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Advance Directives can be short, simple statements expressing your values
and choices.
“Legal
documents that express our wishes are not enough to prepare us for
our final days. We must talk honestly with our loved ones, our clergy
and our doctors and nurses about the choices we would make if confronted
with a chronic or terminal illness.”
- Rosalynn Carter
ABOUT HEALTH CARE DECISIONS
1. What is an Advance Directive?
An Advance Directive is a document in which
you give instructions about your health care, what you want done or not
done, if you can’t
speak for yourself.
2. What is a Health Care Directive?
A Health
Care Directive is a type of Advance Directive that tells your doctor
and your family
members what kind of care you would like to have if you become
unable to make medical decisions. It’s called an “advance directive” because
you choose your medical care before you become seriously ill.
3. What is a Living Will?
A Living Will is
one form of Advance Directive. It usually only comes into effect if
you are terminally ill. Being terminally ill generally means that you
have less than six months to live. 4.
What is a Health Care (Medical) Power of Attorney?
A Health Care (Medical)
Power of Attorney lets you name someone to make medical decisions
for you if you are unconscious or unable to make medical decisions
for yourself for any reason. A Health Care (Medical) Power of Attorney
can be part of another advance directive form, such as a Health Care
Directive or Living Will, or may be a separate document. The person
you appoint to make decisions for you when you cannot is called an “agent.”
5. Does an agent
appointed in a Health Care (Medical) Power of Attorney need
to be a resident of the state in which you live?
No, but they need to
be available if a medical crisis occurs.
6.
What training does a person need to become a Health Care
(Medical) Power of Attorney?
None. Your Health Care (Medical) Power
of Attorney is not a medically trained person. The person you appoint
as your Health Care (Medical) Power of Attorney is a person close
to you that you can talk to about your values and feelings.
Make sure that the person you appoint is willing to assume
the responsibility of being your representative.
7. Can an Advance Directive and a Health Care (Medical)
Power of Attorney be combined into one document?
Yes, they often are.
8. What authority does a Financial or Durable Power
of Attorney have to make health care
decisions?
None. 9. When does an Advance Directive or Health Care
(Medical) Power of Attorney become
effective?
An Advance Directive, including a Health
Care (Medical) Power of Attorney, has no legal effect unless
and until you lack the capacity to make health care decisions
or to give consent for care. Neither the appointed Health
Care (Medical) Power of Attorney, nor a written instruction
can override your currently expressed choice.
10. Must physicians
honor Living Wills, Advance Directives, and a health care surrogate’s
decisions?
Yes, doctors and other health care
providers are legally obligated to follow your Advance
Directive. 11. What
happens if I do not have an Advance Directive?
If you
do not have an advance directive and you cannot make health care
decisions, Arizona law gives decision-making power to default decision-makers
or “surrogates.” These surrogates, who are primarily family
members, can make most health care decisions.
The order of people authorized to make health care decisions is:
1. Guardian
2. Health Care (Medical) Power of Attorney
3. Surrogate
a. The patient’s spouse, unless legally
separated
b. An adult child of the patient, or a majority of adult children
c. A parent of the patient
d. The patient’s domestic partner if the patient is unmarried
e. A brother or sister of the patient
f. A close friend of the patient.
g. If none of the above can be located, the attending physician,
after consulting with an ethics committee. If unavailable,
the physician may make these decisions after consulting with
a second physician.
12. Is a “surrogate” decision-maker
the same as a Health Care (Medical) Power of Attorney? In Arizona, if you do not appoint a Health Care
(Medical) Power of Attorney, a surrogate decision-maker can make most
medical decisions for you. However, a surrogate
decision-maker cannot decide to remove artificial nutrition that has
been started. Legally, only the person, a Health Care
(Medical) Power of Attorney or a Guardian can authorize stopping artificial
nutrition. The decision to withhold or withdraw any other treatment
can be made by any surrogate.
13. What is a Pre-Hospital
Directive (sometimes called an Orange Form)? Emergency medical service
personnel (or “911” responders)
are generally required to resuscitate and stabilize patients until
they are brought safely to a hospital. If needed, you may receive
cardiopulmonary resuscitation (CPR), which is
treatment to try to restart a person’s
breathing or heartbeat. CPR may be done by pushing
on the chest, by putting a tube down the throat
or by shocking the heart in an attempt to restart
it.
If you do not wish to have cardiopulmonary resuscitation (CPR) if
your heart stops or if you stop breathing, you must complete a special
Advance Directive document called a “Pre-Hospital
Directive.”
14. What is special about a Pre-Hospital Directive
(Orange Form)?
This document must be printed on bright orange
paper and states that you do not want
cardiopulmonary resuscitation (CPR) to restart your heart or breathing.
The Pre-Hospital Directive must be signed by you and must be
signed by either your
physician or other health care provider.
15. If I complete a Pre-Hospital Directive do I
need any other Advance Directive?
Yes. The Pre-Hospital Directive has
a limited role.
The Pre-Hospital Directive is only effective outside of a health
care institution (at home and in the
community); it is not effective in the hospital or other
health care institution.
16. Do I need a lawyer to complete an Advance Directive?
No. You do
not need a lawyer to make an Advance Directive.
17. Do I need to use a special form?
You
do not have to use a specific form. Although there is a sample form
in Arizona law, you may use any form, as long as it is conforms to
the law and is properly witnessed.
18.
Must a Health Care (Medical) Power of Attorney or Advance Directive
be notarized?
In Arizona these documents may be either witnessed
or notarized. The witness must know that you signed freely and had
the capacity to understand what you were doing. The witness may not
be the individual you have named as your agent, someone related to
you by blood marriage or adoption, someone who will benefit from your
estate, or your healthcare provider. Some states require notarization.
If you plan to travel out of Arizona, it is recommended that you have
these documents notarized when you sign them.
If you have completed an Advance Directive,
you still remain in control of your health care decisions as long as
you are able to communicate your wishes. By expressing your wishes
in advance, you help family and friends who might otherwise struggle
to decide on their own what you want done.
19. Are Advance Directives written
in other states valid in Arizona?
Yes, if they conform to the law of
the state in which they were prepared and to Arizona law. Witnessing
requirements may vary from state to state.
20. Who should get a copy
of my Advance Directive and Health Care (Medical) Power of Attorney?
You or your agent should keep the original documents at home (not
in a safe deposit box). Give copies to your physician(s), family
members and anyone else you want to know about your wishes. Give
a copy to other health care personnel, at the Emergency Room, Outpatient
Clinic, or Hospital.
21. What if I change my mind, or want
to change my Directive?
You can cancel or change any Advance
Directive by telling your agent or health care provider in writing
of your decision to do so. Destroying all copies of the old one and
creating a new one is the best way. Make sure you give a copy of the
new one to your physician and anyone else who received the old one.
The most recent directive is the legally binding one.
22. What if I don’t
have time to change my Directive in writing?
If you do not have
time to put your changes in writing, you can make them known verbally.
Tell your doctor and any family or friends present exactly what you
want to happen. Wishes that are made in person will be followed in
place of the ones made earlier in writing. Be sure your instructions
are clearly understood by everyone you have told.
23. What is a Mental Health Care Power
of Attorney?
A Mental Health Care Power of Attorney
is a document that lets you name someone to make
decisions for you related to your mental health if you are
unable to make those decisions for yourself.
24. What is special
about a Mental Health Care Power of Attorney?
Only a Mental
Health Care Power of Attorney, or a guardian appointed by the court,
can authorize your admission to a mental health care facility for
treatment of mental illness (including dementia with behavioral problems)
without your consent.
Talk to your family, friends, neighbors,
clergy, and doctors. Let them know what you have decided, what your
values and preferences are, and what you do and do not want when you
cannot speak for yourself.
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