A.R.S. tit. 36 ch. 32 — Arizona Revised Statutes Title 36 Chapter 32 — Living Wills And Health Care Directives

36-3201. Definitions In this chapter, unless the context otherwise requires: 1. "Agent" means an adult who has the authority to make health care treatment decisions for another person, referred to as the principal, pursuant to a health care power of attorney. 2. "Artificially administered" means providing food or fluid through a medically invasive procedure. 3. "Attending physician" means a physician who has the primary responsibility for a principal's health care. 4. "Comfort care" means treatment given in an attempt to protect and enhance the quality of life without artificially prolonging that life. 5. "Health care directive" means a document drafted in substantial compliance with this chapter, including a mental health care power of attorney, to deal with a person's future health care decisions. 6. "Health care power of attorney" means a written designation of an agent to make health care decisions that meets the requirements of section 36-3221 and that comes into effect and is durable as provided in section 36-3223, subsection A. 7. "Health care provider" means a natural person who is licensed under title 32, chapter 11, 13, 15, 17 or 25, a hospice as defined in section 36-401 that is licensed under chapter 4 of this title or an organization that is licensed under this title, that renders health care designed to prevent, diagnose or treat illness or injury and that employs persons licensed under title 32, chapter 11, 13, 15, 17 or 25. 8. "Inpatient psychiatric facility" means a hospital that contains an organized psychiatric services unit or a special hospital that is licensed to provide psychiatric services. 9. "Interested person" means the patient, a person listed under section 36-3231, subsection A, a health care provider directly involved in the patient's medical care or an employee of a health care provider. 10. "Living will" means a statement written either by a person who has not written a health care power of attorney or by the principal as an attachment to a health care power of attorney and intended to guide or control the health care treatment decisions that can be made on that person's behalf. 11. "Mental health care power of attorney" means a written designation of an agency to make mental health care decisions that meets the requirements of section 36-3281. 12. "Physician" means a doctor of medicine licensed pursuant to title 32, chapter 13 or doctor of osteopathic medicine licensed pursuant to title 32, chapter 17. 13. "Principal" means a person who is the subject of a health care power of attorney. 14. "Qualifying health information exchange organization" means a nonprofit health information organization as defined in section 36-3801 that is designated by the department of health services pursuant to section 36-3291 to operate the health care directives registry. 15. "Surrogate" means a person authorized to make health care decisions for a patient by a power of attorney, a court order or the provisions of section 36-3231. 36-3202. Revocation of health care directive; disqualification of surrogate Except as provided in section 36-3285 in regard to a mental health care power of attorney, a person may revoke the person's own health care directive or disqualify a surrogate by doing any of the following: 1. Making a written revocation of a health care directive or a written statement to disqualify a surrogate. 2. Orally notifying the surrogate or a health care provider. 3. Making a new health care directive. 4. Any other act that demonstrates a specific intent to revoke or to disqualify a surrogate. 36-3203. Surrogate; authority; responsibilities; immunity A. A person authorized as a surrogate to make health care decisions under this chapter is not responsible for paying the patient's health care costs unless the person is otherwise required to do so. B. This chapter does not authorize a surrogate to consent to any act or omission to which the patient could not lawfully consent. C. The surrogate shall make health care decisions for the patient in accordance with the patient's wishes as expressed in the health care directive. If the health care directive does not provide sufficient information to know what the patient would want in a particular circumstance, the surrogate shall base these decisions on the surrogate's knowledge of the patient's values if those are known or can be determined to the surrogate's satisfaction. If neither the health care directive nor the surrogate's knowledge of the patient's values provides a sufficient basis for making a health care decision, the surrogate shall decide based on the surrogate's good faith belief as to what is in the patient's best interest. D. A surrogate who makes good faith health care decisions for a patient is not subject to civil or criminal liability for those decisions. Acts and refusals to act made in reliance on the provisions of a health care directive are presumed to be made in good faith. A court shall base a finding of an absence of good faith on information known to the surrogate and shall enter its finding only after it has made a determination of bad faith in written findings of fact based on clear and convincing evidence of improper motive. For the purposes of this subsection, "good faith" includes all health care decisions, acts and refusals to act based on a surrogate's reasonable belief of a patient's desires or a patient's best interest if these decisions, acts or refusals to act are not contrary to the patient's express written directions in a valid health care directive. E. A surrogate who is not the patient's agent or guardian shall not consent to or approve the permanent withdrawal of the artificial administration of food or fluid. 36-3204. Responsibilities of health care providers A. A health care provider shall comply with health care decisions made by the patient's surrogate unless those decisions are inconsistent with the patient's health care directive as known to the provider or the provider has transferred responsibility to another provider pursuant to section 36-3205, subsection C, paragraph 1. If the directive requires provision of treatment, food or fluids that would have a significant possibility of sustaining the patient's life, the provider shall ensure the provision until the transfer is completed. B. A health care provider has a duty to volunteer and otherwise disclose information about the patient's health status and care to the patient's surrogate to the same degree that the provider owes this duty to the patient. 36-3205. Health care providers; immunity from liability; conditions A. A health care provider who makes good faith health care decisions in reliance on the provisions of an apparently genuine health care directive or the direction of a surrogate is immune from criminal and civil liability and is not subject to professional discipline for that reliance. B. Health care provider acts and refusals to act made in reliance on the provisions of a health care directive or directions of a surrogate are presumed to be made in good faith. A court shall base a finding of an absence of good faith on information known to the provider and shall enter its finding only after it has made a determination of bad faith in written findings of fact based on clear and convincing evidence of improper motive. For the purposes of this subsection, "good faith" includes all health care decisions, acts and refusals to act based on a health care provider's reasonable belief of a patient's desires, a patient's best interest or the directives of a patient's surrogate if these decisions, acts or refusals to act are not contrary to the patient's express written directions in a valid health care directive. C. A health care provider is not subject to criminal or civil liability or professional discipline for any of the following: 1. Failing to comply with a decision or a direction that violates the provider's conscience if the provider promptly makes known the provider's unwillingness and promptly transfers the responsibility for the patient's care to another provider who is willing to act in accordance with the agent's direction. 2. Failing to consult a patient with a disability or incapacitated patient's surrogate if the surrogate cannot be contacted after the health care provider has made a reasonable effort to do so or if an emergency situation does not provide the health care provider with sufficient time to locate and consult with the surrogate. 3. Relying on a court order concerning a patient. 4. A guardian's failure to comply with section 14-5303, subsection B relating to the requirement that the petition include a statement that the authority granted to the guardian may include the authority to withhold or withdraw life sustaining treatment, including artificial food and fluid. D. This section does not relieve a health care provider from civil or criminal liability or prevent a provider from being subjected to professional disciplinary action for the provider's negligent treatment of a patient if the negligence is unrelated to the provider's reliance on a health care directive, directions from a surrogate or the recommendations of an institutional ethics committee pursuant to section 36-3231. 36-3206. Enforcement or challenge of a directive or decision; judicial proceedings; automatic stays A. An interested person may file a verified petition with the superior court to determine the validity or effect of a health care directive or the decision of a surrogate. B. The petition shall include the following information: 1. The name and current location of the patient and any surrogate or guardian authorized to make decisions for the patient. 2. The name and address of any health care provider known by the petitioner to be providing health care to the principal. 3. If a health care directive exists, a description or a copy of the health care directive. 4. The judicial relief sought by the petitioner. C. On the filing of the petition, the court shall enter a temporary order directing compliance with section 36-3203, subsection E. Notice of this order shall be provided by personal service on the surrogate, the patient, the health care providers immediately responsible for the patient's care and other persons the court requires to be notified. D. The court shall review the petition, any other pleadings on file and any evidence offered by the petitioner to determine if it should order temporary orders without a further hearing. The court may enter a temporary order directing the provision or the withholding of specific medical treatment pending a further hearing if the court determines that there is reasonable cause to believe that health care decisions are being made by a surrogate or a health care provider that derogate the patient's wishes or, if the patient's wishes are not known, the patient's best interests. E. The court shall schedule and conduct a hearing within five working days of the filing of a petition. Notice shall be provided by personal service on the surrogate, the patient, the health care providers immediately responsible for the patient's care, and other persons the court requires to be notified. F. On the filing of the petition the court may: 1. Appoint an attorney for the patient if it appears that this is in the patient's best interests. 2. Appoint an investigator as provided under section 14-5308 or a physician, or both, to evaluate the patient and submit a written report to the court before the hearing. 3. Enter other temporary orders that the court determines are necessary and appropriate to protect the wishes or the best interests of the patient, including an order exercising the power of a guardian or appointing a temporary guardian as provided under section 14-5310. G. A person filing a petition under this section is not required to post a bond unless the court determines that a bond is necessary to protect the interests of any party. H. If a petition is filed to challenge the decision of a guardian to permanently withdraw the artificial administration of food and fluid from a patient who is in an irreversible coma or is in a persistent vegetative state that the patient's doctor believes is irreversible or incurable, there is a rebuttable presumption that a patient who does not have a valid living will, power of attorney or other health care directive has directed the patient's health care providers to provide the patient with food and fluid to a degree that is sufficient to sustain life, including, if necessary, through a medically invasive procedure, by way of the gastrointestinal tract or intravenously, and that that provision is in the patient's best interests. I. The presumption pursuant to subsection H of this section may be rebutted only if either of the following applies: 1. In reasonable medical judgment any of the following applies: (a) The provision of food or fluid is not medically possible. (b) The provision of food or fluid would hasten death. (c) Because of the medical condition of the patient, the patient would be incapable of digesting or absorbing the food or fluid so that its provision would not contribute to sustaining the patient's life or provide physical comfort to the patient. 2. The court finds both of the following by clear and convincing evidence: (a) The patient is in an irreversible coma or is in a persistent vegetative state that is irreversible or incurable. Evidence that the patient is in an irreversible coma or is in a persistent vegetative state that is irreversible or incurable must be supported by either of the following: (i) The opinion of an independent physician who is licensed pursuant to title 32, chapter 13 or 17 and who is a specialist in neurology. The petitioner, the patient or the patient's attorney may present additional evidence of the patient's medical condition that is supported by the opinion of a physician selected by that party. (ii) If a specialist in neurology is not available, the opinion of an independent physician who is licensed pursuant to title 32, chapter 13 or 17 and who has examined the patient specifically to assess whether the patient is in an irreversible coma or a persistent vegetative state that is irreversible or incurable supported by a recommendation of the institutional bioethics committee of the health care facility. (b) While competent the patient manifested the patient's intent that medically invasive life prolonging treatment, including the artificial administration of food or fluid, not be administered in the case of an irreversible coma or a persistent vegetative state that is irreversible or incurable. J. On notice and a hearing, the court may enter appropriate orders to safeguard the wishes of the patient. If the court is unable to determine those wishes, the court may enter appropriate orders to safeguard the patient's best interest. These orders may include: 1. Appointing a surrogate if the procedural requirements of title 14, chapter 5, article 3 have been met. 2. Removing an agent or any other surrogate and appointing a successor. 3. Directing compliance with the terms of the patient's health care directive, including the provisional removal or withholding of treatment if the court finds that this conforms with the patient's wishes or, if the patient's wishes are not known, is in the patient's best interest. 4. Directing the transfer of the patient to a suitable facility or to the care of a health care provider who is willing to comply with the patient's wishes. 5. Assessing court costs and attorney fees against a party found to have proceeded in bad faith. K. Notwithstanding a person's incapacity, the court may deny a petition to appoint a guardian for that person based on the existence of a valid and unrevoked health care directive. L. A guardian appointed pursuant to this section is immune from civil and criminal liability to the same extent as any other surrogate pursuant to section 36-3203, subsection D. M. A superior court order that authorizes a guardian to permanently withdraw food or fluid from a patient who is in an irreversible coma or in a persistent vegetative state that is irreversible or incurable is automatically stayed for five business days to allow a party, or that party's successor in interest in the event of the original party's death, to seek an expedited appeal with the court of appeals. A decision from the court of appeals is automatically stayed for five business days to allow a party, or that party's successor in interest in the event of the original party's death, to seek review by the supreme court. Food or fluid shall not be permanently withdrawn pending a decision on the merits of the case by the court of appeals or a decision on a petition by the supreme court. 36-3207. Health care directives; effect on insurance and medical coverage A. A person shall not require a person to execute or prohibit a person from executing a health care directive as a condition for providing health care services or insurance. B. An insurer shall not refuse to pay for goods or services under a patient's insurance policy because the decision to use the goods or services was made by the patient's surrogate. C. If a patient's death follows the withholding or withdrawing of any medical care pursuant to a surrogate's decision not expressly precluded by the patient's health care directive, that death does not constitute a homicide or a suicide and does not impair or invalidate an insurance policy, an annuity or any other contract that is conditioned on the life or death of the patient regardless of any terms of that contract. 36-3208. Prior and out of state health care directives; validity A health care directive prepared before September 30, 1992, or prepared in another state, district or territory of the United States is valid in this state if it was valid in the place where and at the time when it was adopted and only to the extent that it does not conflict with the criminal laws of this state. 36-3209. Health care directives; conflicts A. If there are conflicts among the provisions of valid health care directives, the most recent directive is deemed to represent the wishes of the patient. B. Notwithstanding any other law, if there is a conflict between a provision of a valid health care directive, the decision of a patient's agent pursuant to a valid health care power of attorney or the decision of a surrogate decision maker pursuant to section 36-3231 and a health care provider's order, including an order regarding life-sustaining treatment or a similar document, the health care directive, the decision of the patient's agent or the decision of the surrogate decision maker is presumed to represent the decision of the patient. 36-3210. Suicide; mercy killing This chapter does not approve or authorize suicide, assisted suicide or mercy killing. 36-3211. Principals; significant relationships; contact orders; definitions A. Unless inconsistent with the express directions of the principal in a health care directive, an agent shall encourage and allow contact between the principal and other persons who have a significant relationship with the principal. B. An agent may not limit, restrict or prohibit reasonable contact between the principal and any other person without prior court approval, unless the principal has granted the agent such authority in a health care directive. C. A person who has a significant relationship with the principal and whose contact with the principal has been limited, restricted or prohibited by an agent may petition the court for an order compelling the agent to allow the person to have contact with the principal. The petition shall describe the nature of the relationship between the person and the principal and the type and frequency of contact being requested. The person has the burden of proving that the person has a significant relationship with the principal and that the requested contact is in the principal's best interest. The petition and notice of the hearing on the petition shall be personally served on the principal and the agent and shall be provided to any other persons the court orders. D. A principal whose contact with a person who has a significant relationship with the principal has been limited, restricted or prohibited by an agent may petition the court for an order compelling the agent to allow the principal to have contact with the person. The petition shall describe the nature of the relationship between the person and the principal and the type and frequency of contact being requested. The principal has the burden of proving that the person has a significant relationship with the principal and that the requested contact is in the principal's best interest. The petition and notice of the hearing on the petition shall be personally served on the agent and the person whose contact will be affected and shall be provided to any other persons the court orders. E. If an agent who does not have authority expressly granted in a health care directive to limit, restrict or prohibit contact between the principal and another person reasonably believes that contact between the principal and the person is not in the principal's best interest, the agent may petition the court for an order that limits, restricts or prohibits contact between the person and the principal. The petition shall describe the nature of the relationship between the person and the principal and the limitations or restrictions on the contact being requested and why the limitations or restrictions are in the principal's best interest. If the agent requests an order that prohibits all contact between a person and the principal because the contact would be detrimental to the principal's physical or emotional health or well-being, the agent shall file with the court a written statement or report of a physician, psychologist, physician assistant or registered nurse who has recently evaluated the principal and who supports this position. The petition and notice of the hearing on the petition shall be personally served on the principal and the person whose contact will be affected and shall be provided to any other persons the court orders. F. In determining what, if any, contact between a person and the principal is in the principal's best interest, the court shall consider all factors that are relevant to the principal's health, safety and welfare, including the following: 1. The past and present relationship between the principal and the person whose contact is being considered. 2. If the principal has sufficient mental capacity to make an intelligent choice, the wishes of the principal. 3. The mental and physical health of the principal and the person whose contact is being considered. 4. Whether the person whose contact is being considered has committed any of the following: (a) Act involving domestic violence as defined in section 13-3601. (b) Child abuse. (c) Abuse, neglect or exploitation of a vulnerable adult. 5. Whether the person whose contact is being considered has abused drugs or alcohol or has been convicted of any drug offense listed in title 13, chapter 34 or a violation of title 28, chapter 4, article 3. 6. Whether the person whose contact is being considered is listed in the elder abuse central registry pursuant to section 46-457 or is required to register pursuant to section 13-3821. 7. Whether the person whose contact is being considered has been convicted of a violation of section 13-2907.02 or 13-2907.04. G. On the filing of a petition under this section, the court: 1. Shall appoint an attorney or guardian ad litem, or both for the principal. 2. May appoint an investigator as provided under section 14-5308 or a physician, or both, to evaluate the principal and submit a written report to the court before the hearing. 3. May enter any other temporary order that the court determines is necessary and appropriate to protect the wishes or best interests of the principal, including an order exercising the power of a guardian or appointing a temporary guardian as provided under section 14-5310. 4. May issue, without notice, a temporary protective order that limits, restricts or prohibits contact between the principal and another person if the petition is supported by a written statement or report of a physician, psychologist, physician assistant or registered nurse who has recently evaluated the principal and the court finds, based on the statement or report and other specific facts shown by affidavit or verified petition, reasonable grounds to believe that contact between the principal and the person before the matter can be heard would result in immediate and irreparable injury, loss or damage to the principal. The temporary protective order expires on the date prescribed by the court but not later than fourteen days after the order is entered, unless within that time the court extends the order for good cause shown or the person whose contact is limited, restricted or prohibited consents to the extension. If the temporary protective order is issued, the court shall require that the petition and order be personally served on the principal and the person whose contact is the subject of the order within the time ordered by the court but not more than seventy-two hours after entry of the order. If the court issues a temporary protective order without notice, the principal or the person whose contact has been limited, restricted or prohibited may file a motion requesting that the order be dissolved or modified. The person filing the motion shall cause a copy of the motion to be personally served on the agent and any other person the court orders. The court shall proceed to hear and determine the motion as expeditiously as possible. H. Except as provided in subsection G, paragraph 4 of this section, the petitioner shall cause notice of the time and place of hearing of any petition filed under this section to be given at least fourteen days before the hearing. I. Unless inconsistent with the standards and procedures set forth in this section, a petition filed under this section shall be heard and determined as a formal proceeding filed under title 14 and governed by the rules of probate procedure. J. A principal, an agent or a person who has a significant relationship with the principal may petition the court to modify a contact order if a material change in circumstances affecting the principal's health, safety or welfare has occurred since the last contact order was entered. The petition shall be supported by an affidavit alleging the change of circumstances that has occurred since the entry of the last contact order. The court shall deny the petition unless the court finds that the petition establishes good cause for a hearing, in which case the court shall set a hearing on the petition. The petition and notice of the hearing on the petition shall be served on the principal, the agent and the person whose contact is being considered and shall be provided to any other persons the court orders. K. A principal, an agent or a person who has a significant relationship with the principal may file a motion asking the court to temporarily modify or suspend a contact order if a material change in circumstances affecting the principal's health, safety or welfare has occurred since the last contact order was entered. The motion shall be supported by an affidavit alleging the change of circumstances that has occurred since the entry of the last contact order. The motion shall be filed contemporaneously with or after the filing of a petition to modify the prior contact order. The motion shall state whether the petitioner requests that the prior contact order be modified or suspended with or without notice to affected persons. L. The court may temporarily modify or suspend a contact order without notice only if both of the following apply: 1. It clearly appears from specific facts shown in the motion or affidavit that immediate and irreparable injury, loss or damage likely will result if the order is not issued before the affected persons can be heard in opposition. 2. The moving party or the moving party's attorney certifies to the court in writing the efforts, if any, that the moving party or the moving party's attorney has made to give the notice or the reasons supporting the claim that notice should not be required. M. If the court grants a motion to temporarily modify or suspend a contact order without notice, the court shall set a hearing on the motion. N. An order temporarily modifying or suspending a contact order that is granted without notice shall state the injury, loss or damage that would likely have occurred if the order were not issued before giving the affected persons the opportunity to be heard in opposition. The temporary order expires at the date and time set for the hearing on the motion unless the temporary order is extended by the court for good cause. O. The moving party shall personally serve a copy of the order and notice of the hearing on the person whose contact with the principal has been modified or suspended without notice within the time period the court directs but not more than seventy-two hours after entry of the order. The moving party shall personally serve a copy of the order and notice of hearing on the principal or the agent if either person is not the moving party. P. On notice and a hearing, the court may enter appropriate orders to safeguard the wishes of the principal if those wishes can be reasonably ascertained. The court may assess court costs, reasonable attorney fees and the cost of any professionals appointed to evaluate the principal against a party found to have proceeded in bad faith or to have acted unreasonably. Q. In a proceeding brought pursuant to this section, the court may order alternative dispute resolution, including mediation. R. For the purposes of this section: 1. "Abuse" in relation to a vulnerable adult has the same meaning prescribed in section 46-451. 2. "Child abuse" means abuse as defined in section 8-201 of an individual who is under eighteen years of age. 3. "Contact" includes communications through any method, including in person, in writing and by electronic methods. 4. "Court" means the superior court. 5. "Exploitation" has the same meaning prescribed in section 46-451. 6. "Neglect" has the same meaning prescribed in section 46-451. 36-3221. Health care power of attorney; scope; requirements; limitations; fiduciaries A. A person who is an adult may designate another adult individual or other adult individuals to make health care decisions on that person's behalf or to provide funeral and disposition arrangements in the event of the person's death by executing a written health care power of attorney that meets all of the following requirements: 1. Contains language that clearly indicates that the person intends to create a health care power of attorney. 2. Except as provided under subsection B of this section, is dated and signed or marked by the person who is the subject of the health care power of attorney. 3. Is notarized or is witnessed in writing by at least one adult who affirms that the notary or witness was present when the person dated and signed or marked the health care power of attorney, except as provided under subsection B, and that the person appeared to be of sound mind and free from duress at the time of execution of the health care power of attorney. B. If a person is physically unable to sign or mark a health care power of attorney, the notary or each witness shall verify on the document that the person directly indicated to the notary or witness that the power of attorney expressed the person's wishes and that the person intended to adopt the power of attorney at that time. C. A notary or witness shall not be any of the following: 1. A person designated to make medical decisions on the principal's behalf. 2. A person directly involved with the provision of health care to the principal at the time the health care power of attorney is executed. D. If a health care power of attorney is witnessed by only one person, that person may not be related to the principal by blood, marriage or adoption and may not be entitled to any part of the principal's estate by will or by operation of law at the time that the power of attorney is executed. E. A person whose license as a fiduciary has been suspended or revoked pursuant to section 14-5651 may not serve as an agent under a power of attorney in any capacity unless the person is related to the principal by blood, adoption or marriage. This prohibition does not apply if the person's license has been reinstated and is in good standing. 36-3222. Health care power of attorney; amendments An amendment to a health care power of attorney shall meet the requirements of section 36-3221, subsection A, paragraphs 2 and 3 unless the amendment is only made to indicate an agent's change of address or telephone number. 36-3223. Agents; powers and duties; removal; responsibility; fiduciaries A. The individual designated in a health care power of attorney to make health care decisions is an agent entitled to make and communicate these decisions while the principal is unable to do so. B. An agent's authority to make health care decisions on behalf of the principal is limited only by the express language of the health care power of attorney or by court order as prescribed under section 36-3206. C. The appointment of a person to act as an agent is effective until that authority is revoked by the principal or by court order. D. A person whose license as a fiduciary has been suspended or revoked pursuant to section 14-5651 may not serve as an agent under a power of attorney in any capacity unless the person is related to the principal by blood, adoption or marriage. This prohibition does not apply if the person's license has been reinstated and is in good standing. 36-3224. Sample health care power of attorney Any writing that meets the requirements of section 36-3221 may be used to create a health care power of attorney. The following form is offered as a sample only and does not prevent a person from using other language or another form: 1. Health Care Power of Attorney I, ___________________________________, as principal, designate ______________________ as my agent for all matters relating to my health care, including, without limitation, full power to give or refuse consent to all medical, surgical, hospital and related health care. This power of attorney is effective on my inability to make or communicate health care decisions. All of my agent's actions under this power during any period when I am unable to make or communicate health care decisions or when there is uncertainty whether I am dead or alive have the same effect on my heirs, devisees and personal representatives as if I were alive, competent and acting for myself. If my agent is unwilling or unable to serve or continue to serve, I hereby appoint ____________________ as my agent. I have _____ I have not _____ completed and attached a living will for purposes of providing specific direction to my agent in situations that may occur during any period when I am unable to make or communicate health care decisions or after my death. My agent is directed to implement those choices I have initialed in the living will. I have _____ I have not _____ completed a prehospital medical care directive pursuant to section 36-3251, Arizona Revised Statutes. This health care directive is made under section 36-3221, Arizona Revised Statutes, and continues in effect for all who may rely on it except those to whom I have given notice of its revocation. ______________________________ Signature of Principal Witness: _____________________ Date: _____________________ _______________________________ Time: _____________________ Address: _____________________ ____________________________ _______________________________ ____________________________ Address of Agent Witness: _____________________ ____________________________ _______________________________ Telephone of Agent Address: _____________________ _______________________________ (Note: This document may be notarized instead of being witnessed.) 2. Autopsy (under Arizona law an autopsy may be required) If you wish to do so, reflect your desires below: _______ 1. I do not consent to an autopsy. _______ 2. I consent to an autopsy. _______ 3. My agent may give consent to or refuse an autopsy. 3. Organ Donation (Optional) (Under Arizona law, you may make a gift of all or part of your body to a bank or storage facility or a hospital, physician or medical or dental school for transplantation, therapy, medical or dental evaluation or research or for the advancement of medical or dental science. You may also authorize your agent to do so or a member of your family may make a gift unless you give them notice that you do not want a gift made. In the space below you may make a gift yourself or state that you do not want to make a gift. If you do not complete this section, your agent will have the authority to make a gift of a part of your body pursuant to law. Note: The donation elections you make in this health care power of attorney survive your death.) If any of the statements below reflects your desire, initial on the line next to that statement. You do not have to initial any of the statements. If you do not check any of the statements, your agent and your family will have the authority to make a gift of all or part of your body under Arizona law. _______ I do not want to make an organ or tissue donation and I do not want my agent or family to do so. _______ I have already signed a written agreement or donor card regarding organ and tissue donation with the following individual or institution: ___________________________________ _______ Pursuant to Arizona law, I hereby give, effective on my death: [] Any needed organ or parts. [] The following part or organs listed: _____________________________________________________ _____________________________________________________ _____________________________________________________ for (check one): [] Any legally authorized purpose. [] Transplant or therapeutic purposes only. 4. Physician Affidavit (Optional) (Before initialing any choices above you may wish to ask questions of your physician regarding a particular treatment alternative. If you do speak with your physician it is a good idea to ask your physician to complete this affidavit and keep a copy for his file.) I, Dr. ___________________________ have reviewed this guidance document and have discussed with _______________ any questions regarding the probable medical consequences of the treatment choices provided above. This discussion with the principal occurred on _________________. (date) I have agreed to comply with the provisions of this directive. ___________________________ Signature of Physician 5. Living Will (Optional. Section 36-3262, Arizona Revised Statutes, has a sample living will.) 6. Funeral and Burial Disposition (Optional) My agent has authority to carry out all matters relating to my funeral and burial disposition wishes in accordance with this power of attorney, which is effective upon my death. My wishes are reflected below: _______ Upon my death, I direct my body to be buried. (as opposed to cremated) _______ Upon my death, I direct my body to be buried in ___________________________________________________. (Optional directive) _______ Upon my death, I direct my body to be cremated. _______ Upon my death, I direct my body to be cremated, with my ashes to be_______________________________________. (Optional directive) _______ My agent may make all funeral and burial disposition decisions. (Optional directive) 36-3231. Surrogate decision makers; priorities; limitations A. If an adult patient is unable to make or communicate health care treatment decisions, a health care provider shall make a reasonable effort to locate and shall follow a health care directive. A health care provider shall also make a reasonable effort to consult with a surrogate. If the patient has a health care power of attorney that meets the requirements of section 36-3221, the patient's designated agent shall act as the patient's surrogate. However, if the court appoints a guardian for the express purpose of making health care treatment decisions, that guardian shall act as the patient's surrogate. If neither of these situations applies, the health care provider shall make reasonable efforts to contact the following individual or individuals in the indicated order of priority, who are available and willing to serve as the surrogate, who then have the authority to make health care decisions for the patient and who shall follow the patient's wishes if they are known: 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. 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. B. 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. C. A person who makes a good faith medical decision pursuant to this section is immune from liability to the same extent and under the same conditions as prescribed in section 36-3205. D. A surrogate may make decisions about mental health care treatment on behalf of a patient if the patient is found incapable. However, a surrogate who is not the patient's agent or guardian shall not make decisions to admit the patient to an inpatient psychiatric facility licensed by the department of health services, except as provided in subsection E of this section or section 14-5312.01, 14-5312.02 or 36-3281. E. If the admitting officer for a mental health care provider has reasonable cause to believe after examination that the patient is incapable as defined in section 36-3281 and is likely to suffer serious physical harm or serious illness or to inflict serious physical harm on another person without immediate hospitalization, the patient may be admitted for inpatient treatment in an inpatient psychiatric facility based on informed consent given by any surrogate identified in subsection A of this section. The patient shall be discharged if a petition for court ordered evaluation or for temporary guardianship requesting authority for the guardian to consent to admission to an inpatient psychiatric facility has not been filed within forty-eight hours of admission or on the following court day if the forty-eight hours expires on a weekend or holiday. The discharge requirement prescribed in this section does not apply if the patient has given informed consent to voluntary treatment or if a mental health care provider is prohibited from discharging the patient under federal law. 36-3251. Prehospital medical care directives; form; effect; immunity; definitions A. Notwithstanding any law or a health care directive to the contrary, a person may execute a prehospital medical care directive that, in the event of cardiac or respiratory arrest, directs the withholding of cardiopulmonary resuscitation by emergency medical system personnel, hospital emergency department personnel and, as provided in subsection L of this section, direct care staff persons. For the purposes of this article, "cardiopulmonary resuscitation" includes cardiac compression, endotracheal intubation and other advanced airway management, artificial ventilation, defibrillation, administration of advanced cardiac life support drugs and related emergency medical procedures. Authorization for the withholding of cardiopulmonary resuscitation does not include the withholding of other medical interventions, such as intravenous fluids, oxygen or other therapies deemed necessary to provide comfort care or to alleviate pain. B. A prehospital medical care directive shall be printed on an orange background and may be used in either letter or wallet size. The directive shall be in the following form: Prehospital Medical Care Directive (side one) In the event of cardiac or respiratory arrest, I refuse any 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. Patient: ______________________ date: ________________ (Signature or mark) Attach recent photograph here or provide all of the following information below: Date of birth ________ sex _____ Eye color ________ hair color ______ race ______ Hospice program (if any) _____________________________ Name and telephone number of patient's physician ______________________________________________________ (side two) I have explained this form and its consequences to the signer and obtained assurance that the signer understands that death may result from any refused care listed above. ________________________________ date __________ (Licensed health care provider) I was present when this was signed (or marked). The patient then appeared to be of sound mind and free from duress. ________________________________ date ___________ (Witness) C. A person who has a valid prehospital medical care directive pursuant to this section may wear an identifying bracelet on either the wrist or the ankle. The bracelet shall be substantially similar to identification bracelets worn in hospitals. The bracelet shall be on an orange background and state the following in bold type: Do Not Resuscitate Patient: _________________________________________ Patient's physician: _____________________________ D. If the person has designated an agent to make health care decisions under section 36-3221 or has been appointed a guardian for health care decisions pursuant to title 14, that agent or guardian shall sign if the person is no longer competent to do so. E. A prehospital medical care directive is effective until it is revoked or superseded by a new document. F. Emergency medical system personnel, hospital emergency department personnel, direct care staff persons and any civilian bystanders who make a good faith effort to identify the patient and who rely on an apparently genuine directive, an indicator as prescribed in section 28-3167 on the patient's driver license or nonoperating identification license or a photocopy of a directive on orange paper are immune from liability to the same extent and under the same conditions as prescribed in section 36-3205. If a person has any doubt as to the validity of a directive or the medical situation, that person shall proceed with resuscitative efforts as otherwise required by law. Emergency medical system personnel and direct care staff persons are not required to accept or interpret medical care directives that do not meet the requirements of this section. G. In the absence of a physician, a person without vital signs who is not resuscitated pursuant to a prehospital medical care directive may be pronounced dead by any peace officer of this state, a professional nurse licensed pursuant to title 32, chapter 15 or an emergency medical technician certified pursuant to this title. H. This section does not apply to situations involving mass casualties or to medical emergencies involving children and adults with disabilities in public or private schools that are not licensed health care institutions as defined in section 36-401. I. After being notified of a death by emergency medical system personnel, the person's physician or the county medical examiner is then responsible for signing the death certificate. J. The office of emergency medical services in the department of health services shall print prehospital medical care directive forms and make them available to the public. The department may charge a fee that covers the department's costs to prepare the form. The department and its employees are immune from civil liability for issuing prehospital medical care directive forms that meet the requirements of this section. A person may use a form that is not prepared by the department of health services if that form meets the requirements of this section. If an organization distributes a prehospital medical care directive form that meets the requirements of this section, that organization and its employees are also immune from civil liability. K. Any prehospital medical care directive prepared before April 24, 1994 is valid if it was valid at the time it was prepared. L. A direct care staff person may comply with a prehospital medical care directive pursuant to this section if the physician of the person who has the valid prehospital medical care directive has ordered a hospice plan of care. M. The department of economic security or the Arizona health care cost containment system administration may prescribe guidance for training and education of direct care staff persons regarding the requirements of this section. N. For the purposes of this section: 1. "Direct care staff person" means a person who is employed or contracted to provide direct services pursuant to title 36, chapter 5.1. 2. "Emergency medical system personnel" includes emergency medical technicians at all levels who are certified by the department of health services and medical personnel who are licensed by this state and who are operating outside of an acute care hospital under the direction of an emergency medical system agency recognized by the department of health services. 36-3261. Living will; verification; liability A. An adult may prepare a written statement known as a living will to control the health care treatment decisions that can be made on that person's behalf. The person may use the living will as part of or instead of a health care power of attorney or to disqualify a surrogate. B. If the living will is not part of a health care power of attorney, the person shall verify his living will in the same manner as prescribed by section 36-3221. C. A health care provider who makes good faith health care decisions based on the provisions of an apparently genuine living will is immune from criminal and civil liability for those decisions to the same extent and under the same conditions as prescribed in section 36-3205. 36-3262. Sample living will Any writing that meets the requirements of this article may be used to create a living will. A person may write and use a living will without writing a health care power of attorney or may attach a living will to the person's health care power of attorney. If a person has a health care power of attorney, the agent must make health care decisions that are consistent with the person's known desires and that are medically reasonable and appropriate. A person can, but is not required to, state the person's desires in a living will. The following form is offered as a sample only and does not prevent a person from using other language or another form: Living Will (Some general statements concerning your health care options are outlined below. If you agree with one of the statements, you should initial that statement. Read all of these statements carefully before you initial your selection. You can also write your own statement concerning life-sustaining treatment and other matters relating to your health care. You may initial any combination of paragraphs 1, 2, 3 and 4 but if you initial paragraph 5 the others should not be initialed.) _____ 1. If I have a terminal condition I do not want my life to be prolonged and I do not want life-sustaining treatment, beyond comfort care, that would serve only to artificially delay the moment of my death. _____ 2. If I am in a terminal condition or an irreversible coma or a persistent vegetative state that my doctors reasonably feel to be irreversible or incurable, I do want the medical treatment necessary to provide care that would keep me comfortable, but I do not want the following: _____ (a) Cardiopulmonary resuscitation, for example, the use of drugs, electric shock and artificial breathing. _____ (b) Artificially administered food and fluids. _____ (c) To be taken to a hospital if at all avoidable. _____ 3. Notwithstanding my other directions, if I am known to be pregnant, I do not want life-sustaining treatment withheld or withdrawn if it is possible that the embryo/fetus will develop to the point of live birth with the continued application of life-sustaining treatment. _____ 4. Notwithstanding my other directions I do want the use of all medical care necessary to treat my condition until my doctors reasonably conclude that my condition is terminal or is irreversible and incurable or I am in a persistent vegetative state. _____ 5. I want my life to be prolonged to the greatest extent possible. Other or Additional Statements of Desires I have _____ I have not _____ attached additional special provisions or limitations to this document to be honored in the absence of my being able to give health care directions. 36-3281. Mental health care power of attorney; scope; definition A. An adult, known as the principal, pursuant to section 36-3282 may designate another adult or adults, known as the agent, to act as an agent and to make mental health care decisions on that person's behalf. The principal may also designate an alternate adult or adults to act as agent if the original designated agent or agents are unwilling or unable to act. B. An agent under section 36-3283 may make decisions about mental health treatment on behalf of the principal if the principal is found incapable. If an adult does not have a mental health care power of attorney pursuant to this section, an agent with a health care power of attorney under section 36-3221 may make decisions about mental health treatment on behalf of the principal if the principal is found incapable, except as provided in section 36-3283, subsection F. These decisions shall be consistent with any wishes the principal has expressed in the mental health care directive, mental health care power of attorney, health care power of attorney or other advance directive. C. An agent shall not be a person who is directly involved with the provision of health care to the principal at the time the mental health care power of attorney is executed. D. For the purposes of this section, "incapable" means that in the opinion of a physician who is licensed pursuant to title 32, chapter 13 or 17 and who is a specialist in neurology or psychiatry or a psychologist who is licensed pursuant to title 32, chapter 19.1, a person lacks the ability to give informed consent as defined in section 36-501. 36-3282. Execution requirements A. To be valid, a mental health care power of attorney shall: 1. Be executed by a principal who is not incapable, as defined in section 36-3281. 2. Be in writing. 3. Contain language that clearly indicates that the principal intends to create a mental health care power of attorney. 4. Except as provided pursuant to subsection C of this section, be dated and signed or marked by the principal. 5. Be notarized or witnessed in writing by at least one adult who affirms that the notary or witness was present when the principal dated and signed or marked the mental health care power of attorney and that the principal appeared to be of sound mind and free from duress, fraud or undue influence at that time. B. If a mental health care power of attorney expressly provides that the agent can admit the principal to an inpatient psychiatric facility licensed by the department of health services, each paragraph that grants this authority must be separately initialed by the principal at the time the mental health care power of attorney is signed and witnessed. C. If the principal is physically unable to sign or mark a mental health care power of attorney, the notary and each witness shall verify on the document that the principal indicated to the notary or witness that the mental health care power of attorney expressed the principal's wishes and that the principal intended to adopt the mental health care power of attorney at that time. D. A notary or witness shall not be any of the following: 1. A person designated to make medical decisions on the principal's behalf. 2. A professional care provider directly involved with the provision of care to the principal at the time the mental health care power of attorney is executed. E. If a mental health care power of attorney is witnessed by only one person, that person shall not be either: 1. Related to the principal by blood, marriage or adoption. 2. Entitled to any part of the principal's estate by will or by operation of law at the time that the power of attorney is executed. F. A mental health care power of attorney may be used as part of or independent of a health care power of attorney as defined in section 36-3201. 36-3283. Powers and duties of an agent A. An agent may make mental health care decisions for the principal while the principal is incapable, as defined in section 36-3281. B. Except as limited by subsection F of this section, an agent's authority to make mental health care decisions is limited only by the express language of the mental health care power of attorney or by a court order pursuant to section 36-3206. C. The appointment of a person to act as an agent is effective until that authority is revoked by the principal or by a court order. D. An agent has the same right as the principal to receive information and to review the principal's medical records regarding proposed mental health treatment and to receive, review and consent to the disclosure of medical records relating to that treatment. E. An agent shall act consistently with the wishes of the principal as expressed in the mental health care power of attorney. Except as limited by subsection F of this section, if the principal's wishes are not expressed in the mental health care power of attorney and are not otherwise known by the agent, the agent shall act in accordance with what the agent in good faith believes to be in the principal's best interests. F. An agent may consent to admit the principal to an inpatient psychiatric facility licensed by the department of health services if this authority is expressly stated in the mental health care power of attorney or health care power of attorney under section 36-3221. G. An agent is not subject to criminal or civil liability for decisions made in good faith pursu