Death To Dust: What Happens To Dead Bodies?
Grave Words: Notifying Survivors About Unexpected
Ethics In Emergency Medicine
Durable Power of Attorney for Health Care (Health Care Power of
· Living Will
· Prehospital Advance Directive
has perhaps the most modern advance directive law in the country.
Simple and designed for people to download and use, Arizonans have
successfully used these documents for about a decade. There are
several unique things about these documents.
There is no requirement for patients to be "terminal"
(whatever that means) to use them.
can be used for children (such as those in home hospice programs)
as well as adults.
are ADVANCE DIRECTIVES, not physician orders. Patients initiate
prehospital advance directive law ("orange form") has
eliminated the unwanted and often accidental resuscitative efforts
in dying patients. Few other states have such a patient-friendly
device. [For additional information about this form, see: Iserson
KV: A simplified prehospital advance directive law: Arizona's
approach. Ann Emerg Med 1993;22:11:1703-1710.]
these to your legislators! There is no reason why your state can't
have such simple, usable, patient-friendly forms.
36-3224. SAMPLE HEALTH CARE
POWER OF ATTORNEY
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:
Health Care Power of Attorney
__________________________, 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
(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.
Organ Donation (Optional)
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
 Any needed organ or parts.
 The following part or organs listed:
for (check one):
 Any legally authorized purpose.
 Transplant or therapeutic purposes only.
Physician Affidavit (optional)
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 ________________.
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.)
ARS 36-3262. SAMPLE
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:
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
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
(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.
or Additional Statements of Desires
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.
ARS: 36-3251. PREHOSPITAL
MEDICAL CARE DIRECTIVES; FORM; EFFECT; DEFINITION
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" shall include
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.
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:
Medical Care Directive
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
Date of birth ______ sex ____
Eye color ________ hair color ______ race ______
Hospice program (if any) ____________________
Name and telephone number of patient's physician ________
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 ___________
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's physician: _____________________________
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.
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 photocopy thereof 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.
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.
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.
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.
Any prehospital medical care directive prepared before April 24,
1994 is valid if it was valid at the time it was prepared.
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.