Living Wills

All adults have the basic right to control decisions about their own medical care. People have the right to decide whether or not to withhold certain treatment. They can choose not to receive medical or surgical procedures that only prolong the dying process.

Iowa law ensures that the rights and desires of the terminally ill are honored. It provides that adults can direct, in advance, whether they want to be kept alive by artificial means in the event they become terminally ill and are incapable of taking part in decisions regarding their medical care. This written declaration is commonly referred to as a “living will.” Because it is signed in advance of its use, it's also referred to as an “advanced directive.” Federal law requires most hospitals, long-term care facilities, and home health agencies to notify persons being admitted of their right to execute advanced directives.

This section answers questions commonly asked regarding living wills. This is a general summary, and not a substitute for legal advice. You should see a lawyer to get complete and current legal advice. In particular, your lawyer will be able to provide a document that satisfies the requirements of Iowa law.

 

What is a Living Will?

A living will is best defined as a written declaration that informs medical personnel of your desire to have life-sustaining procedures withheld or withdrawn if you are diagnosed as being terminally ill and you cannot participate in the decision-making process regarding your treatment, and the use of life-sustaining procedures would merely prolong the dying process.

 

How do I make a Living Will?

A living will can only be made by a competent adult who is age 18 or older. The declaration can be signed in the presence of two witnesses or a notary public. If witnessed, the witnesses must be age 18 or older and it is recommended that at least one witness not be a member of the declarant’s immediate family. A healthcare provider and its employees cannot be witnesses. The witnesses also must sign the document. The declaration must be signed voluntarily.

A declaration executed in another state or jurisdiction that is in compliance with the law of the state or jurisdiction will be valid in Iowa to the extent that the declaration is consistent with the law of Iowa.

 

What should I do with the Living Will once it is signed?

The original living will must be given to your doctor in order to act on it. Under Iowa law, it is your responsibility to provide your attending physician with the declaration. An “attending physician” is the doctor who is primarily responsible for your care. This doctor may not always be your family doctor. However, it is a good idea to give a copy of the living will to your family doctor for his or her files. In addition, the living will’s existence should be made known to family members.

 

When should I make a Living Will?

As long as you are age 18 or older and competent, you can execute a living will at any time. It can be signed before or after diagnosis of terminal illness. Federal law requires most medical facilities to inform all patients of the right to sign a living will or health care power of attorney.

 

How does the Living Will affect my medical treatment?

You may direct your doctors to withhold or withdraw life-sustaining procedures in the event you become terminally ill, are unable to participate in the decision making process and the use of life-sustaining procedures will merely prolong the dying process.

 

What is a “Terminal Condition”?

Under Iowa law, a terminal condition is defined as an incurable or irreversible condition that, without life-sustaining procedures, results in death within a relatively short period of time or a state of permanent unconsciousness from which there can be no recovery, to a reasonable degree of medical certainty.

 

What are “Life-Sustaining Procedures”?

 

What is “Resuscitation”?

Resuscitation is defined as “any medical intervention that utilizes mechanical or artificial means to sustain, restore, or supplant a spontaneous vital function, including but not limited to chest compression, defibrillation, intubation, and emergency drug usage intended to alter cardiac function or otherwise to sustain life.”

 

Who decides whether my condition is terminal?

Your attending physician makes this decision, but another physician must confirm the determination. The doctors’ conclusions must be entered in your written medical records.

 

What if I make a Living Will but I change my mind?

You may revoke a living will at any time simply by notifying your attending physician of your intent to revoke the document. Your intent must be communicated by you or someone else, to your attending physician, who will then record the communication as part of your medical record.

 

When do the provisions of a Living Will take effect?

The provisions take effect after (1) your doctor and another doctor decide that your condition is terminal and record their conclusion in your medical record, (2) your doctor is presented with your living will, and (3) you are unable to make decisions regarding your care and treatment. Accordingly, even if you make a living will, you have the right to make decisions regarding the use of life-sustaining procedures so long as you are able to do so. The living will only become effective when you are unable to participate in these decisions.

 

What happens if the original Living Will cannot be found or if someone tampers with, destroys or conceals my Living Will?

If the original living will cannot be located, then the law identifies a hierarchy of persons who are authorized to make the decision in your stead. See the next section for this list. If your living will is destroyed without your consent, that person has committed a crime.

When can life sustaining procedures be withheld or withdrawn without a Living Will?

Life-sustaining procedures may be a withheld or withdrawn from a patient who is in a terminal condition and who is comatose, incompetent, or otherwise physical or mentally incapable of communication and has not made a living will under Iowa law, if there is a consultation and a written agreement for the withholding or the withdrawal of life-sustaining procedures between the attending physician and any of the individuals listed in the section below.

 

What if I do not make a Living Will and I become terminally ill and unable to participate in decisions regarding my treatment?

If you have no living will, your treatment will be made between your attending physician and any of the following individuals in this order:

 

Does a Living Will affect existing life insurance benefits?

The law provides that making a living will does not affect a life insurance policy, whether you already own a policy or are yet to purchase one. You cannot be required to sign a living will in order to obtain life insurance. Finally, the law specifically provides that death from the withdrawal of life-sustaining procedures pursuant to a living will does not constitute suicide or homicide.

 

Where can I obtain a Living Will form?

If you are interested in creating a living will, you can contact an attorney or download the form from the  Iowa State Bar Association.

Living Will
 

Out Of Hospital Do-Not-Resuscitate (OOH DNR):

Under an Iowa law, adult, terminally ill patients can make non-resuscitation decisions in out-of-hospital settings. This allows the patient to have their physicians prepare and sign an OOH DNR order. The OOH DNR is a physician’s order authorizing medical care providers to allow a patient’s wishes not to be resuscitated in the out of hospital setting. Patients will still receive comfort care, including pain medication, to make the patient as comfortable as possible. The patient may also purchase a uniform identifier which EMS providers and other healthcare providers can easily recognize.

For more information on OOH DNR, contact the Iowa Department of Health and Human Services at 1-800-972-2017.