Title 18: Health
Chapter 231: ADVANCE DIRECTIVES FOR HEALTH CARE AND DISPOSITION OF REMAINS
18 V.S.A. § 9708. Authority and obligations of health care providers, health care facilities, and residential care facilities regarding do-not-resuscitate orders and clinician orders for life sustaining treatment
§ 9708. Authority and obligations of health care providers, health care facilities, and residential care facilities regarding do-not-resuscitate orders and clinician orders for life sustaining treatment
(a) As used in this section, "DNR/COLST" shall mean a do-not-resuscitate order ("DNR") and a clinician order for life sustaining treatment ("COLST") as defined in section 9701 of this title.
(b) A DNR order and a COLST shall be issued on the Department of Health's "Vermont DNR/COLST form" as designated by rule by the Department of Health.
(c) Notwithstanding subsection (b) of this section, health care facilities and residential care facilities may document DNR/COLST orders in the patient's medical record in a facility-specific manner when the patient is in their care.
(d) A DNR order must:
(1) be signed by the patient's clinician;
(2) certify that the clinician has consulted, or made an effort to consult, with the patient, and the patient's agent or guardian, if there is an appointed agent or guardian;
(3) include either:
(A) the name of the patient, agent, guardian, or other individual giving informed consent for the DNR and the individual's relationship to the patient; or
(B) certification that the patient's clinician and one other named clinician have determined that resuscitation would not prevent the imminent death of the patient, should the patient experience cardiopulmonary arrest; and
(4) if the patient is in a health care facility or a residential care facility, certify that the requirements of the facility's DNR protocol required by section 9709 of this title have been met.
(e) A COLST must:
(1) be signed by the patient's clinician;
(2) include the name of the patient, agent, guardian, or other individual giving informed consent for the COLST and the individual's relationship to the patient.
(f) The Department of Health shall adopt by rule no later than July 1, 2014, criteria for individuals who are not the patient, agent, or guardian, but who are giving informed consent for a DNR/COLST order. The rules shall include the following:
(1) other individuals permitted to give informed consent for a DNR/COLST order who shall be a family member of the patient or a person with a known close relationship to the patient;
(2) parameters for how decisions should be made, which shall include at a minimum the protection of a patient's own wishes in the same manner as in section 9711 of this title; and
(3) access to a hospital's internal ethics protocols for use when there is a disagreement over the appropriate person to give informed consent.
(g) A patient's clinician issuing a DNR/COLST order shall:
(1) place a copy of the completed DNR/COLST order in the patient's medical record; and
(2) provide instructions to the patient as to the appropriate means of displaying the DNR/COLST order.
(h) A clinician who issues a DNR order shall authorize issuance of a DNR identification to the patient. Uniform minimum requirements for DNR identification shall be determined by rule by the Department of Health no later than July 1, 2014.
(i) Every health care provider, health care facility, and residential care facility shall honor a DNR/COLST order or a DNR identification unless the provider or facility:
(1) believes in good faith, after consultation with the agent or guardian where possible and appropriate, that:
(A) the patient wishes to have the DNR/COLST order revoked; or
(B) the patient with the DNR identification is not the individual for whom the DNR order was issued; and
(2) documents the basis for the good faith belief in the patient's medical record.
(j) A DNR/COLST order executed prior to July 1, 2011 shall be a valid order if the document complies with the statutory requirements in effect at the time the document was executed or with the provisions of this chapter.
(k) A health care provider shall honor in good faith an out-of-state DNR order, orders for life sustaining treatment, or out-of-state DNR identification if there is no reason to believe that what has been presented is invalid.
( 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.)