A simplified prehospital advance directive law: Arizona's approach

Abstract

Many of the approximately 400,000 deaths that occur outside of hospitals or chronic care facilities each year in the United States are not only expected but also welcomed as relief from terminal disease. However, patients who lack decision-making capacity cannot communicate to emergency medical services system and emergency department personnel their wish not to be the recipient of advanced life support procedures. Prehospital advance directives (PHAD) offer that opportunity. Arizona is only the fourth state to pass a PHAD statute and the first to simplify the law so it is interpreted easily by both providers and patients. PHAD laws need not be complex, either in their language or in their implementation requirements. Simple and easily understood statues and their resulting directives increase the likelihood that those most likely to need and use this directive will be able to comply with its provisions. Arizona's law addresses several controversial areas yet to be worked out by other states. Placing the PHAD in statute ensures that a statewide attempt will be made to comply with its provisions, and as a law it should be more permanent than advance directive protocols based on administrative fiat. Physicians in other states may want to follow Arizona's lead and employ a joint effort by their state's bar association, hospital association, and medical association to smooth the passage of similar legislation. All parties involved, however, must not seek a perfect statute. Arizona's experience suggests that legislators will need to strike a balance between the needs of the citizens and the fears of lawyers wary of any potential liability for the state or the emergency medical services system.