Health Care Decisions & Advance Directives: Overview of the Basics

Years ago, people young and old were more likely to die quickly of natural causes than they are today, when medical technology can extend the lives of seriously ill people for long periods of time.

Sometimes, modern technology offers us miraculous results; at other times, the latest therapies and procedures seem only to prolong suffering and the dying process.

Thinking about and planning ahead for emergencies and end-of-life situations when you are in good health gives you and your loved ones the opportunity to prepare for a medical crisis that can happen to anyone at any time.

If you become too sick to make your own choices and have not planned ahead for your medical care, your doctor will need to consult with your family or close friends—or perhaps a guardian—to obtain informed consent for your treatment. The best way to guarantee that your wishes are known and honored is to complete an advance directive and talk to members of your family, close friends and health care providers about your preferences for care and treatment. This will relieve them of the burden of having to guess about what you would want in the event that you are unable to speak for

Vermont Advance Directives Registry (VADR)

We each have the right to make our own healthcare decisions. An advance directive ensures your end of life and other critical healthcare decisions will be honored.

The Vermont Advance Directive Registry is an electronic database that stores advance directive documents and makes them accessible to hospitals or other medical service providers.

What is an Advance Directive?

couple reading a form together

An advance directive is a written document, signed by an individual and two witnesses, that outlines the individual’s wishes for medical treatment in the future when he or she no longer can (or wishes to) make decisions about what to do.

It is what many people think of as a “living will,” or a “durable power of attorney for healthcare.”

What Are the Benefits to Having One?

  • Peace of mind, knowing that your choices are secure and will be available to your family and doctors even if you become ill away from home.
  • The serenity of knowing that you will be able to “speak” to your family and doctors through your Advance Directive about your personal philosophy and help them make the decisions you want without feeling guilt or remorse.
  • The security of confidential, 24 hour access to your choices by hospitals and healthcare providers across the country.

Privacy Statement

The Vermont Advance Directive Registry is sensitive to the privacy of registrants, the confidentiality of their information and the documents stored for them.

The registry will provide identifying information, emergency contact information, and an exact copy of the advance directive, provided by the registrant, to any provider with a valid request that complies with the policies and procedures of the registry.

Information transmitted via the internet to your provider or healthcare facility is encrypted and secure.

Shared Decision Making

Often, decisions about the right course of treatment are straightforward and easy to make. The easiest decisions are those in which everyone agrees on the goal, there is only one standard treatment, the treatment is not risky or burdensome and it reliably produces a good outcome.

But many decisions are not so easy to make. Sometimes there are several options, each with different potential risks and benefits, but none is clearly “best.” Or maybe one treatment is considered medically best, but it is not a cure or it has an uncertain outcome or side effects that may be difficult for the patient to endure.

In these cases, the right course of treatment is the one that is right for the individual patient, considering his or her personal preferences and views of the risks, benefits and burdens of the various options.

Decision-making in such cases requires close collaboration between physician and patient, with the physician using his or her medical expertise to guide the patient’s choice in accordance with the patient’s goals.

Such collaboration is the hallmark of Shared Decision-Making. In the Shared Decision-Making model, the physician shares with the patient all relevant risk and benefit information on all treatment options and the patient shares with the physician all relevant personal information that might make one treatment more appropriate than the others.

Through dialogue, the physician learns how the patient views the risks and benefits of the various options and what issues are most relevant to the patient. He or she then helps the patient think about risks and benefits in terms of the values and preferences the patient has expressed. Together physician and patient use the shared information to come to a mutually acceptable decision.

Shared Decision-Making has been hailed for improving patient comprehension, increasing communication and trust and reducing unwanted medical procedures. It also helps to maintain balance between the physician’s sometimes competing ethical duties to do what is best for the patient (the duty of “beneficence”) while honoring the patient’s right to self-determination (the duty of “autonomy”).

For more information, see:

  1. VEN Newsletter – Fall 2010 Edition
  2. The complete chapter on Shared Decision Making by Dr. Denise Niemira.  Found in Chapter 8 of the Handbook for Rural Ethics: A Practical Guide for Professionals
  3. The Center for Shared Decision-Making at Dartmouth Hitchcock Medical Center.  They offer:
    • One-on-one counseling sessions for any medical condition
    • A Decision Aid Library of helpful videotapes, audiotapes, booklets, CD-ROMs, and websites
    • A Healthcare Decision Guide to help you work through a decision on your own
    • Visit The Center for Shared Decision-Making for more information.

  4. Ottawa Hospital Research Institute's Ottawa Decision Aids
  5. Ottawa Personal Decision Guide – to help people assess their decision-making needs for any health related situation.
  6. The Foundation for Informed Decision Making