Advance Directive

When is a good time to start having a conversation with your loved ones about your end-of-life wishes? Right now. You plan for so many events in life: birthdays, anniversaries, grand openings and much more. But, the one aspect of life that is planned for by less than 30% of Americans is death.

What is an Advance Directive?

An advance directive is a document that enables you to make medical decisions about your future. It is a way for you to say what you want done or not done if you become very sick or are in an accident and cannot speak for yourself. With Advance Directives, you are in control of your care even if you cannot communicate. Iowa law provides two types of advance directives – a Durable Power of Attorney for Health Care and a Living Will.

The Durable Power of Attorney for Health Care is a legal document that allows you to choose someone as your agent (someone who acts for you) to make health care decisions whenever you cannot, due to unconsciousness or loss of ability to think and reason. This agent is required to make decisions according to directions you provide in writing, or verbally, to him or her. If your wishes are not clearly understood and defined, then your agent will make decisions based on what he or she believes to be in your best interest. Your agent is given the right to examine your medical records.

The Durable Power of Attorney for Health Care must be filled out and witnessed while you are still capable of making decisions for yourself. Any incapacity you may suffer later in your life will then be covered by the Durable Power of Attorney for Health Care. The Durable power of Attorney for Health Care comes into play when your doctor has determined that you are unable to make health decisions for yourself, even when the situation is temporary, such as after a car accident or a severe, sudden illness.

Living Will, known in Iowa as The Declaration Relating to Use of Life-Sustaining Procedures, is a document directing your physician to withhold or withdraw certain treatments (life-sustaining procedures) that could prolong the dying process. This advance directive becomes effective only at a point when, in the written opinion of your doctor (confirmed by one other doctor), you are unable to make health decisions for yourself (because you are unconscious or unable to think and reason) or you are determined to be permanently unconscious (irreversible coma, persistent vegetative state).

Why make an Advance Directive now?

A serious illness or accident is a scary time. Important decisions often need to be made quickly and it may be difficult for your loved ones to know what you would want done. Completing healthcare directives in advance allows you and your loved ones to think and discuss clearly about medical and end of life issues and what is right for you.

Who do I talk to about Advance Directives? How do I choose an agent?

You should share your thoughts about advance directives with the family and/or friends you want involved in your health care decisions. A person(s) you trust and with whom you can speak openly about your wishes and someone who is capable of understanding the responsibilities involved in being a health care agent. Your agent will have direct control over your health if you become unable to make health care decisions.

An agent can be any adult you choose – a spouse, adult child, other relative, and/or friend. If you do not have anyone to be your agent you can still complete a Living Will and be sure to talk with your medical provider about your end of life wishes. Be sure to write down any specific directions or requests; providing your caregivers with this information will provide them peace of mind should they need to make these difficult decisions.

How do I approach the subject of Advance Directives?

Bringing up the topic of end of life planning is uncomfortable but talking about it in advance will lessen the burden on your family and friends. Would you want to make a life and death decision for someone without knowing what they would want you to do?

Transition points in life can provide natural triggers for having the discussion –birthday, engagement, new job, retirement, birth of a child/grandchild, change in health status. If a friend or relative has recently died, this may open the door to a discussion. Using conversation props such as books or movies or recent news stories can also provide a springboard for discussion.

When considering serious or end of life care, it’s important to take time to assess your values concerning what you identify as important. The Gift of Peace of Mind can help you think through possible situations and provide an opportunity for you to consider what is right for you.

Once I’m ready, how do I complete Advance Directives?

Durable Power of Attorney for Health Care and a Living Will can be completed by having it notarized or witnessed by two individuals, see the forms for specific instructions. Keep the original form and send copies to your physician, hospital, health care agent, and family members. Be sure to keep a copy in a safe accessible place.  

Situations and values change as you age. It’s important to re-evaluate your advance directives every year to ensure they remain accurate. You may change or cancel these documents at any time; copies of the changed advance directives should be made and distributed as before. If you wish to cancel the form(s), you must tell your doctor and it’s a good idea to destroy the document. 

Still have questions? Watch this short video from National Healthcare Decisions Day