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Advance Directives
What are advance directives?
Advance directives are documents that outline what healthcare and treatment decisions should be made if you are unable to communicate these wishes.
In Arizona, there are four types of documents that fall under this category:
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Living Will
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Healthcare Power of Attorney
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Mental Healthcare Power of Attorney
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Pre-Hospital Medical Care Directive – Do Not Resuscitate (DNR)
What is a living will?
A living will is a document that outlines, in writing, your wishes regarding medical treatment in the event you are not able to communicate directly with your healthcare providers.
Your living will can also help guide your designated healthcare power of attorney (if you have elected one).
What can my health care power of attorney (HCPOA) do?
Your HCPOA can make medical decisions if you are not able to make them for yourself.
The HCPOA can discuss treatment options with your doctor and decide on the course of treatment. Your HCPOA only goes into effect when your physician states that you are incapacitated, or you are unable to speak for yourself. Additionally, you can revoke or change your document at any time before your physician declares you are incapacitated.
Who should I choose for my agent/proxy?
It is imperative to choose someone you trust (who is over the age of 18), and feel will be comfortable carrying out and communicating your wishes.
Another factor to consider is how available this person will be to your healthcare team. It is crucial you have a conversation with the individual you are choosing, before finalizing the documents, so you can discuss their role as your agent, along with your treatment and care preferences.
If you have not documented your preferences for a healthcare agent, the healthcare team will turn to your legal next of kin (AZ Surrogate Decision Maker Law) in an emergency, who may not be the person you would have wanted to represent you. Your closest friend or significant other will not be among your legal next of kin and will not have any say in your care unless they are designated on the legal healthcare power of attorney document.
Isn’t it better to have more than one healthcare agent/proxy?
Experts recommend you name one person to make the decisions and then have an alternate if that person cannot communicate your healthcare decisions.
If you name two people, they may disagree, which can make them ineffective advocates for your choices and confuse or slow down the process, making it possible that your decisions are not honored.
I do not have a mental illness, so why would I need a mental healthcare power of attorney (MHPOA)?
A mental healthcare power of attorney or MHPOA in Arizona will allow your chosen agent to make decisions for you regarding behavioral health placement and mental health treatment if you no longer have the capacity to do so due to mental or physical illness.
This can occur for reasons outside a mental illness, such as dementia, Alzheimer’s disease or even a medication interaction. It is an important document to consider as part of your advance care planning.
Who should complete advance directives?
Advance care planning is for EVERYONE.
You cannot predict how and when you will become seriously ill or injured. While your healthcare and power of attorney choices will likely change over time, you can amend your documents as often as you wish.
All people over the age of 18 should complete some advance care planning.
What if I change my mind?
That’s okay. You can always update your documents.
We all experience changes throughout our lifetime. Changes in relationships, where we live and changes in our health status. Consider reviewing and updating your advance care planning documents regularly to be sure they still reflect your wishes. People should use “The Five Ds” to remind us when to review our advance directives:
- Death
- Divorce (or change in relationship status)
- Decline
- Diagnosis
- Decade
After updating your documents, destroy all previous copies. Notify your healthcare power of attorney, family and healthcare team of the changes and provide them with the updated forms. To keep track of who has these documents, you can list who has a copy on the back of your original document.
Do I need an attorney to complete an advance directive forms?
No, you do not need an attorney to complete your advance directives in Arizona.
The forms are available for free on several websites and many resources exist to assist you should you have questions. You can speak with your healthcare team, social service case manager or a member of the clergy in your faith community about completing an advance directive. If you are working with an attorney to complete an estate plan, they can also assist you with completing these documents.
My family knows my wishes, so why do I have to write them down?
While thinking about and planning for what you would want when your health status becomes critical can be difficult, documenting these wishes can ensure that your choices are honored if you are not able to communicate them.
Putting them in writing provides clear instructions and gives your family peace of mind that they are representing your choices accurately. These documents also minimize the chance that family members will disagree about what choices to make, which can have a future impact on relationships.
What is a pre-hospital medical care directive (DNR – Do Not Resuscitate)?
A pre-hospital medical care directive is a document signed by you and your licensed healthcare provider that informs emergency personnel not to use means to resuscitate you. Sometimes this is called a DNR – Do Not Resuscitate.
If you have this form, emergency medical technicians (EMTs), hospital or other emergency personnel will not use equipment, drugs or devices to restart your heart or breathing, but they will not withhold other medical interventions that are necessary to provide comfort, care or to alleviate pain.
What is a POLST?
POLST is a portable medical order that helps people who are seriously ill or frail receive treatments they want and avoid treatments they do not want to receive.
POLST is part of advance care planning but is different than an advance directive. POLST is only for people who are at risk for a life-threatening clinical event because they have a serious life-limiting medical condition, which may include advanced frailty.
Before the healthcare provider can complete the POLST form, they must have a conversation with the person about their medical condition, what is likely to happen in the future, their goals of care and treatment options they want or don’t want. POLST forms tell other providers what care and treatments the person wants. During a medical emergency, if the person can talk, healthcare providers will talk to them about the care they want. POLST forms are used only when the person cannot communicate and needs medical care. POLST is always voluntary, and the seriously ill person must sign the POLST form with the healthcare provider for it to be valid.
Are the materials available in Spanish and other languages?
The Arizona Attorney General’s Life Care Planning packet is available in Spanish from the Secretary of State.
You can download a copy here: https://www.azag.gov/sites/default/files/docs/seniors/life-care/2020/sp/Complete_Spanish_LCP.pdf.
Where can I find free Arizona advance directive forms?
You can get copies of the Life Care Planning Packet and the individual forms on the Attorney General’s Website or by calling the Community Outreach and Education Section at 602-542-2123.
If I do not fill out advance directive forms, who will make medical decisions for me if I am unable?
If I do not fill out advance directive forms, who will make medical decisions for me if I am unable?
If you did not leave a Healthcare Power of Attorney and there is no court-appointed
guardian, healthcare providers will contact the following people, in this order, who will have the authority to make healthcare decisions for you.
These people are called “surrogates”:
- Your spouse, unless you and your spouse are legally separated.
- Your adult child. If there is more than one adult child, the healthcare providers will seek the consent of a majority of the children who are available for consultation.
- Your parent.
- Your domestic partner if no other person has assumed any financial responsibility for you.
- Your brother or sister.
- Your close friend.
Should I complete a Do Not Resuscitate "DNR" Form?
If you are healthy and strong, you may not wish to complete a DNR.
You can express your wishes about how you want to be cared for should you become seriously ill without completing a DNR. DNRs are most appropriate for people who would probably not do well with CPR (cardiopulmonary resuscitation) because they are very sick, terminally ill or otherwise extremely weak. In any case, you will need to discuss the DNR with your doctor, who will also need to sign the form.
At what age should I begin to think about completing advance directives?
Now, so long as you are at least 18 years of age. It is never too early to be prepared.
Can advance directive documents be used in other states?
Each state has its own guidelines for how advance directives from other states can be utilized.
For Arizona, advance directive documents that are prepared in another state, district, or territory of the U.S., based on that region’s guidelines, can be valid in Arizona. If there are treatment options outlined in another state document that do not meet Arizona healthcare laws, they would not be honored in Arizona. For example, a Utah advance directive form that outlines the death with dignity process is not able to be honored in Arizona, as it is not a legal medical process in the state of Arizona.
If you have Arizona advance directives, you will need to check with the Attorney General’s office in the other state to find out if they accept Arizona’s documents.
The Registry
Is the use of the AzHDR free to individual consumers?
Yes, there is no fee for consumers to register their advance directives in the Arizona Healthcare Directives Registry (AzHDR).
Does a person need to submit advance directives to the registry through an organization or provider or can the individual consumer submit documents to the register themselves?
Consumers can submit documents directly to the registry without it passing through a subscriber organization.
Some documents are dated and expire. Will patients be notified to update their documents?
Advance directive documents do not have an expiration date.
An in-hospital DNR document or medical order that is used during a hospital stay may expire, but those are not considered advance directives in Arizona, but instead are considered medical orders, so they are not accepted into the AzHDR.
Can accounts or information ever be removed from the registry?
Registrants can opt out of their AzHDR accounts by sending in a completed and signed/notarized Registration Agreement that requests to remove access to their account from the registry.
Once received, the AzHDR account will no longer be available for viewing by subscribers or the registrant. If a registrant chose to have their documents viewable in the AzHDR, they would need to begin the process again by completing a new Registration Agreement and sending in their advance directive documents.
General
Why did the Arizona Advance Directives Registry move from the Secretary of State’s office to Contexture?
During the 2019 legislative session, Arizona Senate Bill 1352 was passed, giving healthcare providers the ability to have real-time access to patients’ healthcare wishes as documented in their advance directives.
The bill enhances provider access to advance directives by granting the move of the registry from its former location with the Secretary of State’s office to the Arizona health information exchange (HIE), operated by Contexture. The HIE was chosen due to the recognition that sensitive health information was already being managed by this entity in Arizona.
What is Contexture?
Contexture (the umbrella organization for Health Current) operates the Arizona health information exchange (HIE), Arizona’s primary resource for information technology and data exchange, integrating information with the delivery of care to improve the health and well-being of individuals and communities. Contexture also operates Colorado’s largest HIE, making it the leading health information organization in the Western region.
Since 2007, we’ve worked to become Arizona’s primary resource for information technology and exchange, integrating information with the delivery of care to improve the health and well-being of individuals and communities. And now, Health Current is the new home for the Arizona Healthcare Directives Registry.
Since the Arizona Secretary of State is no longer accepting advance directives, now how do I register my advance directives in the state of Arizona?
The Arizona Secretary of State’s office finalized the transfer of currently registered advance directive documents to the new Arizona Healthcare Directives Registry (AzHDR) with Contexture in 2021.
During that interim period, any new documents that were sent to the Secretary of State’s office were forwarded to Contexture where they were reviewed and processed. Registrants who had documents with the Secretary of State received a letter in the mail with instructions on how to set up their new AzHDR account and access their documents in the new registry.
When advance directive documents are sent to Contexture, the consumer owner will receive a letter by mail with information about the AzHDR, access to log into the system for the first time to set up a new account and details about any actions that may be needed on their advance directives. If corrective actions are required on any document, you will be able to make them online within the system or via postal mail.
In the meantime, individuals should continue to share copies of their advance directives with their healthcare providers and those people chosen to make healthcare decisions for them.
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