Types of Advance Directives in Arizona

Advance planning can quickly become confusing, as there are multiple types of documents and many different terms. Today, we’re breaking down the various types of advance care documents and showing where they’re relevant.

We’re focusing specifically on practices and documentation for Arizona, as there are some differences from one state to the next. Because of this, it’s always crucial to check the regulations in your local state and what happens if you or a loved one spends time in multiple states.

Even if you’re not in Arizona, the definitions in this article will give you a sense of what you can expect.

Advance Planning Definitions

Advance planning refers to the process of planning for the future, including health, financial, and estate-related considerations. The term applies not only to the documents themselves, but also to the planning steps and associated conversations.

Advanced care planning. This is a specific type of advance planning that specifically focuses on healthcare and related decisions. Here too, the term refers to the overall planning process and the documentation.

The distinction is that advance care planning focuses on healthcare side of things, while advance planning also considers other topics, including finances and estate considerations.

Seniors and their family members will often use both types of planning. For example, a financial PoA could be used to allow an adult child to assist with their parent’s banking, while a healthcare PoA might be used in conjunction with a Living Will to support healthcare decisions.

Advance Directives

Advance directives fall under the umbrella of advance care planning. Notably, they’re specific legal documents that support a person’s healthcare wishes in cases where they can no longer speak or decide for themselves. .

The term includes Living Wills, Power of Attorney (PoA) documentation, Five Wishes, and any similar type of document. Notably, a DNR order and POLST forms are not considered a type of advance directive.

Doctors are legally obliged to honor advance directives, as long as they are valid and medically reasonable. This makes them crucial documents.

Living Will

This is a legal document that outlines general end-of-life wishes. Arizona has no required format, which allows people to create their own versions. That said, some specific information needs to be included, so it’s best to consult the regulations or a lawyer before creating your own.

In a Living Will, the individual provides details about the types of care they want towards the end of life, such as information about the type of comfort care and which medical interventions they’re comfortable with. For specific examples, see Wish 2 in the Five Wishes sample form. 

Power of Attorney

This is the other main type of advance directive. The document is used to designate a proxy or agent to act on the principal’s behalf. There are multiple types of PoA and the role can be further refined by specifics in the paperwork.

Type of PoA

The following are the main types of PoA.

General PoA. This is the broadest PoA document and gives the agent authority to act in a variety of situations, including legal, financial, and real estate decisions. Despite the broad nature of the document, this PoA doesn’t cover healthcare decisions. 

Financial PoA. Covers financial decisions, such as managing accounts and the sale of property.

Special PoA (or Limited PoA). Grants authority for a specific task and tends to be limited in length and scope.

Healthcare PoA (or Medical PoA). Considers healthcare decisions. This is typically a separate document from other types of PoA.

Mental Healthcare PoA. Mental health decisions are often included as part of the regular PoA documentation. However, Arizona offers a separate form for those who wish to use it. This type of PoA allows the agent to make decisions about mental health treatment and behavioral health treatment, and can be relevant even if the principal does not have a mental illness.

When the PoA Comes into Effect

PoAs can be further categorized into three types based on when they come into effect.

Non-Durable. Only effective while the principal has capacity. This is useful for situations where the principal wants to direct their PoA in tasks, such as the sale of a house or investments. It’s uncommon for long-term financial planning or healthcare needs.

Durable. Begins immediately and continues after the principal loses capacity. This is powerful for when the principal retains decision-making capacity but is not able or willing to do everything themselves.

Springing. Is not immediately active. Instead, it comes into effect in a specific situation. Incapacity is a common trigger for a springing PoA, but the trigger could also be a specific diagnosis or other situation. Springing may require some evidence to prove that the event has happened, which can create a delay between the triggering event and when the agent has authority.

In Arizona, PoA forms are not durable by default. To make them durable, a phrase signaling that the PoA remains in effect even when the principal loses capacity must be included.

Five Wishes

This unique advance planning document is designed to streamline advanced care planning and make it more accessible. It’s essentially an advance directive that includes a Living Will and healthcare PoA, while also including emotional, spiritual and social needs. There are some interesting aspects to consider.

A key advantage is the language. Five Wishes relies on everyday language, which makes it easier to understand than regular PoA and Living Will documents. This language can make the document feel less overwhelming and increases the chance that the final paperwork accurately reflects the user’s wishes.

Despite the everyday language, Five Wishes still meets the legal criteria for a Living Will and PoA in Arizona.

All aspects of Five Wishes come into effect when the principal no longer has the capacity to make decisions for themselves. This is the same as a Living Will, but does not offer the same timing customization as a standalone PoA form.

There is room for customization, as people can cross out parts that do not apply to them and write their own responses. Nevertheless, the individual would have more flexibility by creating their own document.

Medical Orders

Medical orders are often used in conjunction with advance directives, as they provide additional clarification and make life easier for healthcare staff.

POLST

POLST stands for Physician Orders for Life-Sustaining Treatment. Like a Living Will, POLST provides details about the types of medical treatment a person wants and doesn’t want. The document translates the person’s wishes into specific medical orders that can be quickly followed.

For example, the POLST might include Do Not Intubate and Do Not Resuscitate orders, along with decisions about artificial nutrition and life-sustaining interventions.

DNR

A Prehospital Medical Care Directive or DNR (Do Not Resuscitate) is a specific type of medical order that prohibits resuscitation in emergency situations.

In Arizona, the form must be printed on orange paper (either letter-sized or wallet-sized) for it to be valid. The DNR goes beyond CPR to cover a range of resuscitation measures “including cardiac compression, endotracheal intubation and other advanced airway management, artificial ventilation, defibrillation, administration of advanced cardiac life support drugs and related emergency medical procedures.”

Arizona’s version of the form is unusual because individuals can fill it out and sign it themselves, instead of requesting their physician to fill it out. A healthcare provider’s signature is also required, but this does not need to come from the individual’s physician.

The form is only relevant in emergency situations, including emergency rooms and when paramedics are called. In other situations, the information provided on the Living Will and POLST forms will be relevant instead.

It’s important to talk to healthcare providers before signing a DNR, as this paperwork isn’t suitable for everyone. The form is most relevant for frail or seriously ill individuals, for whom resuscitation is less likely to be effective and even if it is effective, the efforts can cause considerable pain and a long recovery time. DNRs are less relevant for people who are young and in good health, as such individuals may recover well following resuscitation and live a long life.

The DNR form is often displayed on the fridge or kept by the bedside of a bedridden individual to ensure it is quickly discovered. Some people also wear orange alert bracelets and keep a copy of the DNR in their wallet.

Crucially, the DNR needs to be sighted by emergency responders before it can be followed. They cannot simply take your word that the DNR exists, making it crucial to keep the DNR form close by.

Things to Consider

Timing Differences

POLST and DNR orders come into effect as soon as they are created, while Living Wills and Five Wishes come into effect when the principal loses the capacity to make decisions for themselves.

PoA is more complex, as the principal can determine when they come into effect. Some operate like Living Wills, so they’re active from when the principal loses capacity. Others may be active immediately, then continue or stop when the principal loses capacity. It is also possible to choose another type of criteria for the PoA to become active, like the diagnosis of a specific illness.

It’s Often Best to Have Multiple Documents

These various documents all perform different roles and work in conjunction with each other.

As such, a person might end up having the following documents:

• Healthcare Power of Attorney, to nominate someone who will make healthcare decisions and interpret the Living Will when the principal cannot.
• Other Power of Attorney documents, like Financial Power of Attorney or Mental Health Power of Attorney. These provide authority for other parts of the principal’s life.
• Living Will, to provide an overview of the individual’s healthcare wishes, including the types of treatment they do and do not want.
• POLST, to translate the wishes of the Living Will into medical orders that can be quickly followed by healthcare staff.
• DNR, this instructs medical professionals to avoid performing CPR. In Arizona, there is a specific form with an orange background that must be used for a DNR. Using different paperwork or the wrong background color will make the form invalid.

Five Wishes includes a Healthcare PoA and Living Will, so you don’t need to fill those out individually. However, you may still wish to have POLST and/or a DNR in place. 

What Matters Most?

The PoA could be considered the most important piece of documentation, as this provides another individual with the authority to make healthcare decisions and to authorize POLST forms if needed.

Ideally, the principal will have discussed their end-of-life wishes with their agent in-depth. This way the agent has all the information they need to support the principal’s wishes.

Despite the power of PoA, it’s best to have a Living Will in place as well. The Living Will ensures that everyone is on the same page with the principal’s wishes and reduces the likelihood of conflict. Anything that reduces conflict risk like this really is crucial, as the process of getting the principal’s wishes followed can be more complicated than it first seems.

Final Thoughts

Advance planning can seem complicated, with multiple types of documents in play and different rules for when these come into effect. Because of this, it’s best to consult a lawyer or an advance care planning expert to learn about how the documents apply in your situation.

If everything feels overwhelming, simply start with Five Wishes. This includes both a Living Will and Power of Attorney, which are the best places to begin.

If you’re also considering a financial Power of Attorney, be sure to talk to the principal’s bank about their requirements. Financial institutions aren’t obliged to accept a PoA and many require extra paperwork before they’ll give you any authority.