Compassion & Choices Arizona
Arizona

ARIZONA REVISED STATUTES
TITLE 36 - PUBLIC HEALTH AND SAFETY
CHAPTER 32 - LIVING WILLS AND HEALTH CARE DIRECTIVES

Article 1 - General Provisions
36-3201 - Definitions
36-3202 - Revocation of health care directive; disqualification of surrogate
36-3203 - Surrogate; authority; responsibilities; immunity
36-3204 - Responsibilities of health care providers
36-3205 - Health care providers; immunity from liability; conditions
36-3206 - Enforcement or challenge of a directive or decision; judicial proceedings; automatic stays
36-3207 - Health care directives; effect on insurance and medical coverage
36-3208 - Prior and out of state health care directives; validity
36-3209 - Health care directives; conflicts
36-3210 - Suicide; mercy killing
Article 2 - Health Care Power of Attorney
36-3221 - Health care power of attorney; scope; requirements; limitations; fiduciaries
36-3222 - Health care power of attorney; amendments
36-3223 - Agents; powers and duties; removal; responsibility; fiduciaries
36-3224 - Sample health care power of attorney
Article 3 - Surrogate Decision Makers
36-3231 - Surrogate decision makers; priorities; limitations
Article 4 - Prehospital Medical Care Directives
36-3251 - Prehospital medical care directives; form; effect; definition
Article 5 - Living Will
36-3261 - Living will; verification; liability
36-3262 - Sample living will
Article 6 - Mental Health Care Power of Attorney
36-3281 - Mental health care power of attorney; scope; definition
36-3282 - Execution requirements
36-3283 - Powers and duties of an agent
36-3284 - Operation of mental health care power of attorney; duties of physician or mental health care provider
36-3285 - Revocation; disqualification of agent
36-3286 - Sample mental health care power of attorney
36-3287 - Surrogate; mental health care power of attorney
Article 7 - Health Care Directives Registry
36-3291 - Health care directives registry; website
36-3292 - Filing requirements
36-3293 - Effect of nonregistration or revocation
36-3294 - Registration; purge of registered documents
36-3295 - Registry information; confidentiality; transfer of information
36-3296 - Liability; limitation
36-3297 - Health care directives registry fund

Article 1 - General Provisions

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 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 13, 15, 17 or 25.

8. "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.

9. "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.

10. "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.

11. "Physician" means a doctor of medicine licensed pursuant to title 32, chapter 13 or doctor of osteopathy licensed pursuant to title 32, chapter 17.

12. "Principal" means a person who is the subject of a health care power of attorney.

13. "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

A person may revoke his 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 disabled 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

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.

36-3210.  Suicide; mercy killing

This chapter does not approve or authorize suicide, assisted suicide or mercy killing.

Article 2 - Health Care Power of Attorney

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)

Article 3 - Surrogate Decision Makers

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 a level one behavioral health 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, subsection D 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 a level one behavioral health 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 a level one behavioral health 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.

Article 4 - Prehospital Medical Care Directives

36-3251.  Prehospital medical care directives; form; effect; definition

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 and hospital emergency department personnel. 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 and hospital emergency department personnel who make a good faith effort to identify the patient and who rely on an apparently genuine directive 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 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 disabled adults 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. For the purposes of this section, "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.

Article 5 - Living Will

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.

Article 6 - Mental Health Care Power of Attorney

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 psychiatry or a psychologist who is licensed pursuant to title 32, chapter 19.1, a person's inability 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 32-3281.

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 a level one behavioral health 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 a level one behavioral health 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 and pursuant to a mental health care power of attorney or health care power of attorney.

36-3284 - Operation of mental health care power of attorney; duties of physician or mental health care provider

A. A mental health care power of attorney is effective when it is executed and remains in effect until it is revoked by the principal pursuant to section 36-3285 or by court order.

B. If the mental health care power of attorney specifically authorizes the agent to admit the principal to a level one behavioral health facility, a principal shall not be admitted to a level one behavioral health facility licensed by the department of health services unless a physician who is licensed pursuant to title 32, chapter 13 or 17 and who is a specialist in psychiatry or a psychologist who is licensed pursuant to title 32, chapter 19.1 does all of the following:

1. Conducts an investigation that carefully probes the principal's psychiatric and psychological history, diagnosis and treatment needs.

2. Conducts a thorough interview with the principal and the agent.

3. Obtains the agent's informed consent, as defined in section 36-501.

4. Makes a written determination that the principal needs an inpatient evaluation or will benefit from care and treatment of a mental disorder or other personality disorder or emotional condition in the program and that the evaluation or treatment cannot be accomplished in a less restrictive setting.

5. Documents in the principal's medical chart a summary of the doctor's findings and recommendations for treatment.

C. The level one behavioral health facility licensed by the department of health services shall conduct a review of the principal's condition and need for admission into the facility and assess the appropriateness of the principal's placement at least once every thirty days. The agent may participate in each review. If possible the agent shall participate in person.

36-3285 - Revocation; disqualification of agent

A. Unless limited by the express authority in the document, a principal even if incapable, as defined in section 36-3281, may revoke all or any part of the principal's mental health care power of attorney by doing any of the following:

1. Making a written revocation of the mental health care power of attorney or a written statement to disqualify an agent.

2. Orally notifying the agent or a mental health care provider.

3. Making a new mental health care power of attorney.

4. Any other act that demonstrates a specific intent to revoke a mental health care power of attorney or disqualify an agent.

B. Unless a facility has instituted proceedings pursuant to section 36-533, if a principal who is a patient in a mental health facility revokes a mental health care power of attorney and requests a discharge in writing, the facility shall discharge that person within twenty-four hours after it receives this request, excluding weekends and legal holidays. The discharge requirement prescribed in this section does not apply if a mental health care provider is prohibited from discharging the person under federal law.

36-3286 - Sample mental health care power of attorney

A person may use any writing that meets the requirements of sections 36-3281 and 36-3282 to create a mental 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.

Mental Health Care Power of Attorney

I, ________________, being an adult of sound mind, voluntarily make this declaration for mental treatment. I want this declaration to be followed if I am incapable, as defined in section 36-3281, Arizona Revised Statutes. I designate _________________ as my agent for all matters relating to my mental health care including, without limitation, full power to give or refuse consent to all medical care related to my mental health condition. If my agent is unable or unwilling to serve or continue to serve, I appoint ____________________, as my agent. I want my agent to make decisions for my mental health care treatment that are consistent with my wishes as expressed in this document or, if not specifically expressed, as are otherwise known to my agent.

If my wishes are unknown to my agent, I want my agent to make decisions regarding my mental health care that are consistent with what my agent in good faith believes to be in my best interests. My agent is also authorized to receive information regarding proposed mental health treatment and to receive, review and consent to disclosure of any medical records relating to that treatment.

This declaration allows me to state my wishes regarding mental health care treatment including medications, admission to and retention in a health care facility for mental health treatment and outpatient services.

(initial one of the following)

_____ This mental health care power of attorney is irrevocable if I am unable to give informed consent.

_____ This mental health care power of attorney is revocable at all times.

The following are my wishes regarding my mental health care treatment if I become incapable, as defined in section 36-3281, Arizona Revised Statutes:

I consent to the following mental health treatments:

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

By initialing here, I consent to giving my agent the power to admit me to an inpatient or partial psychiatric hospitalization program, please initial here: ____ (initial if you consent)

I do not consent to the following mental health treatments:

_____________________________________________________

_____________________________________________________

_____________________________________________________

_____________________________________________________

Additional information about my mental health care treatment needs (consider including mental or physical health history, dietary requirements, religious concerns, people to notify and any other matters that you feel are important):

_____________________________________________________

_____________________________________________________

_____________________________________________________

This mental health care power of attorney is made pursuant to title 36, chapter 32, article 6, Arizona Revised Statutes, and continues in effect for all who may rely on it except to those I have given notice of its revocation pursuant to section 36-3285.

_____________________________________
(signature of principal)

Address of agent________________________________________

________________________________________________________

Telephone number of agent_______________________________

Address of backup agent________________________________

________________________________________________________

Telephone number of backup agent_______________________

Affirmation of witnesses:

I affirm that the person signing this mental health care power of attorney:

1. Is personally known to me.

2. Signed or acknowledged by his or her signature on this declaration in my presence.

3. Appears to be of sound mind and not under duress, fraud or undue influence.

4. Is not related to me by blood, marriage or adoption.

5. Is not a person for whom I directly provide care as a professional.

6. Has not appointed me as an agent to make medical decisions on his or her behalf.

Witnessed by:

__________________________________ (signature and date)

__________________________________ (signature and date)

Acceptance of appointment as agent: (optional)

I accept this appointment and agree to serve as agent to make mental health treatment decisions for the principal. I understand that I must act consistently with the wishes of the person I represent, as expressed in this mental health care power of attorney, or if not expressed, as otherwise known by me. If I do not know the principal's wishes, I have a duty to act in what I in good faith believe to be that person's best interests. I understand that this document gives me the authority to make decisions about mental health treatment only while that person has been determined to be incapable as that term is defined in section 36-3281, Arizona Revised Statutes.

_____________________________________
(signature of agent)

_____________________________________
(printed name of agent)

36-3287 - Surrogate; mental health care power of attorney

The provisions of this chapter that relate to the powers and duties of surrogates apply to a mental health care power of attorney.

Article 7 - Health Care Directives Registry

36-3291 - Health care directives registry; website

A. Subject to the availability of monies, the secretary of state shall establish and maintain a health care directives registry.

B. The registry shall be accessible through a website maintained by the secretary of state.

C. The secretary of state may accept gifts, grants, donations, bequests and other forms of voluntary contributions to support, promote and maintain the registry.

36-3292 - Filing requirements

A. A person may submit to the secretary of state, in a form prescribed by the secretary of state, the following documents and any revocations of these documents for registration:

1. A health care power of attorney.

2. A living will.

3. A mental health care power of attorney.

B. The person who submits a document for registration pursuant to this section must provide a return address.

C. Documents submitted pursuant to this section must be notarized or witnessed as prescribed by this chapter.

36-3293 - Effect of nonregistration or revocation

A. Failure to register a document with the secretary of state pursuant to this article does not affect the validity of a health care directive.

B. Failure to notify the secretary of state of the revocation of a document filed pursuant to this article does not affect the validity of a revocation that otherwise meets the requirements for a revocation pursuant to this chapter.

36-3294 - Registration; purge of registered documents

A. On receipt of a completed registration form, the secretary of state shall create a digital reproduction of the form, enter the reproduced form into the health care directives registry database and assign each registration a unique file number and password.

B. The secretary of state is not required to review a document to ensure that it complies with the particular statutory requirements applicable to the document.

C. After entering the reproduced document into the registry database, the secretary of state shall return the original document to the person who submitted the document and provide that person with a printed record of the information entered into the database under the file number and a wallet size card that contains the document's file number and a password.

D. The person who submitted the document shall review the printed record. If the information is accurate, the person shall check the box marked "no corrections required" and sign and return the printed record to the secretary of state's office.

E. If the person who submitted the document determines that the printed record is inaccurate, the person shall correct the information and sign and return the corrected printed record to the secretary of state. On receipt of a corrected printed record, the secretary of state shall make the proper corrections and send a corrected printed record to the person who submitted the document. If the information is accurate, the person shall check the box marked "no corrections required" and sign and return the printed record to the secretary of state's office.

F. The secretary of state shall activate the entry into the health care directives registry database only after receiving a printed record marked "no corrections required".

G. The secretary of state shall delete a document filed with the registry pursuant to this section when the secretary of state receives a revocation of a document along with that document's file number and password.

H. The entry of a document pursuant to this article does not:

1. Affect the validity of the document.

2. Relate to the accuracy of information contained in the document.

3. Create a presumption regarding the validity of the document or the accuracy of information contained in the document.

I. The secretary of state shall purge a document filed with the registry on verification by the director of the department of health services of the death of the person who submitted the document. The secretary of state shall purge the registry of documents pursuant to this subsection at least once every five years. The director of the department of health services shall share its registry of death certificates with the secretary of state in order to conduct the document purge required by this subsection.

36-3295 - Registry information; confidentiality; transfer of information

A. The registry established pursuant to this article is accessible only by entering the file number and password on the internet web site.

B. Registrations, file numbers, passwords and any other information maintained by the secretary of state pursuant to this article are confidential and shall not be disclosed to any person other than the person who submitted the document or the person's personal representative.

C. Notwithstanding subsection B, a health care provider may access the registry and receive a patient's health care directive documents for the provision of health care services by submitting the patient's file number and password.

D. The secretary of state shall use information contained in the registry only for purposes prescribed in this article.

E. At the request of a person who submitted the document, the secretary of state may transmit the information received regarding the health care directive to the registry system of another jurisdiction as identified by the person.

36-3296 - Liability; limitation

A. Except for acts of gross negligence, wilful misconduct or intentional wrongdoing, this state is not subject to civil liability for any claims or demands arising out of the administration or operation of the registry established pursuant to this article.

B. This article does not require a health care provider to request from the registry information about whether a patient has executed a health care directive. A health care provider who makes good faith health care decisions in reliance on the provisions of an apparently genuine health care directive received from the registry is immune from criminal and civil liability to the same extent and under the same conditions as prescribed in section 36-3205.

C. This article does not affect the duty of a health care provider to provide information to a patient regarding health care directives pursuant to federal law.

36-3297 - Health care directives registry fund

A. The health care directives registry fund is established consisting of monies received pursuant to this article. The secretary of state shall administer the fund. Monies in the fund are continuously appropriated.

B. On notice from the secretary of state, the state treasurer shall invest and divest monies in the fund as provided by section 35-313, and monies earned from investment shall be credited to the fund.

C. The secretary of state shall use fund monies to support, promote and maintain the registry.

D. Fund monies shall not include monies appropriated from the state general fund.