Advance Directives

Deciding today about your care in the future

Competent adults have the right to refuse or accept medical treatment after their providers have told them about the procedures and risks. Competent adults also have the right through written statements and documents to make their treatment preferences known before needing the treatment and to appoint someone to make treatment decisions for them when they cannot.

Advance directives communicate your medical treatment decisions. The following summarizes Iowa las and answers questions about advance directives. This also provides information about do not resuscitate (DNR) orders and the Iowa Physician Orders for Scope of Treatment (IPOST).

These are important personal health care decisions that require careful consideration. You should talk to your medical provider about the effects of withholding or withdrawing different treatments. You also should discuss your decisions with your family, friends, healthcare care providers and other advisers, such as spiritual or legal. Although it isn’t necessary to consult an attorney for your advance directive to be legally binding, it is often helpful. Only DNRs and IPOSTs require physician’s signature.

What is an advance directive?

This document states your health care choices or names someone to make the choices for you if you cannot do so. Iowa law provides two types of advance directives:

  • Declaration Relating to the Use of Life Sustaining Procedures, known as a “living will.”
  • Durable power of attorney for health care.

What is a living will?

This is a document directing your physician to withhold or withdraw certain life-sustaining procedures if you are in a terminal condition and cannot decide for yourself.

When does the living will take effect?

It takes effect only when you have a terminal condition and cannot make decisions.

Durable power of attorney for health care

What is a durable power of attorney for health care?

This is a document to name another person (know as your “attorney in fact” or “agent”) to make health care decisions for you if you cannot make them. This agent must make decisions detailed in the document. Your agent will make decisions in your best interest if your wishes are not known.

How does a durable power of attorney for health care differ from a living will?

Both documents apply only when you cannot make health care decisions:

  • A living will directs your physician to withhold or withdraw life-sustaining procedures if you are in a terminal condition.
  • A durable power of attorney for health care lets you name an agent to make health care decisions according to your wishes. You may specify the healthcare treatments you want or don’t want. It’s not restricted to terminal conditions or decisions about life-sustaining procedures.

Who should be my agent?

The person you name in a durable power of attorney for health care should be someone you trust and has consented to function as your agent.

Completing the documents

Where can I get living will or durable power of attorney for health care forms?

Visit the Iowa State Bar Association’s website, www.iowabar.org. Free single copies are also available by completing the form below and sending it and a stamped, self-addressed business-sized envelope to: Iowa State Bar Association, 625 E. Court Ave., Des Moines, Iowa 50309

Other options

Although advance directives are for use by competent adults despite their medical statuses, Iowa law also recognizes other tools to direct medical treatment for people facing end-of-life decisions or with life-limiting conditions. These other tools are the out-of-hospital do not resuscitate (DNR) order and Iowa Physician Orders for Scope of Treatment (IPOST).

What is a DNR order?

It’s important to talk to your family and physician about your resuscitation desires even if you have a living will or durable power of attorney for health care. For example, if you are terminally ill, you should ensure your physician knows whether to resuscitate you if your heart or breathing stops. If appropriate, your physician may enter a DNR order, which instructs caregiver (including emergency medical services) to not revive you if your heart or breathing stops. Although health care providers do not perform life-saving effort on DNR patients, they keep them as comfortable and pain-free as possible.

Talk to your physician if you have questions about DNR orders.

What is IPOST?

IPOST is a form that consolidates and summarizes a patient’s preferences for life-sustaining treatments including cardiopulmonary resuscitation, general scope of treatment, and artificial nutrition and hydration. For each type of treatment, the patient may refuse treatment, request full treatment or specify limitations. You can find this form on the Iowa Department of Public Health’s website, https://idph.iowa.gov/ipost/form.

An IPOST is for patients who are frail and elderly or have a chronic, critical medical condition or terminal illness. The patient or patient’s agent completes the form with the patient’s health care provider who can explain what each of the choices means for the patient at that time. The patient or the patient’s agent and the patient’s provider sign the form. A signed IPOST is a medical order set, not an advance directive. The IPOST form stays with the patient.

References: Iowa Hospital Association, Iowa Medical Society and Iowa State Bar Association.

Difficult but Necessary Conversations During the Holidays

woman putting hand on elderly man's shoulder

As the holiday season nears and families begin to spend extended periods of time together, MRHC encourages that, amidst the joyous celebrations, it’s crucial to recognize the importance of discussing a topic often overlooked: advance care directives. While these conversations might seem difficult or uncomfortable, addressing them during the holidays can bring families closer and ensure everyone’s well-being.

What are Advance Care Directives?

Advance care directives are legal documents that allow individuals to outline their healthcare preferences. They serve as guiding principles for medical decisions when a person is unable to express their desires due to illness or incapacity. An advance directive can help you think ahead about what kind of care you want to receive as well as guide your loved ones and healthcare team in making clear decisions about your health care when you can’t do it yourself.

All patients have rights that include privacy, informed consent, information about your condition, and information about advance directives. Advance directives can protect these rights if you ever become mentally or physically unable to choose or communicate your wishes due to an injury or illness. Advance directives can also limit life-prolonging measures when there is little or no chance of recovery.

“Advance directives help you protect your right to make medical choices that can affect your life,” said Julie Hodne, R.N., Education Coordinator at MRHC. “They help your family avoid the responsibility and stress of making difficult decisions on your behalf. Advance directives also help your physician by providing guidelines for your care.”

Having these in place empowers individuals to maintain control over their healthcare choices, ensuring that their preferences are honored even when they can’t voice them. Advance care directives also facilitate discussions among family members, fostering a deeper understanding of each other’s values, beliefs, and healthcare preferences. These directives come in various forms, including living wills, healthcare powers of attorney, and do-not-resuscitate (DNR) orders.

Discussing Advance Care Directives During the Holidays

The holiday season presents a unique opportunity for families to gather and connect on a deeper level. While conversations about end-of-life care may initially appear daunting, the holidays can provide a supportive environment for these discussions. Here are a few ways to initiate conversations about advance care directives during the holidays:

  1. Create a Safe Space: Choose a comfortable and quiet setting where family members can openly express their thoughts and concerns without judgment. Emphasize the importance of respecting each other’s perspectives.
  2. Share Personal Stories: Encourage family members to share personal experiences or stories related to healthcare decisions. This can help normalize the conversation and demonstrate the significance of having a plan in place.
  3. Use Resources: Utilize educational materials or seek guidance from healthcare professionals to facilitate discussions and clarify any uncertainties regarding advance care directives.To get a durable power of attorney for health care or a living will, you will need to complete a form available from the Iowa State Bar Association website. Keep a copy in a safe and secure place and provide a copy to your physician to be kept as part of your medical records. Your Durable Power of Attorney for Healthcare will also need a copy. Give copies to a relative or friend who is likely to be notified in an emergency. Review your advance directives regularly and make changes when necessary. Inform you physician, family, and POA of any changes.

    Another document to be considered for any individual who is frail and elderly or who has a chronic critical medical condition, or a terminal illness is the IPOST form (IOWA PHYSICIAN ORDERS for SCOPE OF TREATMENT). The original form is strongly encouraged to be accompanied by the person it is written for. You can discuss this with your medical provider and find more information about here.

  4. Focus on the Positive: Highlight the benefits of having these directives in place, such as reducing stress for loved ones and ensuring that individual preferences are respected.

Hodne suggests that “if you need help preparing your advance directives or if you would like more information, contact your legal counsel, healthcare provider, or any hospital, hospice, home health agency, or long-term care facility.” Hodne reminds everyone that “planning is the key to protecting your rights!”

As you gather with loved ones this holiday season, take the opportunity to engage in meaningful discussions about advance care directives. These conversations, though challenging, can strengthen family bonds and empower individuals to make informed decisions about their healthcare.