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Fall 2019 | Vol. 24, No. 5
VEN Ethics Survey Results

Between July 15 and August 31, 2019 the Vermont Ethics Network conducted a survey of health care settings in Vermont and New Hampshire regarding the clinical ethics questions and/or concerns that arise in their organizations, as well as staff training and/or resource needs that would be beneficial. We heard from 172 individuals from 24 hospitals, 16 home health and hospice agencies, 21 nursing homes, and 15 other organizations. Below are a few of the highlights of what we learned:
Ethics Issues and Frequencies
The following chart summarizes commonly encountered ethics issues and the frequency at which they are experienced by survey respondents:
Top 3 Issues
The graphic below outlines the top 3 ethics issues experienced by respondents as categorized by frequency:
Helpful Ethics Resources
We asked survey respondents to share additional ethics resources that would be helpful in addressing ethical questions or conflicts, and to what extent. They shared the following:
Resources Needed
The top 3 currently unavailable resources identified that would be of the greatest support and help staff address clinical ethics issues more effectively at their organization were:
Opportunities for Improvement
The 3 greatest opportunities identified to improve ethics quality in the organizations surveyed were:
Next Steps
We will be using the information shared in an effort to better resource the individuals, agencies, facilities, and organizations who face these clinical ethics challenges over the next several years. Thank you again to those who participated. We greatly value your input.
Deaths & Hospice Care Report Shows Increased Hospice Care and ICU Deaths in Vermont

The VT Department of Health recently submitted their annual Deaths and Hospice Care Report to the Vermont legislature. A few highlights from this report are:
  • The proportion of Vermont deaths receiving hospice care has increased consistently since 2009, when 27% of deaths reported hospice care. In 2017 and 2018, 46% of deaths received hospice care.
  • The percent of Vermont deaths occurring outside of the hospital setting continues to increase. In 2009, 64% of all Vermont deaths occurred outside of the hospital setting compared to 72% in 2018. Deaths occurring in the decedent’s home have also increased – now comprising nearly half (47%) of all out-of-hospital deaths in Vermont.
  • The number of Vermont deaths occurring in hospice continues to increase, from 116 in 2009 to 293 in 2018. Similarly, those receiving hospice care in the 30 days prior to death has increased in the past 10 years – from 27% in 2009 to 46% in 2018.
Reciprocity of Advance Directives Across New England

VEN often receives questions relative to whether another state will honor a Vermont advance directive. Below is a quick guide to reciprocity information for other New England states:

  • Connecticut: Considered valid as long as it was executed under the laws of another state in compliance with the laws of that state (provided they are not contrary to the public policy of Connecticut). Learn more.
  • Maine: Considered valid as long as it was valid under the laws in the state where it was executed. Learn more.
  • Massachusetts: Enforceable if executed in another state in compliance with the law of that state (provided that it is not contrary to the moral or religious views of the physician to carry out a treatment or to a formally adopted policy of a private facility that is expressly based on religious beliefs). Learn more.
  • New Hampshire: Considered valid as long as it was valid under the laws in the state where it was executed. Learn more.
  • Rhode Island: Considered valid as long as it was valid under the laws in the state where it was executed. Learn more.
Upcoming Events

Thursday, December 5, 8am – 5pm
Essex Spa and Resort, 70 Essex Way, Essex, VT
Effective, empathic, and honest conversations between clinicians, patients, and families are the cornerstones of patient- and family-centered care. TalkVermont: Late Goals of Care is a one-day interactive course based on the national Vital Talk program, designed for practitioners who lead serious illness conversations (physicians, advanced practice nurses, physician assistants, social workers, nurses, and chaplains) with patients and families. Learn more and register.

Friday, November 15, 1pm - 2pm
Hosted by Vermont Association of Area Agencies on Aging (V4A)
Facilitated by Cindy Bruzzese, MPA, MSB and Zail Berry, MD, MPH
Learn how advance care planning changes for persons with dementia or Alzheimer's. People with advancing dementia lose the ability to make decisions for themselves and their loved ones will need to make medical decisions for them at some point. Learn more and register.

National Healthcare Decisions Day 2020
We hope to have a statewide showing for National Healthcare Decisions Day in 2020 (April 16), similar to last year. Our Vermont Advance Care Planning Champions group, which includes practitioners from across the state, has begun this planning effort and hopes to have broad participation. If you are involved in championing advance care planning work in your region or organization and are not already on the list to receive notices of our bi-monthly call of this group, please contact Sarah Brown.
HEALTH DECISIONS is a publication of the Vermont Ethics Network.

The mission of the Vermont Ethics Network is to advance ethics in health care.
Board of Directors
E. Tobias Balivet, Esq.
George K. Belcher, JD
Linda Cohen, JD, MHCDS
Kier Olsen DeVries, MA
Shaden Eldakar-Hein, MD, MS
Linda Hurley, RN, MS
Alden Launer, MDiv
Peg Maffitt
Madeleine Mongan, Esq.
Hilary Ryder, MD
John Saroyan, MD, FAAP
Cindy Bruzzese, MPA, MSB
Executive Director and Clinical Ethicist

Catrina Brackett
Executive Admin/Bookkeeper

Honorary Board Members
James L. Bernat, MD
Michelle Champoux, LICSW
Jean Mallary, RN
Robert Macauley, MD