Arizona Advance Directive Before Surgery: What Hospitals Ask For and Why

Why Hospitals Ask About Advance Directives Before Every Procedure

If you've scheduled surgery at a Banner, Dignity Health, HonorHealth, or Tucson Medical Center facility, you'll encounter this question during pre-admission intake: "Do you have an advance directive?" It's not a formality. It's a federal requirement.

Under the Patient Self-Determination Act, every Medicare/Medicaid-participating hospital must ask whether you have an advance directive, document your answer in your medical record, and provide information about your right to create one. In Arizona, that means hospitals need to know about your Healthcare Power of Attorney, Living Will, and any Prehospital DNR or POLST orders.

This matters for surgery specifically because anesthesia carries real risk. General anesthesia puts you in a state of temporary incapacity — exactly the condition your advance directives are designed to address. If something goes wrong on the table and you can't communicate, your healthcare agent and your documented wishes become the primary guide for your surgical team.

What to Bring to Pre-Op

Arizona hospitals need these documents (if you have them) during the pre-admission process:

Healthcare Power of Attorney (HCPOA): Names your decision-maker. During surgery and recovery, if complications arise and you're sedated or incapacitated, your agent is the person the surgeon calls.

Living Will: Documents your treatment preferences. Relevant if surgery leads to unexpected outcomes — cardiac arrest, stroke, prolonged coma, or a condition requiring life support decisions.

Mental Health POA: Only relevant if your surgery involves psychiatric medications or if you have a history of post-surgical delirium/psychosis where psychiatric intervention decisions may arise.

POLST or Prehospital DNR (if applicable): For patients with advanced illness undergoing palliative or elective procedures. The surgical team needs to know whether "full code" is your preference during the operation itself, even if you have a DNR for other settings.

Note: Hospitals typically ask whether you want your DNR suspended during surgery. Most patients with a DNR still want full resuscitative efforts during a planned procedure — the DNR is for situations where death is imminent from underlying disease, not surgical complications. Discuss this explicitly with your anesthesiologist.

What Happens If You Don't Have Advance Directives

You won't be turned away from surgery. No Arizona hospital refuses to operate because you lack an advance directive. But here's what you're risking:

• No designated agent: If you're incapacitated post-surgery, the hospital uses Arizona's default surrogate hierarchy (spouse → adult child → parent → sibling). If your preferred decision-maker isn't first in that hierarchy, they have no authority.
• No documented wishes: Your surgical team makes decisions based on medical judgment and whatever input your surrogate can provide. If your family disagrees about whether to continue life support, the conflict can escalate to a hospital ethics committee or even court intervention.
• Delays in care: Without a clear agent designation, medical staff may have to locate and verify the appropriate surrogate before making time-sensitive decisions.

Executing Advance Directives Before a Scheduled Procedure

If you don't have advance directives and surgery is approaching, here's how to get them done in Arizona:

Timeline: You can execute advance directives the same day if needed. There's no waiting period. But don't leave it to the morning of surgery — you need a clear head and a qualifying witness or notary.

Execution options:

• A notary public (capped at $10/signature in Arizona) — available at UPS stores, banks, and mobile notary services
• Remote Online Notarization (RON) — execute via video conference from home, legally valid in Arizona
• One adult witness who meets all exclusion requirements (not your agent, not related, not a healthcare provider, not an estate beneficiary)

Hospital social workers can often help. Most Arizona hospitals have staff who provide blank advance directive forms and can facilitate witnessing or notarization during the pre-op process. Ask during your pre-admission appointment.

AzHDR registration: If time permits, submit your executed documents to the Arizona Healthcare Directives Registry (Contexture). This ensures any facility in the state can access them electronically — useful if you're transferred to a different hospital post-surgery.

The Minimum Before Any Surgery

Even if you skip the full planning process for now, do these two things before a procedure requiring general anesthesia:

1. Name a healthcare agent in a properly executed HCPOA. One page, one witness or notary, done.
2. Tell that agent what you want if the worst happens on the table. Even a verbal conversation is better than silence — though documented preferences carry legal weight that verbal instructions don't.

The Arizona Advance Directive & Living Will Kit includes an Execution Checklist specifically designed for time-sensitive situations — so you can complete all documents correctly even on a compressed timeline before a scheduled procedure.

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