Advance care directives, like a Living Will and/or a Durable Health Care Power of Attorney, allow others to follow your directions about your health care. They are your “blueprint” for what you do or do not want done in given situations. Advance care directives can provide specific instructions on how to proceed or the information your surrogates need to fulfill your intent. For a directive to be useful and effective, you must discuss your wishes with your primary care physician and close family members, especially the person you want to be in charge of carrying out your wishes. By discussing your wishes, everyone will be on the same page when someone must make a decision for you.
If you have no Living Will, Durable Health Care Power of Attorney, or court-appointed guardian, health care providers will contact the following people (in the order listed) to make health care decisions for you:
- Your spouse, unless you and your spouse are legally separated.
- Your adult child. If you have more than one, health care providers will seek the consent of the majority of the adult children.
- Your parent.
- If you are unmarried, your domestic partner, if no other person has assumed financial responsibility for you.
- Your brother or sister.
- Your close friend.
LIVING WILL VERSUS DURABLE HEALTH CARE POWER OF ATTORNEY
A Living Will gives guidance and direction to others about your wishes, but is not as broadly applicable as a Durable Health Care Power of Attorney. For instance, your stating in a Living Will that you did not want a feeding tube or artificial means of prolonging life does not permit health care providers to stop that form of care. An agent you appoint with a Durable Health Care Power of Attorney, however, may make such decisions.
Some people have both a Living Will and a Durable Health Care Power of Attorney. If you do, and have signed both, you must attach a copy of your Living Will to the Durable Health Care Power of Attorney. Your signature on the Durable Health Care Power of Attorney form does not need to be notarized, but it must be witnessed by someone who is at least 18 years old. The witness can be a close friend, your minister or a teller at your bank, but cannot be family (related by blood, adoption or marriage) – cannot be your appointed representative or in your will to receive part of your estate and cannot be a health care provider.
After preparing the documents, circulate them among your family members so they can discuss them with you and clear up any misunderstanding they may have of your intentions. These discussions can even lead to suggestions you may not have considered.
WHEN SHOULD YOU DRAW UP YOUR PLAN
The best time to draw up an advance care plan is when you are healthy. Anyone 18 or older can draw up a plan. Putting it off until you’re older may not be a good idea. Researchers have found that people who wait until they have an advanced illness tend to avoid end-of-life conversations to conceal their pain and feelings of self-blame, anger loss or fear. Waiting too long may force your relatives to undertake decisions they are unprepared to make. Since many people see death as failure, they may believe that withholding life-prolonging care is “throwing in the towel” when it may be a goal that is important to both the patient and the family.
WHAT SHOULD BE IN YOUR DIRECTIVES
You should specify who will be in charge of your health care when illness or injury prevents you from being involved: a spouse, a parent or a non-relative. You want someone who clearly understands your wishes and is willing to accept the responsibility of making decisions for you. For the reasons stated above, this is best accomplished with a Durable Health Care Power of Attorney form you can download from the Arizona Attorney General’s web site . You do not need a lawyer to fill it out, but an attorney can help answer your questions. You can appoint a second person as your alternate agent in case the first person is unable, unwilling or unavailable to act for you.
Some people may like to include instructions to make them comfortable with pain relieving medications. How specific you wish to be is entirely up to you. Many people would want to ensure that medical care continues as long as there is a probability of survival or recovery. Maintaining a level of aggressive care comes into question when medical intervention prolongs the outcome but does little or nothing to address a rapidly diminishing quality of life. You may leave instructions where you would like to spend your final days. Some people prefer to be at home, rather than in a hospital or hospice.
SOME GENERAL STATEMENTS FOR A LIVING WILL
You can write your own statement concerning life-sustaining treatment and other matters relating to your health care. Here are some options to use as a guide:
If I lose the ability to make or communicate medical decisions on my own behalf, either temporarily or permanently, and I:
- have a terminal condition; or
- am in an irreversible coma or a persistent vegetative state; or
- suffer from severe brain damage or dementia; then
If my condition is temporary, do whatever is necessary to sustain my life. However, I do not want my life to be prolonged and I do not want life-sustaining treatment, beyond comfort care, that would serve only to artificially delay the moment of death. I especially do not want the following:
- cardiopulmonary resuscitation, for example, the use of drugs, electric shock and artificial breathing; or
- artificially administered nutrition and hydration.
Regardless of my condition, I want my life to be prolonged to the greatest extent possible.
WHO SHOULD HAVE COPIES OF YOUR ADVANCE CARE DIRECTIVES
The person you designated to take charge of your health care should have a copy as well as your primary care physician, your family and your attorney. You may even wish to provide a copy to the hospital where you would most likely be treated. You can keep the original in a safe place, like a safety deposit box, but make sure the people who need them have copies.
You can also register your Advance Care Directive with the Arizona Secretary of State . There is no fee to register. The Advance Directive Registry provides a safe and confidential place to store your advance directive where it will be kept in a virtual, online file cabinet. Care providers are able to easily examine your advance directive to determine your wishes. You decide who has access to the information in the registry. No one can look at your Advance Care Directive without your password. If you have further questions, please contact the Office of the Arizona Secretary of State: 602-542-4285 or 800-458-5842, or go to the Arizona Secretary of State web site .
REVIEW YOUR INSTRUCTIONS ANNUALLY
Your decisions concerning your agent or advance care directives may change over time, so you need to review them regularly and make changes where you feel appropriate. If you do update a Living Will or Durable Health Care Power of Attorney, make sure to circulate copies of the revised documents to the people who had the older versions to prevent confusion later. This is especially important if you’ve changed your mind significantly on end-of-life issues.
ADVANCE CARE DIRECTIVES DO NOT APPLY TO EMERGENCY PERSONNEL
Your Arizona documents will not be effective in the event of a medical emergency. Ambulance personnel are required to provide CPR unless they are given a separate order that states otherwise. These orders, commonly called “do not resuscitate” (DNR) orders, are designed for people in poor health who would have little chance of benefiting from CPR. Your physician must sign a DNR that instructs ambulance personnel not to attempt CPR if your heart or breathing should stop.
Notice: The Arizona Medical Board is providing this information only for patient convenience and should not be interpreted as legal advice nor relied upon to properly execute the referenced documents. Readers are encouraged to obtain legal advice to answer any questions.