Understanding Healthcare Directives: Powers of Attorney, Living Wills, and Emergency Orders

Creating clear legal documents regarding healthcare decisions is essential for ensuring your wishes are respected when you are unable to communicate them yourself. This overview explains the roles of health care powers of attorney, living wills, and pre-hospital medical directives, helping you understand how to prepare and manage these vital documents to safeguard your health care preferences.

Powers of Attorney: Empowering Others to Make Decisions

What Is a Power of Attorney?

A power of attorney (POA) is a formal written authorization that grants one person the legal authority to act on behalf of another. This delegation allows the “agent” to perform specific tasks or make decisions for the “principal,” who grants this authority.

The principal is the individual who authorizes someone else to act in their stead. The person given the authority is called the “agent” or “attorney-in-fact.” When the POA pertains specifically to health care decisions, the agent is often referred to as the “health care representative.”

Defining a Health Care Power of Attorney

A health care POA authorizes a designated person to make medical decisions if the principal becomes unable to do so. This document becomes active when the principal loses the capacity to communicate or decide about their health treatments, whether due to illness, injury, or mental incapacity.

In addition, a mental health care POA can be established separately, granting another individual the authority to oversee mental health decisions when the principal cannot make such choices.

How to Establish a Health Care POA

A health care power of attorney is formalized through a process that involves:

The principal reviewing and understanding the document.
The principal signing the document in front of a Notary Public or a qualified witness.
Ensuring that the signer, witness, and Notary (if applicable) meet specific eligibility criteria, such as being over 18 and not related to the principal by blood or marriage, nor involved in health care provision at the time.

Once executed, multiple copies should be made. The principal should provide a copy to the health care agent, keep one in a secure place, and share copies with relevant medical providers or institutions.

Revoking a Health Care POA

The principal retains the right to revoke this authority at any time, provided they have legal capacity. Revocation can be done in writing, orally communicated to health care providers, or by creating a new POA document that supersedes the previous one.

When Can the Agent Start Making Decisions?

The designated agent can begin acting on the principal’s behalf once the principal is deemed unable to make or communicate health care decisions due to physical or mental incapacity. If the principal can communicate in some way, the agent should discuss treatment options with them to respect their wishes.

Types of Decisions the Agent Can Make

The agent may generally decide on:

Consent or refusal of medical procedures, including surgeries and diagnostic tests.
Authorizing healthcare providers to proceed with care aligned with the agent’s decisions.
Managing payments for healthcare services.
Approving or denying hospital or facility admissions.
Accessing and discussing the principal’s health records with providers.

The principal can specify limitations, restricting the agent from making certain decisions. These laws are governed by Arizona statutes, specifically A.R.S. Title 36, Chapter 32.

Living Wills: Expressing Your Medical Treatment Preferences

What Is a Living Will?

A living will is a document where you, as the principal, outline your preferences for medical treatment if you become terminally ill, in a persistent vegetative state, or in an irreversible coma. It provides clear instructions about what interventions you want or do not want under such circumstances.

How Does a Living Will Differ from a Power of Attorney?

While a health care POA appoints someone to make decisions on your behalf when you are unable to do so, a living will specifies your personal treatment choices in advance. It complements the POA by providing guidance on the types of care you prefer or refuse.

How to Create a Living Will

The process involves:

Carefully reviewing and understanding the document.
Signing it in front of a Notary Public or a qualified witness.
Ensuring that the signer and witnesses meet eligibility criteria, such as being over 18 and not related or involved in the principal’s healthcare.

It’s advisable to make multiple copies: give one to your health care agent, share copies with health care providers, and keep a safe original.

Attaching Living Will and POA Documents

If you have both documents, attach the living will to your original health care POA, and keep copies of each with your other legal and health records. This ensures your wishes are clear and accessible.

Revoking a Living Will

You can revoke your living will anytime if you have legal capacity, either in writing, orally, or by creating a new document. This revocation should be communicated to your health care providers and anyone involved.

What Medical Decisions Are Covered?

Living wills typically address:

Preference for comfort care only, avoiding life-prolonging treatments.
Specific limitations like refusing resuscitation or artificial nutrition.
Decisions related to pregnancy, if applicable.
Care until the doctors determine your condition is terminal or irreversible.
A desire to prolong life as much as possible, if you choose that option.

These documents are governed by Arizona law under A.R.S. Title 36, Chapter 32.

Pre-Hospital Medical Orders: The DNR Directive

What Is a “Do Not Resuscitate” (DNR) Order?

A DNR is a medical order that instructs emergency responders not to perform resuscitation efforts if your heart stops or you stop breathing. This includes procedures like CPR, intubation, and electric shock therapy. However, comfort measures and pain relief are still provided.

How Is a DNR Created?

The process involves:

A licensed health care provider explaining the implications of the DNR to you.
Your signing the document in front of a Notary Public or a witness.
Ensuring the signer and witnesses meet eligibility criteria similar to those for other documents.

Once finalized, the DNR must be visibly displayed—usually on bright orange paper—and kept in an accessible location, such as on your refrigerator or in your wallet.

Revoking a DNR

You may revoke your DNR at any time through written notification, destruction of the document, or verbally informing emergency personnel.

Legal Framework

DNR orders are regulated by Arizona statutes, specifically A.R.S. Title 36, Chapter 32, Article 4.

Additional Resources and References

For further guidance, consult official state resources such as the Arizona Revised Statutes or the Office of the Arizona Attorney General, which provide comprehensive instructions and legal forms for establishing these documents.

Understanding and properly preparing these legal health care directives ensures your wishes are respected and eases decision-making burdens for loved ones and healthcare providers during critical times.