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New Year: Planning for the Very End  

At the start of a new year, it can be a great time to set goals for the future. People resolve to be more present or to be healthier. One thing that may also be good practice, while admittedly not as popular as thinking about whether one’s affairs are for the end of one’s life. End-of-life decisions are incredibly personal, and if not clearly expressed, they are ignored. Even your loved ones who know you best may not know what your wishes are should a life-altering situation occur. It’s important to formalize these decisions and express them so that they will be followed. This article explores a living will, the difference between a living will, an advanced directive, and a durable power of attorney, and the requirements for a living will to be legally valid in Iowa.  

Read our recent article for more information on Iowa Probate Laws.

What Is a Living Will?  

A living will is a document that details specific medical actions an individual wishes to have undertaken in the event they are no longer able to make decisions because of illness or incapacity. It is a document written in advance, and therefore, is also referred to as an advanced directive. A living will provides instructions for whether the individual wishes to have their life preserved through artificial means when they are incapacitated and unable to make medical decisions for themselves and the individual’s condition is terminal. Iowa law has specific requirements for a living will to be valid. This article discusses these requirements and can also be found in Iowa Code 144A “Life-Sustaining Procedures.  

If you wish to give someone close to you the power to make end-of-life decisions on your behalf, you can appoint a Healthcare Power of Attorney.

What Are the Requirements for a Living Will to Be Legally Valid in Iowa?  

Iowa law has several requirements for a living will to be legally valid.  

  1. The declarant (or person creating the living will for themselves) must be a competent adult over 18 years old  
  1. The declarant must sign the living will in the presence of two witnesses who are over the age of 18, and it must contain the date the document was signed  
  1. The witnesses should not be a health care provider taking care of the declarant  
  1. At least one witness must not be related to you by blood or marriage, or adoption  
  1. The witnesses must sign in each other’s presence  
  1. Give the living will to the attending physician  

When Does a Living Will Take Effect?  

A living will takes effect only if the declarant’s condition is determined to be terminal and the individual cannot make decisions for themselves. If the incident temporarily incapacities an individual but is not terminal, medical personnel will continue to perform medical services for the individual. The attending physician will decide whether your condition is terminal, but another physician can also confirm this.  

 

Making Sure Your Wishes Are Granted  

Your loved ones must be aware that you have a living will. If no one knows you have one, it may not be followed. Healthcare providers default to your preserve life. Suppose you do not wish to have your life artificially extended. In that case, it is crucial to have a living will that states you do not wish to be kept alive by artificial means. However, if you have no living will, are incapacitated and terminal, the following people may decide on your behalf, in the following order of priority:  

1. An attorney-in-fact whom you have designated to make these decisions (Durable Power of Attorney for Health Care)

2. With court approval only, a guardian, if one is appointed

3. Your spouse

4. An adult child, or if you have more than one child, a majority of your available children

5. Your parent or parents

6. An adult brother or sister

Having a living will clarifies your wishes and ensures that your loved ones do not have to guess your wishes. Having a living will in place can prevent family feuds and guilt if people feel they are the ones to stop life-preserving measures, which in turn would end your life.  

Some health care providers have apps that allow you to upload a copy of your living will or to answer whether or not you have one, which is helpful to do. It doesn’t negate the need for your next of kin to have a copy of your living will if something happens unexpectedly.  

What Is a Life-Sustaining Procedure?  

A life-sustaining procedure is any medical procedure, treatment, or intervention that  

  1. uses mechanical or artificial means to sustain, restore or supplant a spontaneous vital function, and  
  1. serves only to prolong the dying process  

The following are not considered life-sustaining procedures:  

  1. Providing nutrition or hydration, unless it must be administered parenterally or through intubation
  1. Dialysis  
  1. Blood transfusions  
  1. The administration of medication or provision of any medical procedure deemed necessary to provide palliative care or to alleviate pain

If you or a loved one have a living will that dictates, they do not wish to have their life artificially prolonged, they will still be given “comfort care” including pain medication, food, and water (as long as it does not have to be fed through a tube).

How Specific Can You Get in a Living Will?  

You can direct things like not being coded, that you not have your heart pumped through a machine, that you be given a feeding tube for food and water. In short, you can be rather specific about which procedures you wish to have and which you wish to avoid. Some people wish to have their life artificially preserved for a set period. For instance, “If I am incapacitated for more than three months, I wish to have any life-sustaining procedures stopped.”  

What Happens If I Change My Mind About What I Want For My End-of-life Care?  

It’s possible to revoke a living will at any time, so long as you have the capacity. To revoke a living will, you or someone acting on your behalf must inform your attending physician of your intent to revoke. The attending physician must then enter your intention into your medical record.  

Just like a living will, you can also revoke a Healthcare Power of Attorney.

What Are the Differences Between a Living Will, An Advanced Directive, And A Power of Attorney for Health Care?  

A living will dictates end-of-life medical decisions when a person is terminal and incapacitated. An advanced directive is simply writing out your wishes before an event takes place—usually referring to a living will. A power of attorney for health care (also known as an attorney-in-fact) can make medical decisions on your behalf if you cannot do so. It is a broader power as it does not necessarily mean that you are terminal.  

In conclusion, it is essential to consider what you wish for in your end-of-life care. It may be easy to ignore this, but doing so may burden your family in the future and force them to have to guess what you would want. Many hospitals and health care facilities have ready forms for you to fill in.  

For help creating your living will or other essential estate planning preparations, contact O'Flaherty Law. You can give us a call at (630)-324-6666 or fill out our confidential contact form today.

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