Advance Planning FAQs

Advance planning refers to the process of planning for the future. This includes considering potential financial, estate, legal, and healthcare needs. We’ve discussed different aspects of this in other posts, including what is involved in being a healthcare proxy, the different types of forms, and the difference between POLST and a Living Will.

Today, we’re digging into some of the interesting questions and complexities that surround advance care planning. If we haven’t answered your question here, feel free to email us or check out our consulting service.

What Are the Different Forms?

In brief, there are two main types of forms – advance directives and medical orders. Advance directives include Power of Attorney (PoA) and Living Will, along with documents like Five Wishes that combine these features.

DNR forms are one type of medical order. These focus on resuscitation and may include related procedures like intubation. These forms are typically filled out by a person’s physician, but in Arizona, individuals can fill these in themselves and have them signed by a healthcare professional.

There are also POLST forms (which stand for Physician Orders for Life Sustaining Treatment). These orders translate the desires in a Living Will into actionable medical orders, making it easier for healthcare staff to meet the requests in a Living Will.

What is Five Wishes?

Five Wishes is a national advance care planning program. It offers a single form that includes a Living Will, PoA, and wishes for emotional and spiritual needs. The form is written using everyday language, making it more accessible than most other advance directives.

Because Five Wishes already contains a Living Will and PoA, you don’t need to complete these documents separately.

How Do You Change Your Documents?

To change advance planning documents, you must create a new and updated version that reflects your current wishes. You should send copies of the new document to anyone currently holding copies of your advance planning documents and tell them that the old versions have been revoked.

If your documents have been registered in the Healthcare Directives Registry Arizona, you will need to fill out a new registration form, stating that you are replacing or revoking documents currently in the Registry. Also, you need to change any related forms that are affected by the change, such as forms that state your current agent. There are also forms to help you revoke specific documents, like this Revoke Power of Attorney form from Maricopa County.

Healthcare professionals should always use the most recent version of your paperwork. This is straightforward because all versions will be dated. Nevertheless, it’s helpful to write ‘Revoked’ on all old versions to prevent confusion if older documents are found before newer ones. 

In Arizona, revoking a healthcare directive can be as simple as creating a new version, orally telling the healthcare provider, or any other act that demonstrates the intent to revoke the healthcare directive. Nevertheless, it’s worth being as thorough as possible to make things easier in emergencies. 

Do You Need a Lawyer to Complete Advance Planning Paperwork?

In Arizona, individuals can complete their own advance care paperwork without any input from a lawyer. However, the paperwork should be signed and witnessed/notarized appropriately, and needs to meet Arizona’s legal requirements (which are discussed elsewhere).

Because of these legal requirements, most people would benefit from using a form developed to meet Arizona’s standards. Doing so ensures nothing is missed and reduces the risk of problems when the paperwork is presented.

Arizona offers official life planning documents, including a Health Care Power of Attorney, Living Will, Mental Health Care Power of Attorney, and Do Not Resuscitate Order. These can be found here. These documents are well recognized throughout Arizona, although they are not required forms, simply one option for families to use.

Another option is Five Wishes. Five Wishes combines a Living Will and Healthcare Power of Attorney with wishes about emotional and spiritual needs. It was developed in consultation with lawyers and is legally valid as-is in most states, including Arizona.

Five Wishes is also written in easy-to-understand language, making it more accessible than most other Advance Planning forms. This is a powerful feature, as other forms can be confusing and overwhelming.

Times Where a Lawyer May Be Helpful

While lawyers aren’t required for advance planning paperwork, they can sometimes make things easier.

One situation is where the principal has highly specific wishes that aren’t covered by Five Wishes or the state form. For example, the principal might wish to provide more details about when the PoA comes into effect or be more precise about the powers that their agent will have. Here, they may need to create their own documents with the help of a lawyer to ensure their needs are met.

Another situation is where the principal isn’t confident in their understanding of the document they’re filling out. Here, a lawyer or an advance planning expert may go through it with them and help ensure that the responses they choose accurately reflect the individual’s wishes.

If Your Family Members Already Know Your Wishes, Why Bother with Advance Directives?

The paperwork ensures there’s a formal legal version of your wishes recorded, so that your wishes are followed even if family members forget some aspects or wish to make their own decisions.

A Living Will is also the piece of paperwork that everyone keeps coming back to, including healthcare proxies, surrogates, and medical staff. The Living Will helps ensure that your treatment matches your wishes and keeps everyone working towards the same goals.

Without a Living Will, there’s a higher risk of conflict, like conflict between family members or between the medical staff and your family. What’s more, such conflict can be substantial and is likely to impact the care you receive.

Also, if you have no paperwork at all, then the state will appoint a surrogate for you, based on Arizona’s hierarchy. This may mean the surrogate isn’t the one you would have chosen for yourself, such as your aging parent being chosen instead of your domestic partner.

Do Living Wills Actually Work?

There is much debate on this topic.

One issue is that a person’s imagined wishes may differ from their actual wishes. After all, who we are currently impacts the interventions we think we’ll want in the future. Yet, as we grow, we go through changes in our experiences, values, and goals, which can all impact our decisions.

There’s also the question of whether the Living Will is followed.

While healthcare staff are obliged to respect your wishes, the Living Will may not be found or accepted at the right time. Despite everyone’s best efforts, some combinations of situations can mean that wishes aren’t followed.

Also remember that Living Wills won’t cover every single possible situation – there are simply too many variations.

This is why it’s also essential to have PoA paperwork set up. Your healthcare proxy plays a crucial role in the process, as they advocate for your wishes. Having someone to advocate for you is powerful because the healthcare system often has a curative and life-extending focus. While that focus is often helpful, it can mean people need to push to get their wishes followed.  

Can Healthcare Providers Ignore Your Wishes?

In general, healthcare providers are required to follow the wishes in your Living Will, provided they are medically reasonable. A physician may refuse specific requests on moral grounds or if the request goes against the institution’s policy. However, if they make such a refusal, they’re responsible for transferring the patient to a suitable physician or facility where their wishes will be met.

What Does Losing Capacity Mean?

Advance directives often come into effect when an individual loses capacity. Specifically, this refers to when a person can no longer make decisions for themselves.

Loss of capacity is most apparent when someone has lost consciousness or is in a coma. However, it can occur in other situations too, like when someone has late stage dementia and can no longer understand the decisions they are being asked to make.

Generally, decision-making ability is assessed by the person’s physician, who may consider understanding, appreciation, reasoning, and expression as evidence of capacity. If the individual is conscious, they are typically assumed to have capacity, unless there is significant reason to suspect otherwise.

You may have also heard the term competence before. This also refers to the ability to make decisions, but it is a legal assessment through the courts, rather than from a physician. Assessments of competence can be relevant in some situations, like when a guardian needs to be appointed. Still, capacity is used in most other situations, as the process of assessing competence can be time-consuming and expensive.

Is a Living Will the Same as a Do-Not-Resuscitate Order?

A Living Will and a Do-Not-Resuscitate Order (DNR) are two distinct pieces of paperwork with different purposes. The Living Will provides information about medical care for individuals who cannot speak for themselves. The information is typically used in healthcare settings, including hospitals, and may include requests like do not resuscitate.

In contrast, a DNR (also called a Prehospital Medical Care Directive in Arizona) focuses specifically on resuscitation measures in emergency situations. For those in Arizona, the DNR form is found here and can be filled out by the individual and then signed by a licensed healthcare provider.

A Living Will and POLST documents may also provide information about resuscitation, along with other medical procedures, like intubation and types of comfort care. However, these documents typically come into effect later than a DNR form (often when the principal is incapacitated) and aren’t used by emergency responders.

As such, anyone who does not want to be resuscitated should have a DNR form completed, even if the same information is provided in their Living Will or POLST documents.