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Arizona’s “Orange Form” Permits Withholding Of CPR

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Arizona's orange form

JUNE 5, 2000 VOLUME 7, NUMBER 49

Living wills and health care powers of attorney may take care of most of the end-of-life medical decisions you (or a loved one) will face. But for many patients the final medical decisions must be made outside of the hospital setting. Rather than doctors and nurses, the treatment team may consist entirely of paramedics (or emergency medical technicians—”EMTs”).

EMTs are well-trained, and save thousands of lives every year. The United States is lucky to have an extensive system for emergency care outside the hospital; in most medical emergencies in this country, the wait for an EMT will be a matter of minutes. But EMTs are not doctors, and do not have the luxury of time for thoughtful consideration of the medical history and wishes of the patient or family.

In practice that can translate into a very real dilemma. The terminally ill patient who wishes to avoid resuscitation efforts may have a difficult time ensuring that death can come peacefully. If an emergency call is made (to 911, for example), EMTs may be forced to attempt resuscitation and to transport the patient to the nearest hospital.

As a result of that dilemma, most states have adopted some formalized version of the physicians’ “Do Not Resuscitate” instruction (usually referred to as a “DNR” order). As of late 1999, all but seven of the states (Delaware, Iowa, Mississippi, Nebraska, North Dakota, Pennsylvania and Vermont) had state laws or administrative orders permitting non-hospital DNR orders in at least some specified circumstances.

Some states have developed forms for DNR orders, like the Physician’s Order on Life Sustaining Treatment (the “POLST” form) in Oregon, which are widely recognized and used. Massachusetts, as another example, has recently instructed EMTs to resuscitate patients unless they are presented with a “Comfort Care/DNR Order Verification Protocol Form.” In both of these examples, the form sanctioned by the government and utilized by EMTs is based on the physician’s instruction.

As usual, Arizona has taken a different approach. Rather than leaving the matter to the attending physician, Arizona law permits the individual to sign his or her own instruction to withhold resuscitation. The “Pre-hospital Medical Care Directive” must be in the precise form authorized by law, and must be on orange paper. Because of the color requirement it is commonly referred to as the “orange form.” Once a patient or health care agent has signed the form, EMTs are allowed to forego resuscitation. Arizona’s law on pre-hospital medical care directives can be found at Arizona Revised Statutes section 36-3251.

An important word of caution—most patients who are not terminally ill probably will not want to direct that resuscitation not be attempted. If you are in Arizona and wish to sign the “orange form” contact Fleming & Curti, P.L.C., and we will be happy to provide one at no charge.

2 Responses

  1. How does one make the orange form available to those who would need to see it on short notice? How would an EMT even know there was such a form?

  2. MA:
    The usual answer is to either put the orange form (or, for that matter, any advance directive) in one or both of two places:
    1. At or near the bedside, especially for a bedridden patient (or one in a facility), and/or
    2. In or on the refrigerator. This is one of the places EMTs know to look.
    In addition, in Arizona you can carry a wallet version of the orange form, and you can even get an orange-colored wristband that alerts the EMTs to look in your wallet or purse.
    Finally, it is very helpful to have a fully-informed and actively-involved agent under a health care power of attorney. That will increase the chances that your wishes are known and adhered to.
    Will all that assure that an otherwise-healthy patient injured or taken ill in the community will be able to prevent emergency care in all situations? No. Your goal should be to maximize the likelihood that your wishes will be carried out, but you may not be able to get perfect compliance.

    Robert Fleming
    Fleming & Curti, PLC
    Tucson, Arizona

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Robert B. Fleming


Robert Fleming is a Fellow of both the American College of Trust and Estate Counsel and the National Academy of Elder Law Attorneys. He has been certified as a Specialist in Estate and Trust Law by the State Bar of Arizona‘s Board of Legal Specialization, and he is also a Certified Elder Law Attorney by the National Elder Law Foundation. Robert has a long history of involvement in local, state and national organizations. He is most proud of his instrumental involvement in the Special Needs Alliance, the premier national organization for lawyers dealing with special needs trusts and planning.

Robert has two adult children, two young grandchildren and a wife of over fifty years. He is devoted to all of them. He is also very fond of Rosalind Franklin (his office companion corgi), and his homebound cat Muninn. He just likes people, their pets and their stories.

Elizabeth N.R. Friman


Elizabeth Noble Rollings Friman is a principal and licensed fiduciary at Fleming & Curti, PLC. Elizabeth enjoys estate planning and helping families navigate trust and probate administrations. She is passionate about the fiduciary work that she performs as a trustee, personal representative, guardian, and conservator. Elizabeth works with CPAs, financial professionals, case managers, and medical providers to tailor solutions to complex family challenges. Elizabeth is often called upon to serve as a neutral party so that families can avoid protracted legal conflict. Elizabeth relies on the expertise of her team at Fleming & Curti, and as the Firm approaches its third decade, she is proud of the culture of care and consideration that the Firm embodies. Finding workable solutions to sensitive and complex family challenges is something that Elizabeth and the Fleming & Curti team do well.

Amy F. Matheson


Amy Farrell Matheson has worked as an attorney at Fleming & Curti since 2006. A member of the Southern Arizona Estate Planning Council, she is primarily responsible for estate planning and probate matters.

Amy graduated from Wellesley College with a double major in political science and English. She is an honors graduate of Suffolk University Law School and has been admitted to practice in Arizona, Massachusetts, New York, and the District of Columbia.

Prior to joining Fleming & Curti, Amy worked for American Public Television in Boston, and with the international trade group at White & Case, LLP, in Washington, D.C.

Amy’s husband, Tom, is an astronomer at NOIRLab and the Head of Time Domain Services, whose main project is ANTARES. Sadly, this does not involve actual time travel. Amy’s twin daughters are high school students; Finn, her Irish Red and White Setter, remains a puppy at heart.

Famous people's wills

Matthew M. Mansour


Matthew is a law clerk who recently earned his law degree from the University of Arizona James E. Rogers College of Law. His undergraduate degree is in psychology from the University of California, Santa Barbara. Matthew has had a passion for advocacy in the Tucson community since his time as a law student representative in the Workers’ Rights Clinic. He also has worked in both the Pima County Attorney’s Office and the Pima County Public Defender’s Office. He enjoys playing basketball, caring for his cat, and listening to audiobooks narrated by the authors.