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What if:
- You are in an accident and end up in a permanent coma (or unconscious state)?
- You become terminally ill?
- You suffer from permanent brain damage?
Should your family members keep your body alive for as long as possible? Or allow you to die naturally?
The previous scenarios provide powerful examples of how healthcare directives can make these decisions easier for your family - by knowing your wishes. You have the right to decide who should make decisions about your healthcare and how such decisions should be made if you become unable to make your own decisions. It is important for you to take time to clearly communicate - both verbally and written legally - your wishes to your family, your physicians and/or your surrogate. A surrogate is someone that you choose to make your medical decisions for you in the event that you cannot. A surrogate does not have to be a family member; it can be anyone of your choosing.
More About Healthcare Directives
Healthcare directives are legal documents that allow you to express your wishes regarding future medical care. Healthcare directives will help:
- Protect your right to make medical and mental health choices that affect your life
- Your family avoid the responsibility - and stress - of making difficult decisions
- Your physician by providing guidelines for your care
Healthcare directives can limit life-prolonging measures and ensure that your thoughts regarding the following are clear
- Cardiopulmonary resuscitation (CPR) - attempting to restore stopped breathing and/or heartbeat
- Intravenous (IV) therapy - providing food, water and/or medication through a tube placed in a vein
- Feeding tubes (through the nose, throat, stomach etc.) - providing nutrition
- Respirators - keeping patients breathing through a machine
- Dialysis - cleaning patients' blood by machine, when kidneys no longer function properly
- Pain relief - accepting or refusing pain relief measures
Without healthcare directives
someone you might not want to make healthcare decisions for you could get the authority to do so without a directive. If you are not clear about your wishes, the wishes of others could prevail when treatment decisions are made for you.
Types of Healthcare Directives
In Arizona, four healthcare directives may be used to document your healthcare wishes. These are: Living Will; Health Care Power of Attorney; Mental Health Care Power of Attorney; and the Pre-hospital Medical Care Directive.
Living Will
A living will is a document that includes written instructions explaining the healthcare decisions you support if you have a terminal illness. They are referred to as "living" because they are in effect when patients are still alive.
When preparing your living will:
- Clearly state your underlying values and reasons for preparing a Living Will, such as avoiding a quality of life that is unacceptable to you
- Be as specific as possible in your directions - avoid ambiguous terms such as "heroic measures"
- State how healthcare decisions are to be made when your Living Will is in effect
- Describe the circumstances in which you do not want life-sustaining treatments (such as artificial feeding, CPR, ventilators, surgeries) to prevent your death
- Give directions about using pain medication
- Communicate your wishes regarding autopsy and organ donation
Health Care Power of Attorney, Medical Power of Attorney and Mental Health Power of Attorney
A health care power of attorney is a document that gives a person (called a surrogate) legal authority to make healthcare decisions for you if you become unable to do so. You should choose someone that you trust to make your healthcare decisions. Your surrogate does not have to be a family member and should not be your physician. Ensure that your surrogate is willing to carry out your wishes. If you do not appoint a surrogate and are unable to make your own medical decisions the attending physician will be guided by Arizona State Law concerning who will be the primary decision maker.
When appointing your health care power of attorney:
- Name an alternate to act on your behalf if your primary surrogate is not available
- Define the scope of your surrogate's authority and when that authority is to be in effect
- Request that your surrogate be appointed as your guardian if that becomes necessary
Pre-hospital Medical Care Directive
A pre-hospital medical care directive prevents the use of CPR at any time, under any circumstance. If breathing or heartbeat stop, emergency personnel will attempt CPR unless they are promptly presented with a valid Pre-hospital Medical Care Directive. Neither a Living Will nor Health Care Power of Attorney can be relied upon to prevent emergency personnel from administering CPR.
Making Your Healthcare Directives Official
A living will, health care power of attorney and mental health care power of attorney must be signed and dated in the presence of a notary, an unrelated witness who is not a beneficiary of your estate or two witnesses. A witness may not be your surrogate or someone directly involved in your healthcare.
A pre-hospital medical care directive must be signed, dated and witnessed, and a healthcare professional must also sign.
Distribute Copies
Distributing copies of your healthcare directives to the appropriate individuals can increase the likelihood that your wishes will be followed. Be sure that you give copies to your surrogate, family (especially family member likely to be called in case of emergency) and physician to include as part of your medical records.
It is a good idea to go over your wishes verbally with those individuals. A clearly written directive with treatment instructions will help ensure your wishes are honored (be as specific as possible).
Lastly, it is recommended to keep a card in your wallet stating that you have healthcare directives and where to find them.
Review your healthcare directives regularly and make changes as often as necessary. Inform your physician, family, surrogate and/or any other individuals who have copies of your healthcare directives of any changes.
Sources of Information and Forms
The following organizations provide healthcare directive forms and information:
Aging and Adult Administration
State of Arizona
1789 W. Jefferson, Site code 950A
Phoenix, AZ 85007
602-542-4446
Dorothy Garske Center
4250 E. Camelback Road, Suite 185K
Phoenix, AZ 85018
602-952-1464
www.dgcenter.org
Area Agency On Aging-Region One
1366 E Thomas Rd
Phoenix, AZ
(602) 264-2255
The following national organization also provides healthcare directive forms and information:
Partnership for Caring
1620 Eye Street, NW, Suite 202
Washington D.C. 20006
Frequently Asked Questions
Q: Do my healthcare directives have to be followed?
A: Yes. Both healthcare providers and surrogates must follow your valid healthcare directives.
Q: Am I required to make healthcare directives?
A: You are not required, however, you are encouraged to make healthcare directives so that your wishes regarding your healthcare are known and can be followed.
Q: Can I change or revoke my healthcare directives?
A: Yes. Both healthcare providers and surrogates must follow your valid healthcare directives.
Q: Do my healthcare directives have to be followed?
A: Yes, you can change or revoke them at any time. If you change or revoke your healthcare directives, you should notify all individuals who have a copy (and provide them with a new copy with changes).
Q: Who can make decisions for me if I am unable to make my own decisions and have not made a health care power of attorney?
A: A court may appoint a guardian to make healthcare decisions for you. Otherwise, your healthcare provider must use the following list in order of priority to find a surrogate:
- Your spouse (unless you are legally separated)
- Your adult child (if you have more than one child, the majority of those who are available)
- Your parent
- Your domestic partner (unless someone else has financial responsibility for you)
- Your sibling
- Your close friend (someone who shows special concern for you and is familiar with your healthcare views)
Q: What happens if they cannot find a surrogate?
A:Your healthcare provider can decide with the advice of an ethics committee or another physician.
Q: Can I prevent someone from being selected as my surrogate?
A: Yes. Be sure to put in writing the name of the person you do not want selected as your surrogate.
Q: Do I need a lawyer to make a healthcare directive?
A:No. Just be sure that your healthcare directives are notarized, signed by witnesses and/or valid under Arizona Law.
Q: Where can I get copies of the forms so that I can make my healthcare directives?
A:Please see Sources of Information and Forms
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