Advance Directives

Prev Next

Guiding Your Care and Choices

We encourage you to discuss the goals of your care with family members, caregivers, and health care providers. Consider your answers to the following questions as they relate to your care and health condition and communicate this information to those who are here to help:

  1. What is your understanding?
  2. What are your fears?
  3. What are your hopes?
  4. How can we help?

Your answers to these questions will help define your goals of care. Goals of care may change over time as your health changes, opinions change or understanding of the situation changes.

Legal documents specific to health care choices can help guide the care you receive should you be unable to make your choices and decisions known. These documents (also known as Advance Directives) include a Health Care Directive (also known as a Living Will), Durable Power of Attorney for Health Care (DPOA for Health Care) and Physician Orders for Life-Sustaining Treatment (POLST). If you have not completed these documents and would like to, copies are available from the Social Worker or Nurse or can be found at azag.gov (https://www.azag.gov/seniors/life-care-planning). Your physician, hospice nurse or social worker can help to answer your questions. It is important that your physician, Azorna Hospice team and family members receive copies of these documents so your choices are communicated to those who are helping guide your care.

If you have not completed Advance Directives and become unable to complete them, the state of Arizona authorizes the following individuals, in order of priority, to act as a surrogate decision-maker on your behalf:

  1. The patient’s spouse, unless the patient and spouse are legal 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.
  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.
    1. If the health care provider cannot locate any of the people listed in subsection A of this section, the patient's attending physician may make health care treatment decisions for the patient after the physician consults with and obtains the recommendations of an institutional ethics committee.  If this is not possible, the physician may make these decisions after consulting with a second physician who concurs with the physician's decision. For the purposes of this subsection, "institutional ethics committee" means a standing committee of a licensed health care institution appointed or elected to render advice concerning ethical issues involving medical treatment.

Health Care Directive (Living Will)

This legal document is used only if you have a terminal condition as certified by your physician where life sustaining treatment would artificially prolong the process of dying, or you are certified by two physicians to be in an irreversible coma or other permanent unconscious condition and there is no reasonable hope of recovery. In either situation, the Health Care Directive directs treatment to be withheld or withdrawn to allow a natural death. You may also direct whether you would want artificially provided nutrition and/ or hydration stopped under these circumstances. Also in the directive you can give further instructions regarding your care. The Health Care Directive must be signed by you and two witnesses who are not related to you and will not inherit anything from you. You can change or revoke this directive at any time.

Durable Power of Attorney (DPOA) for Health Care

A DPOA for Health Care is a legal document in which you name someone to make medical decisions on your behalf if or when you are unable to make your wishes known. A DPOA for Health Care is different than a DPOA for Finance (which needs to be notarized) although clauses for making health care decisions may be embedded within a DPOA for Finance. The person you appoint as your DPOA for Health Care can consent to stop or refuse most medical treatment for you. The person you choose should be a trusted family member or friend with whom you have discussed your values and medical treatment choices.

Do Not Resuscitate (DNR)/Do Not Intubate (DNI) Orders

Do Not Resuscitate (DNR) orders tell healthcare staff not to perform potentially life-saving measures, such as CPR, if the person’s heart and lungs stop working. In Arizona, a DNR order also applies to staff outside the hospital (in nursing homes and emergency medical services). A DNR order must be written by a healthcare provider (or, in some cases, certain other healthcare workers). This can only be done with the person’s or family’s consent. If a person has not written an advance directive, their family will decide on a DNR with the help of the healthcare team.

When might a DNR order be written? When the person’s health condition is such that, in the case of cardiac arrest, CPR and other resuscitation methods are not desired. This could be because the chance of successful resuscitation is very low. Or it could be because the care plan now focuses on comfort measures instead of life-sustaining measures. Coma and terminal illness are instances when a DNR order might be used.

The person can cancel a DNR order at any time. The hospice team can answer questions you might have about the DNR/DNI form. 

Physician Orders for Life Sustaining Treatment (POLST)

The POLST form is intended for any individual with serious health condition(s) to indicate choices in advance related to the following life-sustaining treatments:

  • Cardiopulmonary resuscitation (CPR)
  • Medical Interventions
  • Antibiotics
  • Medically Assisted Nutrition

The POLST form is to assist health care facilities and emergency medical personnel in honoring your health care wishes. Whereas a Health Care Directive (Living Will) communicates your wishes, it is not a physician’s order. The POLST form helps to translate your wishes into specific medical orders for health care providers to follow.

It’s important to know that choosing not to receive CPR when the heart stops as a natural consequence of an irreversible illness does not mean care is not provided to prevent suffering as the body is shutting down. In fact, Hospice helps to ensure that those caring for you know how to keep you as comfortable as possible throughout the end of life process.

Whether or not to use antibiotics is a choice as well; there may be infections for which you choose medication other than an antibiotic to help maintain your comfort. Speaking with your physician and hospice team about your goals of care will help you identify specific medical interventions that are in line with your wishes.

The POLST may be changed at any time by completing a new POLST form with the appropriate signatures from the patient (or patient’s legal representative) and physician.