End of Life Care
There may come a time when you are unable to make decisions about your own health care, either because of illness or injury. An advance directive helps you communicate your desires about medical treatment to loved ones and health professionals in the event that you cannot express your wishes yourself.
An advance directive is a legal document that anyone over the age of 18 can prepare at any time. The document provides instructions about your preference for medical treatment. It is an important tool that helps you determine the care you would receive in the future if you were unable to make a decision for yourself because of a serious illness, injury or due to unconsciousness. The advance directive gives your family, caregivers and physician specific information about how you would or would not want to be treated.
Who Needs an Advance Directive?
It’s a good idea to develop the advance directive before you need it – when you can think clearly about difficult decisions. A competent adult of any age can (and should) complete an advance directive.
Who Benefits from an Advance Directive?
You, your family and your health care providers benefit when your care preferences are clearly defined. The advance directive enables you to protect your own best interests by letting you define the types of care you do or do not want, or by designating a person you trust to make decisions on your behalf should you be unable to make those decisions for yourself.
What are Your Choices for an Advance Directive?
There are two types of advanced directives; Living Will and Durable Power of Attorney for Health Care Decisions.
What is a Durable Power of Attorney for Health Care Decisions?
A Durable Power of Attorney for Health Care Decisions enables you to designate a primary person/persons and secondary person/persons as (the "agent") to make health care decisions for you only when you cannot make those decisions yourself.
Your agents must follow your instructions about care, treatment and extraordinary measures to be taken or withheld on your behalf. Many people select a close family member or trusted friend to be their agent. Your doctor or another health care provider cannot serve as your agent.
What is a Living Will?
A Living Will is used if you have a terminal condition or are permanently unconscious and are unable to state your wishes about care. A Living Will lets your doctor know what, if any, life-sustaining procedures you agree to when death is imminent.
If you have both a Living Will and a Health Care Power of Attorney, the Health Care Power of Attorney will apply – unless your agent cannot make decisions for you.
Do You Need an Out-of-Hospital Allow-Natural-Death Order?
If you have a medical emergency and ambulance personnel arrive, they may look to see if you have an out-of-hospital allow-natural-death (AND) order. An out-of-hospital AND lets the paramedics know that you do not want CPR or life-support treatment, such as a ventilator. If you wish to have an out-of-hospital AND order, the State of Iowa requires that Iowa Department of Public Health out-of-hospital AND form be filled out by you and signed by your doctor.
How Do You Make Your Wishes Known?
Although you may choose to create any of these advance directive documents, they cannot be followed if no one knows they exist. It’s important to communicate your wishes in advance to someone you trust: family members, a close friend, a clergy person and your physician. You may want to ask one of these people (except the physician) to act as your Health Care Power of Attorney. It is extremely important, once your Advance Directive is complete to give a copy to family members, friends who are listed as agents, clergy, physicians and other health care providers.