Frequently Asked Questions (FAQ).

With some questions, we know the answer for "many" or "some" states, in addition to Arizona. Contact Choice in Dying or an agency or attorney in your state for additional information. The only order to this list is that questions nearer the top are the ones we are asked most frequently.

Here are links to the FAQs:

Validity of Arizona documents in other states

Validity in Arizona (of documents from other states)

Validity of copies

Notarizing documents

Resident state of agent

Multiple health care agents

Who can sign for an incapacitated person

Expiration of directives

Doctors obligations to honor directives

When directives are not followed

Emergency personnel and directives

Stopping treatments after they have been started

Registering powers of attorney

Health care decisions under a general durable power of attorney

Combining general and health dpas

Combined living wills and health care powers of attorney

Statutory forms

Health care decisions under a trust

Who needs copies of directives and here to keep directives

Changing directives

Making decisions when there are no directives (surrogate rules)

The effects of withholding artificial food and fluids

Authorizing lawsuits in directives

Appointing your doctor as your health care agent

Requirements of agents to serve

Are living wills and other directives done in other states valid in Arizona?
Yes, if they conform to current Arizona law or to the law of the state in which they were prepared when they were prepared. In case you are wondering about how a health care provider determines if a living will signing in Iowa, for example, is valid, they just assume that it is if it looks valid (that is, signed, dated, and witnessed).

A new Federal law has been proposed (S.1345, 1998) that would require all states to accept health care directives that are legal in the state in which they were prepared.

Are Living Wills and other directives done in Arizona valid in other states?
Usually, but not always. If you live part of the year in another state, you may want to make sure your Arizona documents will be honored there.

Is a copy of a valid directive also valid?
YES. Note that copies of the orange Prehospital Medical Care Directive (Arizona) must be on orange paper.

Must a health care power of attorney or living will be notarized?
Both of these documents may be either notarized or witnessed. Many attorneys prefer to have health care powers of attorney notarized because that has been the traditional way of adopting powers of attorney. Whether you have your document notarized or witnessed, the person(s) signing must attest that they know you (the person completing the directive) and that you signed freely and had the capacity to understand what you were doing. Notaries are not expected to provide such affirmations in fulfilling their duties and some will refuse to notarize Arizona directives.

General durable power of attorney documents for financial matters have their own specific adoption requirements in Arizona.

Does an agent appointed in a health care power of attorney need to be a resident of the state in which you live?
Not in Arizona, nor, to our knowledge, in any other state. Your agent, or a successor agent, needs to be available if a medical crisis occurs. A health care agent is unlikely to be able to handle a critical situation over the phone.

Can I have more than one agent or appoint several people to serve concurrently--making decisions by consensus?
You can appoint more than one agent, but extra agents should be appointed as alternate or successor agents. Some people want all of their children to be in agreement --before any critical decision is made. That is best achieved through an informal understanding with all of the children. At any given time, only one person should be legally empowered as your agent and thus responsible for communications with your health care provider.

Can a health care power of attorney or living will be signed by a member of the family for someone who does not have the capacity to sign his or her own document?
NO. These documents must be prepared when you have the capacity to understand what you are doing and can sign or mark your own document. A health care agent may complete an Arizona Prehospital Medical Care Directive for the principal (the person who appointed the agent).

How often must a living will or health care power of attorney be redone?
That is for you to decide; the law in Arizona and most states does not say. You should review your documents every year or two and make changes or redo them as needed. California law originally provided that directives expired after seven years, but that rule was subsequently removed from their statute.

Must doctors honor living wills and a health care agent's decisions?
YES, as long as the requests are medically reasonable. In Arizona, a doctor who refuses a directive as a matter of conscience must transfer the patient to another doctor who will honor the patient's and agent's decisions. Health care providers may try to put it onto the agent or family to find an alternative provider if the provider is unwilling to comply with a patient’s directive or his or her agent’s directions. Arizona law makes it the legal obligation of the provider to do this.

What happens if my directive is not followed?
That all depends on your health care agent. It is not likely that any health care provider who acts contrary to the instructions of your agent or your directive will be disciplined. You are really dependent on the effectiveness of your agent as your advocate and the attitude of your physician toward honoring your wishes.

Will emergency medical personnel honor a living will or health care power of attorney?
This is highly unlikely. This why Arizona law authorizes an orange "Prehospital Medical Care Directive" for people who would refuse CPR from emergency medical services personnel.

If you let them start a life-sustaining treatment (LST), such as artificial nutrition and hydration, isn’t it much harder to get them to stop it?
Legally and ethically there is no difference between starting and stopping LST. There should be no difference in practice, but sometimes there is. Unfortunately, some physicians may be reluctant to start treatment with an uncertain chance of working, if they believe that it may be difficult to stop it even when it does not provide the intended result,

Does a health care power of attorney need to be registered?
Not in Arizona. We know of no other state in which it must be registered. This question arises because sometimes powers of attorney used for financial transactions are registered.

Can the holder of a general durable power of attorney make health care decisions?
Only if the power of attorney specifically authorizes health care as well as financial decision-making.

Should a health care power of attorney be separate from a general durable power of attorney?
That is a good idea, but the law does not require it.

Can a living will and a health care power of attorney be combined into one document?
YES, in Arizona and in many other states as well.

Do I have to use the living will and Health care Power of Attorney forms published in the statute?
Not is Arizona. They are only samples. Some authorities considered them to be poorly drafted.
Some states require you to use the statutory forms. Our research on the law in other states is found in "State law requirements regarding the use of alternatives to statutory forms."

Does a trust cover health care decision making?
Trusts may include provisions for health care decision making.

Who should get a copy of my living will and health care power of attorney and who should keep the originals?
You or your agent should keep original documents. Give copies to your alternate agent(s), your doctor(s), close family, and anyone else you would want to know about your wishes. Keep your copy in your home with other important papers (NOT in a bank safe-deposit box).

How are changes made in a living will or health care power of attorney?
Other than changes of agent’s address information, all changes must be initialed, dated and witnessed. When you wish to change an agent or to substantially change your instructions, it is advisable to prepare a new document.

Can family members make health care decisions if there is no agent appointed through a health care power of attorney or a court-appointed guardian?

In Arizona, the law provides for decision-making in these circumstances by family members or other persons, but their authority to direct the withdrawal of tube feeding is restricted.

Without a directive, someone you might not want to make health care decisions for you could get that authority. Without a directive (or if your directive is vague), values and wishes other than your own are more likely to prevail when treatment decisions must be made for you.

Arizona and many other states include a list of "surrogates" one of who MUST be consulted if there is no guardian or health care agent. The Arizona list in order of selection is:

"1. The patient's spouse, unless the patient and spouse are legally separated.

2. An adult child of the patient. If the patient has more than one adult child, the health care provider shall seek the consent of a majority of the adult children who are reasonably available for consultation.

3. A parent of the patient.

4. If the patient is unmarried, the patient's domestic partner if no other person has assumed any financial responsibility for the patient. (Comment: This strange language was apparently inserted to strike a blow against immorality!)

5. A brother or sister of the patient.

6. A close friend of the patient. For the purposes of this paragraph, "close friend" means an adult who has exhibited special care and concern for the patient, who is familiar with the patient's health care views and desires and who is willing and able to become involved in the patient's health care and to act in the patient's best interest." (A.R.S. 36.3231)

If none of these persons is willing and able to serve, the patient’s physician may serve as the surrogate after consulting with another physician or an ethics committee.

This provision raises the prospect that someone you definitely would not want to make health care decisions for you could become your health care surrogate. If this is a concern, tell the individual or individuals you want them to refuse to serve as your agent, should they be called upon. You can also state your wish in your directive. This site contains a supplemental form for that purpose.

Isn’t it wrong to starve someone to death by withholding artificial nutrition and hydration?
It is wrong to "starve someone to death," but that is not what happens when artificial nutrition and hydration are forgone. Forgoing artificial nutrition and hydration can actually easy the dying process. Providing it can increase a patient’s discomfort and cause medical complications. Whenever it is clear that the patient would not want to be kept alive by means of artificial nutrition and hydration, it should not be used for that purpose. (Ten years ago, this was one of the most frequently asked questions! A more complete discussion of this issue is found in the detail instructions that accompany the form as well as in numerous professional publications.)

Should my directive authorize or even direct my agent to initiate a lawsuit if my wishes are not followed?
You can give whatever instructions you wish in your directive. However, your agent would not need such language to initiate legal action on your behalf. Including instructions of this nature could undermine the efforts of your agent to obtain the cooperation of your health care providers, which is the most promising strategy for realizing your wishes.

Can my doctor be my agent?
It's not prohibited by law in Arizona, as it is in some states, but it is not a good idea. If you want to do this, make certain this is acceptable to your doctor.

How is a living will or health care power of attorney revoked?
By destroying the documents, by your agents, health care providers and family not to honor them, or by doing new ones. Make sure that all copies of a revoked (or amended) document are retrieved and replaced with copies of a new (or amended) document. We recommend keeping a copy of revoked directives, provided they are clearly marked "revoked." This provides a history of your attention to this subject.

Does my agent have to serve?
Actually, nobody has ever asked this question, but people should be aware of the answer: NO. That is why careful selection of agents and full discussion of your directives with them is so critical.

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