Beyond any advance directives, what you most need is an Advocate or “Surrogate” (Surrogate is the AZ legal term, sometimes called “proxy” or "agent" or “advocate”).

Having encountered some people in Tucson who are alone and have no one to represent them, I'm willing to fill that void. I am available for hire to serve as your advocate/surrogate/proxy should you become institutionalized in a care facility or hospital.  As such, I will do my utmost to make sure that, in terms of medical care or treatment, you absolutely get only what you want and do not get what you do not want!

The sad fact is that advance directives alone do not work.  A growing body of evidence that suggests your instructions are all too often ignored when it comes to end of life care.

I maintain that one needs an advocate even when not terminally ill or is not yet unable to speak for oneself. To be a "patient" is to be acted upon, and it is extremely difficult to be assertive, thorough, and fully in charge of your care when distressed and in a hospital or care facility.

Whoever you choose to represent you, it is best if your advocate:
    Is legal with Medical Durable Power of Attorney;
    Is thoroughly familiar with your wishes – physical, emotional, and spiritual state -- communicates often and is give specific information, at least every 6 months;
    Is introduced to others involved with your care;
    Has original signed documents of any advance directives;
    Is not an immediate relative;    
    Has people skills, impeccable integrity, and honesty, and is completely trustworthy;
    Is articulate, assertive, and can be a SOB or witch on wheels if necessary.

The terminally ill in our society are subject to and vulnerable to the will of others.  All too often they are  --
Bedridden and hidden with the topic forbidden,
dehumanized and marginalized,
drugged and plugged,
medicalized and bureaucratized,
under appreciated, needlessly emaciated and overly sedated,
alive but deprived,
isolated and denigrated,
neglected and rejected,
used and abused, and even adroitly exploited.

    I would contract with you to serve as your advocate, accepting in advance private payment exclusively; I would not be reimbursed by Medicare, Medicaid, HMO's, insurance or anyone else involved with care. Additionally, it is my policy as Advocate to never accept referral fees, or "kick-backs" from home health care agencies, assisted living facilities, nursing homes, physicians, attorneys, or vendors. In this way, I advocate strictly for my clients and maintain my integrity and total independence. Please contact me at 520-235-5646 (J-O-H-N) or for a listing of exactly what services are provided or for a copy of the most recent fee schedule.
I have posted the video about "How to be a Very, Very, Good Advocate" on YouTube if you care to watch it. It is 28 minutes and 33 seconds long. It is easiest to view on "full screen" mode.
It's about how to be a very good advocate/surrogate/health care agent/proxy -- the terms vary from state to state. Made about 13 years ago yet all the more pertinent these days.
At the end is a small tribute to Earl, Eloise, and John who have since died. Earl Wettstein was a founding member of Final Exit Network, and John Westover was twice national President of the Hemlock Society, from which Final Exit Network emerged. Tucson was the first city to have a local chapter of the Hemlock Society.
 Please feel free to post a "comment" below on the YouTube site. I hope this is helpful. Here is the link to YouTube:

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