Clients often wonder about DNR (or “Do Not Resuscitate”) orders — and how to make sure they have one entered in their own medical records. Arizona does recognize DNR orders. Many patients (and not a few medical professionals) are confused, though, about the different forms, terminology and choices.
There are a few different kinds of medical orders in Arizona. Any or all of those forms can be registered with the Arizona Healthcare Directives Registry. Registration gives healthcare providers access so they can provide your desired treatment. But first you have to figure out which forms you want to sign.
Arizona’s Prehospital Medical Care Directive (The Orange Form)
The Orange Form is, as you might expect, an orange sheet of paper. This medical order tells Emergency Medical Services (EMS) your preference for no resuscitation efforts. If you stop breathing or your heart stops beating, EMS should not take any action to restart your breathing or your heart.
Many authorities recommend that you keep this medical order in (or on) your refrigerator. Most people have a refrigerator, and EMS knows to look there. Assure that it is both protected and visible: put it in a protective but transparent sleeve. Some people post their orange forms on the refrigerator door. That works, as does using the main compartment or even the freezer. But keep it visible and accessible.
Arizona’s “orange form” is popular and useful, but it is not, technically, a DNR order. That is true even though the state-provided version of the form bears the prominent label: “Do Not Resuscitate”. The instructions with that form further confuse the issue by claiming that a DNR must always be on orange paper — that is simply not correct, though the Prehospital Medical Care Directive does need to be orange.
Physician Orders for Life-Sustaining Treatment (POLST)
The POLST is a pink sheet of paper provided to physicians. It describes the types of medical treatment the patient would accept and would like to avoid. This medical order is meant to be used only in a hospital or emergency room. EMS should not look at this document. The POLST is recommended for individuals with a serious diagnosis, frail condition, or are likely to die within a year. This document must be signed by the healthcare provider as well as the patient.
Healthcare Power of Attorney
Your Healthcare Power of Attorney allows you to nominate an agent. The agent makes healthcare decisions on your behalf if you are incapacitated or unable to make decisions for yourself. Your healthcare power of attorney should include the full legal names and phone numbers of your agent and alternate agents. You should update this medical order every three to five years. This allows you to stay up to date with any changes in your life or the lives of your agents.
Of course, a healthcare power of attorney is not a DNR order. But your healthcare agent can sign the DNR consent on your behalf if it becomes necessary and appropriate.
Typical powers given to a healthcare power of attorney include the ability to: give or withhold consent for treatment and placement; review medical records; hire medical care workers; limit contact with other persons; make decisions relating to mental health care; and make final arrangements. However, you have the ability to add new powers or remove any of the powers listed above.
After you create your healthcare power of attorney, you can have it registered with the State of Arizona so medical providers can easily find your documents. The State of Arizona will also provide you with a wallet-sized card that you can carry with you to provide notice of the existence of your health care power of attorney.
Your healthcare power of attorney should include a living will provision. The living will details your wishes in regards to desired medical treatments. This document can describe specific medical conditions under which you would or would not want certain treatments. It can even specify that you would want a DNR order entered by your physician. It might specify what circumstances you think justify a DNR order, or give broad authority to your health care agent to make the decision. You can even direct that you would NOT want a DNR order.
The living will typically specifies what kinds of care an individual would want if in a terminal condition or a vegetative state that their doctors feel is likely incurable or irreversible. Arizona law permits it to be broader than that, however — it can apply even when you do not have a terminal condition but can not give direction yourself. This document often includes provisions such as your wishes about a future feeding tube (if you were unable to feed yourself), or the artificial provision of water or breathing mechanisms.
Generally, everyone should have a healthcare power of attorney with a living will provision. This document is essential to allow you to receive your desired medical care whenever you are unable to communicate your wishes. If you hire an estate planning attorney to create a will, your estate planning attorney will likely create a healthcare power of attorney with a living will provision as a part of their services. Medical orders such as the Orange Form and the POLST are more important for people near the end of their life who want to avoid receiving specific medical treatment that could extend their life.