Five Wishes vs a Healthcare PoA in Arizona

Like many states, Arizona doesn’t require you to complete specific Power of Attorney forms. It’s even possible to create your own documents, as long as these contain the correct language and meet the legal requirements.

Despite this flexibility, it’s best to use a pre-prepared form. Doing so streamlines the process and ensures you don’t miss any important topics.

There are two stand-out options in Arizona – the state-provided form and an independent document called Five Wishes. Both are legally valid, but they have different strengths and features. Today, we’re examining the two in detail to help you decide which is best for your situation.

You’ll also need to think carefully about the identity of your healthcare proxy. We’ve covered this topic in detail in our post How to Choose the Best Healthcare Proxy.

What is Five Wishes?

Five Wishes is a national advance care planning program that aims to make advance directives more accessible nationwide. The Five Wishes document was created in consultation with lawyers, so that it would be usable anywhere in the United States.

The document generally stands on its own, although people in New Hampshire, Kansas, Ohio, or Texas may need to fill out additional paperwork to complete their advance directive.

Beyond this, Five Wishes is a comprehensive form. It acts as a Living Will and PoA, while also talking about emotional, spiritual, and comfort wishes. This pattern isn’t seen with other advance directives.

Five Wishes vs Healthcare PoA

Where They’re Found

Arizona’s official forms can be found on the site of the Arizona Attorney General Kris Mayes. There are various documents and combinations available, including forms in English and in Spanish. These can all be downloaded as you wish, with no fees.

The Five Wishes form can be purchased through the Five Wishes site or may be provided by a Five Wishes facilitator. The form is inexpensive, with the digital version costing $15 and the paper one costing just $5. You can also view a free sample here.

What They Offer

Both forms have the same general goal – allowing you to designate a healthcare proxy (plus someone to act as backup). However, there are some differences between them.

Five Wishes

After you’ve designated your proxy and backup, Five Wishes provides details about how to choose your proxy. Following on, there’s a section detailing the specific rights you want your proxy to have. You can cross out any rights you don’t want them to have and write in additional changes to their powers.

A few of the areas covered include:

• See and approve the release of medical records and personal files
• Interpret instructions
• Take legal action needed to carry out wishes
• Donate useable organs
• Apply for Medicare etc.

Five Wishes also provides a section to indicate preferences around organ donation. Five Wishes also has a section where you can indicate if you want to be cremated or buried, where to place your remains, discuss details of memorial services, as well as name the individual who would have more information about post-death arrangements.

Finally, Five Wishes ends with a section that highlights what to do if you change your mind about having a healthcare agent.

Arizona’s Form

After the section on proxies, Arizona’s form includes a paragraph that gives the proxy authority for all healthcare decisions. The phrasing can be seen below:

After this, you can write any specific healthcare decisions that you don’t authorize. While the approach is quite different from the Five Wishes form, the outcome is much the same. Then there’s a set of sections that cover wishes regarding autopsy, organ donation, funeral, and burial.

Next, Arizona’s form asks whether you have a Living Will, POLST, or a Prehospital Medical Care Directive (the Living Will and POLST should be attached to the form).

Finally, there’s an optional Physician Affidavit and a formal HIPAA waiver of confidentiality (which can be seen below).

When They Come into Effect

Both forms can be considered springing PoAs, as they’re not effective immediately and only come into effect when the principal can no longer make healthcare decisions (i.e. they’ve lost decision making capacity). The documents define this as follows:

• Five Wishes: “This person will make my health choice if both of these things happen: My attending or treating doctor finds I am no longer able to make health care choices, AND, another health care professional agrees this is true.”
• Arizona’s Form: “I AUTHORIZE my agent to make health care decisions for me when I cannot make or communicate my own health care decisions.”

Things to Consider About Five Wishes

Strengths of Five Wishes

Regular PoA forms can seem difficult and overwhelming. They’re especially hard for people who are stressed and overwhelmed, or who have limited education. And, let’s face it, few people actually want to think about end of life anyway. Having to go through a complex form makes the topic even less appealing.

Five Wishes is different.

It relies on familiar language, making it easy to read and understand. It’s also available in 30 languages, which makes it even more accessible.

Five Wishes is also as streamlined as possible. In many states, everything you need is provided in a single document. If extra paperwork is needed, then this is sent to you along with the original form.

This approach reduces the amount of paperwork and makes the whole process easier.

Weaknesses of Five Wishes

The weaknesses of Five Wishes sound serious at first, but they’re mostly just a side effect of the simplified language.

Most can be avoided by the principal explaining the document to healthcare professionals before the PoA comes into effect. This way everyone knows that Five Wishes reflects the individual’s wishes and is completely authentic.

Can Be Unfamiliar

Five Wishes isn’t as well-known as official forms, and the language differs from most legal paperwork. Some people mightn’t have heard of it all, which could mean your paperwork initially gets rejected and you need to advocate for its authenticity.

A few members of the AgingCare forums have experienced the problem first-hand and found it incredibly frustrating. Even so, lack of recognition and acceptance may be rare. After all, Five Wishes is becoming increasingly well-known and many people recognize that advance directives can take many forms.

Some Options Overlap with Other PoAs

Five Wishes includes authority for some non-healthcare decisions, including specific legal actions and applying for programs. These could cause conflict if the principal also has a separate financial or legal PoA.

In such a case, you may need to write extra information on Five Wishes, clarifying the specific authorities that people have.

Some Permissions Mightn’t Be Enough

Five Wishes suggests that the document alone is enough for all the permissions highlighted. But, there are some cases where this mightn’t be true.

For example, Five Wishes grants the proxy with the authority to see personal files, including bank records, for some of their tasks. Yet, financial institutions may even refuse financial PoAs without additional paperwork. Most probably won’t accept Five Wishes on its own.

There’s also the HIPPA authority to consider. This is included in Five Wishes, but the language doesn’t have the same specificity as the Arizona form or other official paperwork. Some healthcare staff may be resistant to grant this authority from Five Wishes alone.

Here, it’s important to talk to staff members early. By doing so, you can find out whether there are any other steps you need to follow.

When is Five Wishes Best?

• For people who struggle to understand other documents
• For time-sensitive situations where paperwork needs to be completed as quickly as possible
• For people who are resistant to any type of end-of-life paperwork
• For anyone who wants clear indications of what the proxy will and will not be able to do
• For people with no advance planning paperwork, as you’re completing a Living Will at the same time as the PoA
• For anyone who wants to talk about spiritual and emotional wishes

Things to Consider About Arizona’s PoA

Strengths of Arizona’s PoA

• Precise language. The precision of language reduces any ambiguity. This reduces confusion and should help the PoA be implemented without issue.
• Familiarity. Arizona’s document uses a familiar combination of style and language and is well-known throughout the state. As a result, it is easily recognized and accepted by healthcare staff.
• Makes other paperwork easier to find. By including checkboxes for other paperwork, Arizona’s version ensures that everything can be identified and found easily.
• Includes specific information about organ donation, funeral, burial, and autopsy.

Weaknesses of Arizona’s PoA

The language in Arizona’s form can make it difficult for some to use or understand, while also making the form feel fairly overwhelming. These are big issues for anyone who is already resistant to filling out this type of paperwork.

Indeed, the language in Arizona’s form is a poor fit for many people, including those with limited education, anyone stressed or with low concentration, and some seniors.

This document is also specific to Arizona and may not be accepted in all other states. Some people may even need entirely new paperwork if they move states, which is seriously frustrating.

When is Arizona’s Form Best?

• When there is plenty of time to plan, like for people completing advance directives when they’re first diagnosed with an illness or young people preparing for the future. The time allows you to work on the form gradually.
• When there’s a risk of conflict. Five Wishes is less well-known and less precise than the Arizona form, creating more room for it to be contested. This could lead to serious issues in families where siblings disagree on the best type of care or there are arguments about who should be the proxy.
• When precision is needed. Using simpler language makes Five Wishes less precise than Arizona’s form. While this is fine most of the time, the decrease in precision could create issues with some complex medical or family situations.

What About Another Healthcare PoA?

Alternatively, you might choose another pre-prepared PoA form or create your own PoA with a lawyer. Doing so is most relevant if you’re unhappy with some aspects of the forms we’ve been discussing. For example:

• You might want to define decision making capacity more precisely to reduce the risk of debates or complications.
• You may want to change some aspects of the proxy’s authority, perhaps by giving them authority over more areas or fewer ones.
• You might want the PoA to come into effect earlier. This is particularly relevant for people who want their proxy’s help with decision making.

It’s best to consult with a lawyer here, as other forms or your own documents won’t be as well-examined as the two we’ve been discussing today. A lawyer can also help you determine whether your PoA truly reflects your needs.

Final Thoughts

For many people, the debate between Five Wishes and Arizona’s PoA form comes down to personal preference. Both documents have the same overall goal, allowing you to designate your chosen PoA and provide details about their authority.

The biggest difference comes down to language. The simpler language of Five Wishes makes it easier to use, but may sometimes reduce acceptance by healthcare providers. Arizona’s form uses more complex language, which makes it harder to understand, but adds precision and may improve acceptance.

Regardless of the form, it’s important to begin communication early. This includes talking to healthcare staff about the senior’s wishes and the paperwork you plan to use. Doing so means that any issues can be identified and resolved without causing harm.