A Guide to Advance Care Planning in the Age of COVID-19

Below is a reprint of an article that we ran in the Times-Argus on Saturday, April 11. National Healthcare Decisions Day is Thursday, April 16. It’s a day devoted to helping people think about their healthcare wishes.

Under normal circumstances, we would say that there is no better time than  right now to start on your advance care planning journey. These days, it’s more important than ever to do what you can to put your advance care plan in place. We checked in with two local experts, Howard Hoffman, Medical Social Worker at Central Vermont Home Health & Hospice (CVHHH) and Cindy Bruzzese, Clinical Ethicist and Executive Director of the Vermont Ethics Network, for their tips for navigating advance care planning in the age of COVID-19.

According to Cindy, the time to think about advance care planning is when you are healthy and before a medical emergency or health crisis happens. Howard concurs, adding that the best way to ensure that your wishes are honored is to talk with those closest to you about what matters most. The outcome of these conversations can serve as an advance care plan, which functions like a guide to help others know what your priorities are if you are unable to speak for yourself.

“Get talking,” says Cindy. Governor Phil Scott’s Stay Home, Stay Safe order, it’s easier than ever to talk to your family and friends. “Talk about your hopes and fears for the future. Share what you want your doctor to know so that they are better able to provide care that aligns with your personal goals and health priorities.” Some questions to discuss are, What are your goals if your health declines? Are there situations you would like to avoid? What does a good day look like? What matters most? Howard asks his clients these questions to develop plans now that feel right the future. While you’re at it, Cindy says to review your old documents and make sure they still reflect what important to you.

With social distancing in place, signing and witnessing documents, such as the appointment of a health care agent or advance directive forms, in accordance with Vermont’s law can be a challenge. Cindy says that even with these limitations, your wishes still matter. “While you may not be able to sign and witness a document in accordance with the “letter of the law”, what you write down is in keeping with the “spirit of the law” and your right to be self-determining. Ethical obligations exist regardless of the legality of the document. Documents created right now, while we are doing the best we can, still carry “moral weight” and would be considered in decision-making if that becomes necessary.”

Howard says that before the pandemic, most of his clients said they knew something about advance care planning and had taken some steps. A small portion had done nothing. “In response to COVID-19, people have moved inward,” he says. “They are taking care of themselves, staying safe, and isolating.” He says that if you can catch a breath and think about your advance care plan, you free yourself up to be fully supported emotionally if you were to fall ill. Cindy acknowledges that these are stressful and uncertain times. “We can’t control what will happen if we become sick with COVID-19. We can control who will make decisions for us and ensure that our health care providers know what matters if we do become ill. There can be peace of mind in knowing you have a plan.”

Additional Resources

The Vermont Ethics Network has a number of resources for community members, including videos, on its website. You can also find all of the advance-care planning forms you’ll need on the Vermont Ethics Network website.