LIVING WILLS

Living Wills, also called Advance Care Directives, are documents that set forth your personal wishes with respect to medical care. All adults have the basic right to control decisions about their own medical care. People have the right to decide whether or not they want to receive certain medical treatments. You can choose to decline medical procedures that only prolong the process of dying, or choose to use those procedures if you are terminally ill.

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 is also referred to as an Advanced Directive. Federal law now requires hospitals and long-term care facilities to notify persons being admitted of their right to execute advanced directives.

What is a Living Will?

The term ""living will"" is not entirely accurate. A living will is best defined as a written declaration that informs medical personnel of your desire not to have life-sustaining procedures induced if you are diagnosed as terminally ill and you cannot participate in the decision-making process regarding your treatment, and 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. The witnesses must be age 18 or older, and should not be members of the family if at all possible. A health care provider and its employees cannot be the witnesses. The witnesses must also sign the document. The declaration must be signed voluntarily. A declaration made in another state or jurisdiction that is consistent with the law of Iowa will be valid in Iowa to the extent the declaration is consistent with Iowa law.

What Should I Do with a 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. The doctor may not always be your family doctor. 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 members of your family.

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 the diagnosis of a terminal illness. A recent federal law now requires medical facilities to inform all patients, prior to admission, 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 time or a comatose state from which there can be no recovery, to a reasonable degree of medical certainty.

What are "Life-Sustaining" Procedures?

Under Iowa law, a life-sustaining procedure refers to any medical procedure or treatment that meets both of the following requirements:

1. The use of mechanical or artificial means to sustain, restore or take the place of a spontaneous vital function, and which,
2. When applied to a patient in a terminal condition, would serve only to prolong the dying process.

In April, 1992, Iowa law was amended to include the withdrawal of nutrition and hydration as a life-sustaining procedure, but only when required to be provided parenterally or by intubation. Parenterally is defined as "something introduced to the body other than through the intestine." It is important to note that the term does not include the provision of medicine or procedures necessary to provide comfort or to ease pain.

Who Decides Whether My Condition is Terminal?

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

What if I Make a Living Will and Then 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 this communication as a part of your medical record.

When Do the Provisions of the Living Will Take Effect?

The provisions take effect after 1) your doctor and another doctor decide that your condition is terminal and record their conclusions in your medical records, 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 becomes effective when you are unable to participate in those decisions.

My Living Will was Signed Prior to April 23, 1992, is it Still Valid?

Effective April 23, 1992, Iowa law was amended to include the withdrawal of nutrition and hydration as life-sustaining procedures, and the definition of a terminal condition was expanded to include a comatose state from which no likelihood of recovery is expected. Living wills executed prior to this date are still valid, but their effectiveness will not include the changes. You must affirmatively elect these changes in the law by signing a new living will. However, if a living will executed prior to the effective date contained language prohibiting the use of life-sustaining procedures in the case of nutrition, hydration, or comatose state, then that language now will be given effect.

What Happens if the Original Living Will Cannot Be Found or if Someone Tampers With it, 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, a serious misdemeanor.

What if I Do Not Make a Living Will and I Become Terminally Ill and Unable to Make Decisions Regarding My Treatment?

If you have no living will in this situation, your treatment decisions may be made, in front of a witness, by the attending doctors and any of the following persons, in the following order:

1. The person you designated in a power of attorney, if any.
2. Your court appointed guardian, if any. Your guardian must obtain court approval before making this decision.
3. Your spouse.
4. Your adult child. However, if you have more than one child, then the decision is to be made by a majority of your available adult children.
5. Your parent or parents
6. An adult brother or sister.

Does a Living Will Affect Life Insurance Benefits?

The law provides that making a living will does not affect a life insurance policy, whether you already own the 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.