Vermont Balances ACP Convenience and Safeguards

May 15, 2023
8 min
Dr. Michael Madison, CEO

Recently, the Vermont House of Representatives passed a significant piece of legislation authorizing remote witnessing for advance directives. This move aims to improve accessibility and convenience for individuals seeking to complete their advance directives remotely. However, the same bill introduces additional requirements for a specific provision known as the Ulysses Clause, emphasizing the need for in-person interaction between the principal and the clinician. Let's delve into the implications of this legislation and explore the balance between convenience and the safeguards it offers.

Enhancing Accessibility through Remote Witnessing: The authorization of remote witnessing for advance directives is a positive step forward in providing individuals with greater flexibility and accessibility. With the advancement of technology, remote witnessing allows individuals to complete their advance directives from the comfort of their homes, ensuring their wishes are documented and legally binding. This change acknowledges the need to adapt to modern communication methods while accommodating those who may have limitations in physically attending witness appointments.

The Ulysses Clause and its Unique Safeguards: While remote witnessing is a convenient option, the bill recognizes the exceptional nature of Ulysses Clauses, which allow individuals to express preferences for care that may contradict their current wishes in the future. These clauses require additional safeguards to ensure a thorough understanding of their implications. Consequently, the legislation mandates that the clinician assessing understanding and the individual explaining the Ulysses Clause be physically present together with the principal. This requirement, though potentially inconvenient, aims to ensure clarity, comprehension, and informed decision-making when invoking such exceptional provisions.

Striking the Balance: The inclusion of the in-person requirement for Ulysses Clauses demonstrates the delicate balance between convenience and the need for safeguards in advance care planning. While the additional requirement may add complexity to the process, it acknowledges the gravity of decisions made through a Ulysses Clause. These clauses allow individuals to maintain control over their healthcare, even in situations where their current wishes may not align with their future preferences due to cognitive decline or other circumstances.

Promoting Informed Decision-Making: The legislation encourages individuals to engage in thoughtful discussions with their healthcare providers regarding Ulysses Clauses. These discussions provide an opportunity for the principal to fully comprehend the nature and implications of invoking such provisions. By requiring in-person interaction, the legislation ensures that the individual receives comprehensive explanations, can ask questions, and fully understand the consequences of their choices. This commitment to informed decision-making promotes autonomy and safeguards against the potential misunderstanding or misinterpretation of Ulysses Clauses.

Vermont's legislation to allow remote witnessing for advance directives while maintaining additional safeguards for Ulysses Clauses demonstrates the state's commitment to balancing convenience and ensuring informed decision-making in end-of-life care planning. By embracing technology for remote witnessing, individuals gain greater accessibility and flexibility, while the physical presence requirement for Ulysses Clauses underscores the importance of careful consideration and comprehension in making exceptional provisions. It is through such thoughtful legislation that we can empower individuals to plan for their future healthcare needs while protecting their autonomy and ensuring their wishes are respected.