Medical Power of Attorney | Advanced Directives in Arizona

Three types of advanced directives

This is a general category of documents that people can sign to arrange for their health care decision making. There are essentially three kinds of documents:

• Living Will
• Medical Decisions Power of Attorney
• Orange Card

A Living Will is a statement of a persons philosophy about right to die issues and a general request that the philosophy govern that person's medical care. For example, "I believe in the sanctity of life, but if I am diagnosed with a terminal illness, I want only comfort care." Or another example might be, "I don't care if they tell me I have a terminal illness. I demand that the physicians do everything in their power to save my life."

A Medical Decisions Power of Attorney is a document sanctioned by the Arizona Legislature in which an individual (the "Grantor") appoints another person to make health care decisions. The document only comes into effect if the Grantor is unable to make or communicate responsible decisions concerning his healthcare.

An Orange Card is a limited purpose document sanctioned by the Arizona Legislature. It is the way that a person communicates to Emergency Medical Teams (EMT's) that if they find the Orange Card , they are not to initiate emergency resuscitation if I have a cardiac arrest or if I stop breathing. An Orange Card is not an instruction to any other type of health care provider. It will not guide doctors, ER staff, or nursing home behavior.

What Advance Medical Directives are permitted in Arizona?

• Living Will
• Medical Decisions Power of Attorney
• Orange Card

Is an Advance Medical Care Directive that was prepared in another state valid in Arizona?

Living Wills and Medical Decisions Powers of Attorney which were prepared in another state and which were valid when prepared there will be valid in Arizona.

If I have a Living Will, do I need a Medical Power of Attorney?

A Living Wills a statement of your philosophy about right to die issues. A Medical Power of Attorney is your way to appoint an agent to carry out that philosophy. But there is more to it. Remember these points:

• If you want to remove someone from the decision making loop, someone like a spouse or a son, then you should do a Medical Power of Attorney and specifically exclude them from the decision making process.
• You may need to have decisions made for your short of life or death decisions. It may be useful to appoint an agent who can consent to surgery or who can admit you to a hospital or even a nursing home if you are disabled and unable to make such a decision on your own.
• Some people, usually sufferers of certain terminal cancers, would benefit from a discontinuation of the artificial administration of food and fluids. There are only two types of people who can carry out that kind of wish for you. One is a court appointed Guardian. The other is a person who is your agent under a Medical Decisions Power of Attorney to whom you have expressly given that authority.

When does a Medical Power of Attorney come into effect?

If you are able to make and communicate responsible decisions about your own health care, your agent under a Medical Power of Attorney has no authority to act for you. When you loose that ability, the Medical Decisions Power of Attorney "springs" into effect.

What should be included in an advance directive?

You should use the advance directive, whether it is a living will or a medical power of attorney, to communicate what constitutes an acceptable quality of life for you.  This is hard for most people to do on their own, but we can help with this.  Your advance directive should then state what kinds of treatments or medical approaches would not be welcome if you have a condition that falls below the quality of life that you have defined as acceptable.  Consult with both your lawyer and your doctor about your advance directive.

Should everybody have an Orange Card?

Definitely NOT. A Hospice patient is by definition a patient who has a terminal illness and who is expected to die in six months or less. That person has elected to have comfort care only. That person could reasonably sign an Orange Card. A person who is not a hospice patient but who, nevertheless has an inevitably fatal illness, the end stages of which impose horrible suffering could consider an Orange Card. Finally, a person who is so frail that they would likely suffer grave disability even as the result of receiving resuscitation should consider an Orange Card.

What is a DNR order?

DNR stands for "Do Not Resuscitate". It is a direction that a physician gives to nursing staff, usually in a hospital or nursing home setting.

Can a nursing home require that every resident sign an Orange Card?

It violates Federal Law and Arizona Law to require it.

Can a Medical Decisions Power of Attorney sign an Orange Card on behalf of the Grantor of the Medical Power of Attorney?

Yes, the law which enables Medical Decisions Powers of Attorney in Arizona permits the agent to sign a DNR for his principal.

What powers can go into a Medical Decisions Power of Attorney?

The power to:

• Review medical records
• Consult with the patient's health care providers
• Place the patient in a hospital or nursing facility
• Consent to surgery
• Appoint a guardian
• Direct obedience to a Living Will (which can be combined in the Power of Attorney)