ARIZONA DEPARTMENT OF ECONOMIC SECURITY
Division of Developmental Disabilities
DECISIONS ABOUT
YOUR HEALTH CARE
Living Wills and Other Health Care Directives
In 1991 a federal law
was passed regarding
living wills and other
health care directives
for adults. The purpose
of this booklet is to
help you make informed
decisions about your
health care.
In addition to reviewing
this information, we
encourage you to discuss
health care issues with
your family, doctor or
anyone else who could
help you in making
these decisions.
DEPARTAMENTO DE SEGURIDAD ECONÓMICA DE ARIZONA
División de Incapacidades del Desarrollo
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Who makes my health care decisions?
You or your guardian, if you have one. Your doctors should tell you
about all the treatments and medications they recommend, other
reasonable alternatives, and any potential risks and benefits involved. You
have the right to decide what health care, if any, you will accept.
What happens if I become unable to make or communicate my
health care decisions?
Planning ahead will allow you some control over your health care. One
way to plan ahead is to make a health care directive, or name someone
to make these decisions on your behalf. If no person is named, your
doctors must seek someone authorized by law to make these decisions
for you. This person is called a “surrogate.”
Who can legally make health care decisions for me if I have not
appointed a health care power of attorney, and am unable to
make my own decisions?
A court may appoint a guardian to make health care decisions for you.
If no guardian is appointed, your health care provider must seek a
surrogate from the following list (please note that the list is in descending
order of priority):
1. Your husband or wife, unless you are legally separated.
2.
Your adult child. If you have more than one adult child, a
majority of those children who are available may be appointed as
surrogates.
3. Your mother or father.
4. Your domestic partner, unless someone else has financial
responsibility for you.
5. Your brother or sister.
6. A close friend (someone who shows special concern for you and
is familiar with your health care views).
If a health care provider cannot find an available and willing surrogate, he
or she can make decisions with the advice of an ethics committee, or, if
this is not possible, through consultation with and approval from another
doctor.
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You can prevent a specific person from becoming your surrogate by
stating, in writing, that you do not want that person to make health care
decisions for you.
A surrogate will not have the right to decide to have food or fluids
witheld from you unless:
you have appointed that surrogate to make health care decisions
for you as your health care power of attorney;
a court has appointed that surrogate as your guardian to make
health care decisions on your behalf; or
you have stated in a health care directive that you do not want
this specific treatment.
What is a health care directive?
It is a written statement about your health care decisions. Arizona law
recognizes three types of health care directives:
1. HEALTH CARE POWER OF ATTORNEY — a written
statement naming an adult to make health care decisions on your behalf
if you cannot make or communicate your own. A health care power of
attorney must:
state the name of the person to make health care decisions for
you if you become unable to make or communicate your own. It
must also specify an additional person(s) as backup surrogate(s),
should your primary surrogate be unable to make the decisions.
Surrogates must be at least 18 years old;
be signed or marked by you, and dated; and
be either notarized or signed by an adult witness(es) who saw
you sign or mark the document. The witness must state that
you seem to be of sound mind and free from duress. The notary
public or witness cannot be your health care provider or your
named surrogate. A person who is related to you or stands to
inherit any property from you cannot act as your only witness.
2. LIVING WILL — a written statement identifying the health care
you want and do not want. It is to be followed if you are unable to make/
communicate such decisions. It must:
state how you want your health care decisions to be made in the
future;
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be signed or marked by you, and dated; and
be notarized or witnessed as described above in Health Care
Power of Attorney.
3. PRE-HOSPITAL MEDICAL CARE DIRECTIVE — a directive
refusing cardiopulmonary resuscitation (CPR). By law, a special orange
form must be completed to invoke this directive. Pre-hospital medical
care directives must be:
in the exact form required by law;
printed on orange paper;
signed or marked by you, and dated; and
signed by both a licensed health care provider and a witness.
You may wear a special orange bracelet to alert emergency medical
personnel to the fact that you have a pre-hospital medical care directive.
The bracelet states your name, your physician’s name and the words “do
not resuscitate.”
These documents, used separately or together, identify the treatments
you want and those you do not want.
Must my health care directives be honored?
Yes. Health care providers and surrogates must follow valid health
care directives. Doctors must honor your directives as long as they are
medically reasonable. If a doctor refuses as a matter of conscience, he
or she must transfer your care to another doctor who will honor your
wishes.
Can I be required to make a health care directive?
No, it is entirely up to you. A health care provider cannot refuse to care
for you based upon whether or not you have a health care directive.
Can I change or revoke my health care directive?
Yes. If you decide to change or revoke your health care directive, you
should notify everyone who has a copy.
What if I already have a living will or other health care
directive?
A health care directive valid elsewhere in the United States is also valid in
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Arizona. There are, however, new choices available to you since Arizona
laws changed on September 30, 1992. You should review your health
care directives periodically, and revise them as needed.
Do I need a lawyer to make a health care directive?
No, but be sure that your health care directive is valid under Arizona law.
Who should have copies of my health care directive(s)?
Your doctors and any health care facility upon admission, as well as your
appointed surrogates, should have copies of all your directives. You may
also want to give copies to close family members and your Division of
Developmental Disabilities Support Coordinator.
To alert emergency medical personnel to your wishes, it is a good idea to
post an orange copy of your pre-hospital medical care directive on your
refrigerator at home, because that is where they are trained to look first,
and keep one in your car. Extra copies should be kept in a safe place.
Legal Options Manual
The “Legal Options Manual” is a useful reference document developed
for the Developmental Disabilities Plan Council. It can be accessed
through Arizona Center for Disability Law at www.acdl.com or by
calling (602) 274-6287 or toll-free (800) 927-2260.
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Acknowledgement of Receipt
Name of individual and responsible person, if applicable:
_________________________________________________
Individual’s Name
(please print)
__________________________________________________
Responsible Person’s Name
(please print)
__________________________________________________
Relationship
I acknowledge that I have received the publication “Decisions
About Your Health Care”
_________________________________________________
Signature of Individual (if able) Date
__________________________________________________
Signature of Responsible Person Date
Detach here
Equal Opportunity Employer/Program • Under Titles VI and VII of
the Civil Rights Act of 1964 (Title VI & VII), and the Americans with
Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act
of 1973, the Age Discrimination Act of 1975, and Title II of the Genetic
Information Nondiscrimination Act (GINA) of 2008, the Department
prohibits discrimination in admissions, programs, services, activities,
or employment based on race, color, religion, sex, national origin,
age, disability, genetics and retaliation. The Department must make
a reasonable accommodation to allow a person with a disability to
take part in a program, service or activity. For example, this means if
necessary, the Department must provide sign language interpreters
for people who are deaf, a wheelchair accessible location, or enlarged
print materials. It also means that the Department will take any other
reasonable action that allows you to take part in and understand
a program or activity, including making reasonable changes to an
activity. If you believe that you will not be able to understand or
take part in a program or activity because of your disability, please
let us know of your disability needs in advance if at all possible. To
request this document in alternative format or for further information
about this policy, contact the Division of Developmental Disabilities
ADA Coordinator at (602) 542-0419; TTY/TDD Services: 7-1-1. •
Free language assistance for DES services is available upon request.
PAD-588-PD (11-11)
