A SIMPLIFIED PREHOSPITAL ADVANCE DIRECTIVE LAW - ARIZONA APPROACH

Many of the approximately 400,000 deaths that occur outside of hospita ls or chronic care facilities each year in the United States are not o nly expected but also welcomed as relief from terminal disease. Howeve r, patients who lack decision-making capacity cannot communicate to em ergency medical services system and emergency department personnel the ir wish not to be the recipient of advanced life support procedures. P rehospital advance directives (PHAD) offer that opportunity. Arizona i s only the fourth state to pass a PHAD statute and the first to simpli fy 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 i mplementation requirements. Simple and easily understood statutes and their resulting directives increase the likelihood that those most lik ely to need and use this directive will be able to comply with its pro visions. 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 ba sed on administrative fiat. Physicians in other states may want to fol low Arizona's lead and employ a joint effort by their state's bar asso ciation, hospital association, and medical association to smooth the p assage of similar legislation. All parties involved, however, must not seek a perfect statute. Arizona's experience suggests that legislator s 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.