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.

Plan Ahead for Your Medical Care

woman putting hand on elderly man's shoulder

Do your loved ones and medical providers know what type of medical treatment you prefer? By planning ahead, you can ensure you receive the medical care you want, avoid unnecessary suffering, and relieve caregivers of decision-making burdens during moments of crisis or grief. You can also help reduce confusion or disagreement about the choices you would want people to make on your behalf.

What Is an Advance Directive?

An advance directive is a legal document that explains how you want medical decisions to be made if you cannot make them yourself. This directive lets your healthcare team and loved ones know what kind of healthcare you want or who you want to make decisions for you when you can’t.

Julie Hodne“Advance directives help you protect your right to make medical choices that can affect your life,” said Manning Regional Healthcare Center Education Coordinator Julie Hodne, RN. “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.”

Why Are Advance Directives Important?

All patients have rights, including privacy, informed consent, and access to information about their condition and treatment options. Advance directives help protect these rights if you become unable to communicate due to an injury or illness. They can also limit life-prolonging measures when there is little or no chance of recovery.

Under the Patient Self-Determination Act (PSDA), healthcare providers are required to inform patients of their rights regarding advance directives upon admission to a facility. This ensures that patients are aware of their options and can make informed decisions about their care. For example, advance directives can help patients decide if they want:

  • Cardiopulmonary resuscitation (CPR)
  • Artificial nutrition or hydration
  • Intubation, ventilators, or dialysis
  • Pain control and comfort care
Let Your Values Guide Your Decisions

When creating your advance directives, consider what is most important to you. Discuss your feelings with your family, physician, religious leader, or legal counsel to determine what is best for you. This might include:

  • Avoiding pain and suffering
  • Maintaining independence in decision-making
  • Ensuring your family is not burdened with difficult choices
  • Aligning your care with religious beliefs
  • Being surrounded by loved ones at the end of life
Types of Advance Directives

The most common types of advance medical directives include:

  1. Living Will: Outlines your wishes regarding life-sustaining treatment.
  2. Durable Power of Attorney for Healthcare: Designates a person to make medical decisions on your behalf if you become unable to do so.
  3. Do Not Resuscitate (DNR) Order: Specifies that you do not want CPR if your heart stops, or you stop breathing.
  4. Health Care Instructions: Provides detailed guidance about specific treatments or interventions.
How to Obtain and Complete Advance Directives

Advance directive forms vary by state, so you should consult your state’s health department, legal resources, or healthcare provider for the appropriate documents. For example, in Iowa, you can obtain forms from the Iowa State Bar Association.

To receive the form by mail, send a self-addressed, stamped envelope to:
Iowa State Bar Association
625 E. Court Avenue, Des Moines, Iowa 50306

Include your full name, address, and date of birth. You can also print and download the form online. Once you have the forms:

  1. Put your wishes in writing and be as specific as possible.
  2. Review your advance directives with your family, physician, and power of attorney (POA).
  3. Sign, date, and have them witnessed and notarized as required by your state.
  4. Keep a copy in a safe place and provide a copy to your physician for your medical records.
  5. Ensure your POA and a trusted relative or friend have copies.
  6. Review and update your directives regularly, especially after major life events (e.g., marriage, divorce, or a change in health status). Inform your physician, family, and POA of any changes.
IPOST: An Additional Consideration

For individuals who are frail, elderly, or have a chronic critical medical condition or terminal illness, the Iowa Physician Orders for Scope of Treatment (IPOST) form may be beneficial. The original IPOST form should be kept with the person it applies to. You can discuss this option with your medical provider and find more information through the Iowa Department of Public Health.

Get Help with Advance Directives

“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 suggests. She reminds everyone, “Planning is the key to protecting your rights!”

Additionally, Medicare covers advance care planning discussions during annual wellness visits, so take advantage of this opportunity to discuss your wishes with your healthcare provider.

By taking these steps, you can ensure that your medical preferences are respected and that your loved ones are spared the burden of making difficult decisions on your behalf. Planning ahead is a gift to yourself and those who care about you.