interpret. A COLST tells emergency responders what to do right now — it's a direct medical order.

You need both. The advance directive covers the broad range of future medical decisions your proxy might face. The COLST handles the specific, time-critical interventions that EMTs must decide in minutes.

DNR Orders

A Do Not Resuscitate order is one component of the COLST form — specifically, the instruction not to attempt CPR if your heart stops or you stop breathing. In Vermont, a standalone DNR order can be indicated by wearing approved DNR identification jewelry (a bracelet or necklace), which EMTs are trained to check before beginning resuscitation.

A DNR order does not mean "do not treat." It applies only to cardiac or respiratory arrest. You can have a DNR order and still receive antibiotics, pain management, hospitalization, and all other medical treatments.

Special Rules for Court-Appointed Guardians

If a probate court has appointed a guardian for an incapacitated person, the guardian must obtain court approval before consenting to a COLST on the ward's behalf. This is an additional legal step that family guardians often don't realize is required — signing a COLST without court authorization could expose the guardian to legal liability.

Putting It All Together

For a complete healthcare planning setup in Vermont:

1. Complete your advance directive naming a healthcare proxy and stating your treatment preferences
2. Register it with VADR for electronic access statewide
3. Give copies to your proxy, primary care physician, and local hospital
4. If you have a serious medical condition, talk to your clinician about completing a COLST
5. Keep the original COLST on your refrigerator
6. Consider approved DNR identification jewelry if you have a DNR component in your COLST

The Vermont Basic Estate Planning Kit includes the advance directive template, VADR registration instructions, and a guide to understanding when a COLST conversation is appropriate — integrated with your will, power of attorney, and property transfer planning.

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