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What To Do When Emergency Resuscitation Is Unwanted

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In the past decade advance directives have become widespread and, at the same time, widely accepted. In fact, almost every state has adopted legislation specifically recognizing both medical powers of attorney and “living wills.” In 1992, the Arizona legislature adopted a progressive, far-reaching law on the subject.

As a result of the adoption of the 1992 law, there is no longer any doubt that both living wills and health care powers of attorney are valid in Arizona. Gone are any requirements that a person be terminally ill before such documents are valid. The law even recognizes that most people do not sign health care directives, and provides a mechanism for family members (and, in some cases, friends or other interested persons) to make most medical decisions for incapacitated patients.

Arizona law even goes one step further. It attempts to deal with one of the most difficult problems in administering advance medical directives–the response of emergency medical personnel.

Emergency medical technicians (EMTs, including paramedics) have a vital but narrow mission. They exist precisely to resuscitate patients in emergency situations, without stopping to question the patient’s history or preferences. A patient who wishes to be allowed to die peacefully is likely not to want the aggressive, sometimes even violent, treatment associated with resuscitation. In fact, some people note that the outcome of resuscitation (particularly with elderly and frail patients) is often more debilitating than the original illness or condition.

EMTs, however, correctly note that their mission is to act quickly in literal life-and-death circumstances. They do not have time to pause, ask questions of nearby family members, and review documents. They must be prepared to take decisive action in all cases.

For many years, family members of the terminally ill have been advised to avoid the problem by simply not calling on the emergency medical system. Unfortunately for that approach, the use of “911” and other emergency notification systems has become ubiquitous, and family members have a very difficult time watching even a terminally ill loved one perish without making the emergency call. Furthermore, there are many patients who are not terminally ill, but who nonetheless would not like to undergo resuscitation.

Arizona’s law tackles this problem with a separate kind of advance directive, called a Prehospital Medical Care Directive. When completed, signed and witnessed, it directs EMTs not to resuscitate even if they are called to the scene. Because it is a very potent document, and because EMTs do not have time to read individual documents, it must be in precisely the form set out by the law. It must also be on orange paper, must be signed by a medical provider (who certifies that he or she has advised the patient that lack of resuscitation could lead to death) and must include a description or picture of the patient.

The Prehospital Medical Care Directive is a unique approach to the problem of unwanted emergency resuscitation. Only one other state (Montana) has adopted a similar approach. A number of states have recently approved “Do Not Resuscitate” (DNR) orders. Unlike the DNR legislation in other states, however, the Arizona/Montana approach makes it clear that the decision is the patient’s, not the physician’s, and permits even healthy patients who fear or disapprove of emergency resuscitation to effectively make their wishes known.

Reports from EMTs indicate that the Prehospital Medical Care Directive law has worked. For a copy of the directive, or the relevant section of Arizona law, look up the Arizona Attorney General’s website on advance directives. Remember that the directive must be on (or copied onto) orange paper to be effective.

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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.