Arizona Living Will Form

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An Arizona living will is a legal document that would allow one to provide a written statement outlining their desires with regard to their medical treatment in the event circumstances change and they are no longer able to provide instructions about their medical care on their own. With this document, the principal states the decisions they wish to express while of sound mind. No family member or friend will have the legal ability to change these decisions and so you may wish to speak with a qualified attorney, member of clergy and/or your Doctors before putting this information into your medical file.

Laws§ 36-3261 and § 36-3262

Medical Power of Attorney – If the individual writing their living will would also like to have a surrogate be able to make health care decisions on their behalf they should complete this form.

How to Write

Step 1 – Principal’s Instructions and Information – The Principal, must carefully review the information at the top of the form before continuing. Should the Principal decide that this is, in fact the form they would like to use, in the “My Information” area, they must begin by entering the following:

  • Name
  • Age
  • Address
  • Date of birth
  • Telephone Number

Step 2 – End of Life Care Decisions – Provided in this section are some general statements with regard to decisions you (Principal) may be interested in making for your health care at the end of your life. The Principal must review the information in statements A through E and initial only those you wish to be used in an end of life situation. If you would select option E, you need not initial any other lines. Review the statements as stated on the form, before making your selection(s):

  • A. Comfort Care Only: 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. (NOTE: “Comfort care” means treatment in an attempt to protect and enhance the quality of life without artificially prolonging life.)
  • B. Specific Limitations on Medical Treatments I Want: (NOTE: Initial or mark one or more choices, talk to your doctor about your choices.) If I have a terminal condition, or I am in an irreversible coma or a persistent vegetative state that my doctors reasonably believe 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 the following:
  • 1.) Cardiopulmonary resuscitation, for example, the use of drugs, electric shock, and artificial breathing
  • 2.) Artificially administered food and fluids.
  • 3.) To be taken to a hospital if it is at all avoidable
  • C. Pregnancy: Regardless of any other directions I have given in this Living Will, 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.
  • D. Treatment Until My Medical Condition is Reasonably Known: Regardless of the directions I have made in this Living Will, 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.
  • E. Direction to Prolong My Life: I want my life to be prolonged to the greatest extent possible

Step 3 – Other Statements or Wishes for End of Life Care – Your living will does not have to be as simple as what is to be selected within this form. If you have other wishes for your end of life care or how you would prefer to have your medical wishes met, you may add a sheet with additional information. If you choose to make additions be certain to initial one of the following so that attention will be brought to the fact that you do have further information to be reviewed:

  • A. I have not attached additional special provisions or limitations about End of Life Care I want
  • OR
  • B. I have attached additional special provisions or limitations about End of Life Care I want

Step 4 – Principal or Witness Signature – Once you’ve completed the form, indicate by dated signature, that these are your wishes and desires for your end of life care. If you are unable to provide a signature, you may have a witness sign in your stead as follows:

  • A. I am signing this Living Will as follows:
  • Provide Principal’s Signature
  • Date Principal’s Signature in mm/dd/yyyy format
  • OR
  • B. I am physically unable to sign this Living Will, so a witness is verifying my desires as follows:
  • The witness must review carefully the Witness Verification section. If in agreement the witness must enter the following:
  • Witness’ Signature
  • Date of witness’ signature in mm/dd/yyyy format

Step 5 – Notarization – Once the notary public has witnessed the signature of the Principal or Witness, the notary must carefully review the “Witness” section just before notarization. If the notary public is in agreement with all of the statements, then the notary will complete the remainder of the document(s) and authenticate by affixing the state seal.


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