PAD Stories

"This time, with a PAD, I did not receive any treatments that I did not want. They were very respectful.  I really felt like the hospital took better care of me because I had my PAD. In fact, I think it's the best care that I've ever received."

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Arizona Q and A

Please note: the following 10 FAQs are designed to provide a quick and accessible guide to what your state’s Statutes say – or do not say – about PADs.  The FAQs do not attempt to provide a complete picture of the law in your state, nor can they take the place of legal advice.  The answers were accurate when written in December 2006.

1.  Can I write a legally-binding psychiatric advance directive (PAD)?

Yes.  The statute allows you to appoint an agent to make mental health care decisions on your behalf, should you become unable to make those decisions yourself.  There is no mandatory form as long as your document is correctly witnessed (see question 3).  However, the Office of the Arizona Attorney General has produced a recommended standard form and further information .

2.  Can I write advance instructions regarding psychiatric medications and/or hospitalization?

Yes, but not in a freestanding document.  If you want to specify instructions about medications or hospitalization, including refusals of either, they must take the form of instructions to your agent.  You should include them in your document, at sections 3 and 4.  You should also thoroughly discuss your wishes with your agent when you create your document.

3.  Does anyone have to approve my advance instructions at the time I make them?

No.  However, your advanced instructions must be contained in a written document and signed by you and either one or more witnesses or a notary.  If you choose a witness, that person must not be an employee of your health care provider, a relative of yours, or the agent you have appointed.  

4.  Can I appoint an agent to make mental health decisions for me if I become  incompetent?

Yes, as explained above.

5.  If I become incompetent, can my agent make decisions for me about medications, and/or hospitalization?

Yes.  Your agent may make any mental health decisions that you could have made if you were competent.  In particular, the statute allows your agent to admit you to a behavioral health facility, provided that is your express wish.  There is a space on the standard form to indicate your preference regarding such an admission.  If you do consent to being admitted to a behavioral health facility, you would only be admitted after an investigation by a psychiatrist or psychologist.  

6.  Does my agent have to make decisions as he/she thinks I would make them (known as “substituted judgment”), or does he/she have to make them in my “best interests”?   

Your agent must act in accordance to the preferences you have expressed in your document and your wishes as he/she otherwise knows them.  If your agent does not know your wishes, he must act in your best interests.

7.  Is there any rule that says that I can only make advanced instructions, only appoint an agent, or that I must do both?

Yes.  As explained above, the statute is designed for the appointment of an agent, not for the making of freestanding instructions.  If you appoint an agent, the extent to which you also document instructions is up to you.

8.  Before following my PAD, would my mental health care providers need a court to determine I am not competent to make a certain decision?

No.  Your PAD will be followed whenever it is the opinion of a licensed psychiatrist or psychologist that you cannot give “informed consent” – meaning that you lack the ability to understand and/or communicate treatment choices.  

9.  Does the statute say anything about when my mental health providers may decline to follow my PAD?

No.  However, if you have been involuntarily committed under Arizona law, or otherwise in an emergency, your provider is likely to be able to override your PAD.  

10.  How long does my PAD remain valid?

Your declaration remains valid as long as you do not revoke it.  You may choose whether you want your document to be revocable.  One option is to specify that your document should be irrevocable at any time you are incompetent, even if you say at that time that you do wish to revoke it.  Another option is to specify that your document should be revocable.  You may choose the conditions under which your document may be revoked.  These choices are set out in the standard form.