January 2022

2022 Palliative Care Task Force Legislative Report Released

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In partnership with the Palliative Care and Pain Management Task, the Vermont Ethics Network has released the 2022 Palliative Care Task Force Report to the Vermont Legislature. The Palliative Care Task Force was created in 2009 with a goal of coordinating palliative care initiatives across the state, providing ongoing education to health care clinicians and consumers about palliative and end-of-life care, as well as ensuring access to those services when needed. Additionally, when barriers to access or gaps in services are identified, it was intended that the Task Force would make the legislature aware of such issues and, where appropriate, propose solutions.

This year, the report supports two legislative actions. The first, an extension of remote witnessing provisions for advance directives. The provision was initially passed in 2020 to allow advance directives to be completed while respecting physical distancing recommendations due to COVID-19 and remains an essential option for individuals seeking to complete their advance directive documents while maintaining their physical safety. With the existing provision due to sunset in June 2022, the Task Force recommends an extension of at least one year and consideration of making the provision permanent.

The second recommendation is in support of the changes to Vermont’s medical aid in dying law as proposed in bill S.74. This bill would enable telemedicine access to medical aid in dying and extend protections to health professionals that are not currently granted immunity under the existing law. “At present, Vermont’s law only provides explicit immunity for the prescribing physician, leaving the liability protections for other professionals (i.e. pharmacists, certifying second physician, etc.) necessarily involved in the process unclear” (2022 Report, page 2). These updates to Vermont’s law would be consistent with other states that have made medical aid in dying a legally available option and remove unnecessary barriers to access.

To learn more about this year's recommendations and the work that the Task Force does for Vermonters, read the full report on our website.

Read the Task Force Report

For further reading on the topic of medical aid in dying in Vermont, the 2022 Vermont Department of Health Report Concerning Patient Choice at the End of Life is also available on the VEN website. The report summarizes Vermont data on medical aid in dying since the passage of Act 39 in 2013.

Read the Dept. of Health Report

Healthcare Workers Battle Burnout

COVID surges, new variants and national debate over vaccine mandates have taken a serious toll on healthcare workers, with many wondering how much longer they can keep their heads above water. Now, hospitals and health systems must battle to protect the mental health of their staff and the health of communities. VEN recognizes the importance of caring for those who care for us and would like to spotlight some recent articles on the topic.

Further Reading:

Making Updates to Advance Directives:

Which Option is Right For Me?

When was the last time you looked at your advance directive? If the answer is "never", or, "it's been a few years", then now is the perfect time to review and ensure that the document is still accurate. Advance directives provide critical information about your health care goals and wishes to your doctors and family members in the event that you cannot speak for yourself. Many of us have completed advance directives and registered copies with the Vermont Advance Directive Registry, but have not reviewed our documents in many years.


If you have reviewed your directive, you may have found that some your goals, values and wishes have changed. If this the case, then it is time to update your advance directive. Depending on the number and nature of the changes, there are some options for how to update your directive.

Completing a New Advance Directive

This is recommended for updating most directives as it ensures physicians and health care agents have access to the most current information in one document. Consider completing a new directive if:

  • You would like to make changes in multiple sections of your directive.
  • You have received significant new medical information that will impact your future care.

While you may be copying over some information from past documents to complete the new directive, this will ensure that all of your wishes are accurately reflected, and legally signed and witnessed.

Creating an Addendum or Amendment

This is an option if you are changing only a few selections in your directive or looking to add details about a particular medical circumstance. Consider an amendment if:

  • Changing only your health care agent
  • Adding COVID-19 Addendums
  • Adding Dementia Directives

An amendment or addendum is used to add information or revise a small part of your existing directive. They are designed to be attached to an existing directive and used alongside the directive. Signing and witnessing is required on all addendums/ amendments. The best practices for completing an amendment are explained below.

Find the Best Form for You:

Visit the VEN website to browse available forms and download the best form for you.

Browse Forms

Top Tips for Completing an Advance Directive Form

With so many options available, it can be difficult to decide what information to include. Here are some questions to think about when completing your next advance directive.

  1. Who would you trust to make decisions about your health care if something sudden or unexpected happened?
  2. What abilities are so critical to your life that you cannot imagine living without them?
  3. If you became ill, how much would you be willing to go through for the possibility of gaining more time?
  4. What does your family need to know about your health care priorities to best guide your health care team?
  5. What are your biggest fears and worries about the future with your health?
  6. What are your most important goals if your health situation worsens?

The VEN website has many useful tools for Advance Care Planning (ACP). Browse our resources using the link below.

Browse ACP Resouces

What is the VADR?

Read more about the Vermont Advance Directive Registry in our 2021 Guide to using the VT Advance Directive Registry.

Read the VADR Guide

Making an Amendment to your Advance Directive:

There is no specific form for amendments, but the Appointment of a Health Care Agent form is often used when making changes to health care agents. If you are revising a different section of the directive, a written letter is often preferred.

Whatever method you choose, ensure that the following is included:

  • Your full name, date of birth, and the date of the amendment/addendum on all pages.
  • A description of the changes being made.
  • Language that references your previous advance directive. VEN recommends "See attached Advance Directive document dated ‘X/X/XX’. The preferences and priorities therein still reflect my current wishes”(or something to this effect).
  • Your signature, and the signatures of two adult witnesses. (Note that witnesses cannot be your appointed health care agent(s), spouse, children, siblings, parents or grandchildren.)

When submitting your documents to the Vermont Advance Directive Registry (VADR), include a copy of your original Advance Directive along with your amendment/addendum and Authorization to Change forms.


When completing the VADR Authorization to Change form, complete the Required Registrant Information on page 1 and Document B: Authorization to Change on page 2. When selecting options for the type of change, check the box for “Amend” to ensure that your existing documents remain on file.


Documents can be submitted to the VADR via mail, fax, or email at the address below.

Vermont Advance Directive Registry

PO Box 2789

Westfield, NJ 07091-2789

Fax: 1-908-645-1919

Email: VADRSubmissions@uslwr.com

Completed updates must also be distributed to anyone with a copy of the previous directive. This likely includes primary care physicians, the local hospital, family members. Keep any original documents for your records.

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In case you missed it...

Throughout the fall of 2021, the Vermont Ethics Network hosted a 5-week Virtual Ethics Education Series via Zoom. In each of these 75-minute sessions, presenters and participants dove into ethically complex cases and questions to expand their knowledge of bioethics. Recordings of all five presentations are now available on the VEN website.

Featured Presentations Include:

  • Tangled Terminology: Avoiding the Ethical Pitfalls of Misnomers in Decision-making Language - Cynthia Bruzzese, MPA, MSB, HEC-C
  • Exceptions to the Rule: When Minors Get to Make Their Own Medical Decisions - Bob Macauley, MD, FAAP, FAAHPM, HEC-C
  • Determining Capacity on the Frontlines - Evie Marcolini, MD, FAAEM, FACEP, FCCM
  • What I Hate About Advance Directives: A Panel Discussion - Linda Hurley, MS, RN & Belle Matheson, APRN
  • Let's Talk Refusals - Sally Bliss, RN, MSB, HEC-C ; Erika Smart, JD and Stas Amato, MD
Watch the Series

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

Geraldine Amori, PhD, ARM, CPHRM, DFASHRM

E. Tobias Balivet, JD

Linda Cohen, JD, MHCDS

Linda Hurley, RN, MS

Evie Marcolini, MD, FAAEM, FACEP, FCCM

Peg Maffitt

Kier Olsen DeVries, MA

Zail Berry, MD, MPH, FACP

Michelle Tavares, MSN, RN-BC


Cindy Bruzzese, MPA, MSB, HEC-C

Executive Director and Clinical Ethicist

Taylor Murray

Advance Care Planning Program Manager

Joshua Hayes-High

Executive Assistant & Office Manager

Honorary Board Members

James L. Bernat, MD

Michelle Champoux, LICSW

Jean Mallary, RN

Robert Macauley, MD