An "advance directive" allows adult individuals to direct their medical care in the event they become incompetent and are unable to make medical decisions for themselves. Advance directive statutes define those medical situations in which individuals can direct their future care and steps they need to take to best assure legal recognition of their advance directives.
Iowa statutory law provides for three types of advance directives:
- Life-Sustaining Procedures Act (living will);
- Durable Power for Health Care Decision Making; and
- Out-of-Hospital Do-Not-Resuscitate Orders (OOH-DNR).
There are similarities and distinctions among these three types of directives. To enjoy the statutory immunities afforded to physicians under Iowa's advance directive laws, physicians must be aware of and adhere to the particulars of each statute.
Life-Sustaining Procedures (Living Will) Act
A living will declaration under Iowa's Life Sustaining Procedures Act allows an adult individual to direct future decisions regarding the withholding or withdrawal of life-sustaining procedures in the event the individual is in a terminal medical condition and is not competent. The definitions of the law are critical. The statute specifies processes for executing a living will declaration and for withholding or withdrawing life sustaining procedures consistent with a patient's declaration. A process also is provided for withholding or withdrawing life-sustaining procedures from a patient in a terminal condition where the patient does not have a living will. Immunities for acting consistent with the statute are provided.
Durable Power for Health Care Decision Making
A durable power of attorney for health care is executed by an adult individual for purposes of authorizing another individual, called the "attorney in fact," to make health care decisions on the individual's behalf in the event the individual, called "the principal," is unable, in the judgment of the attending physician, to make health care decisions. Processes and procedures for executing and relying upon a durable power for health care decisions are set forth in the statute. Immunities for acting consistent with the statute are provided.
Out-of-Hospital Do-Not-Resuscitate Order
This chapter allows emergency care providers and others in settings outside the hospital to rely upon a physician-issued do-not-resuscitate (DNR) order for an adult individual in a terminal condition. Rules of the Iowa Department of Public Health further detail the out-of-hospital do-not-resuscitate (OOH-DNR) process. Immunities for acting consistent with the statute and rules are provided.
In response to the federal Patient Self-Determination Act of 1990, which seeks to inform individuals of their rights under state law to execute advance directives, the Iowa Hospital Association, the Iowa Medical Society and the Iowa State Bar Association jointly developed an informational pamphlet entitled "Advance Directives for Health Care - Deciding Today About Your Care in the Future." Contact the Iowa Hospital Association for pamphlets..
The Iowa State Bar Association has developed forms that individuals may use to execute a living will or a durable power of attorney for health care.