A health care directive does not become effective just because you are hospitalized or endure a medical emergency. In Iowa, it only goes into effect if you are ever unable to give informed treatment decisions and are either:

• Permanently unconscious; or
• In a terminal condition

According to Iowa’s Life Sustaining Procedures Act, the attending physician must make these diagnoses to a reasonable degree of medical certainty. In the case of permanent unconsciousness, they must be reasonably certain that there will be no recovery.

In the case of a terminal condition, the attending physician must determine that there is an irreversible condition that will result in death in a short period of time in the absence of life-sustaining procedures. If the physician makes these determinations, your health care directive becomes operative.

Yes, through a durable power of attorney for health care (a “POA”), you can name someone to make medical decisions for you. They would only do so if you become medically unable to make informed medical decisions for yourself. The person you choose for this role is legally known as your attorney-in-fact. An attorney-in-fact (sometimes referred to as a “health care agent” or “health care representative”) does not need to be an attorney.

Your attorney-in-fact has a broad decision-making capability for your medical care. So, they should understand your health care preferences and beliefs before taking on this role. Their legal duty is to make medical decisions according to your wishes. So, be sure to talk to them to make sure that they would be willing to take on this important responsibility, if necessary. Don’t forget to provide them with a copy of your health care directive so they are familiar with your end-of-life treatment wishes.

When choosing an attorney-in-fact, you may not choose your health care provider or an employee of your health care provider for this role. The only exception to this would be if this person is a close relative of yours. It may also be best to choose someone who lives nearby and will be available in the event of a medical emergency.

According to chapter 144B of the Iowa statutes, your attorney-in-fact will be responsible for carrying out your medical wishes if you are ever medically unable to make treatment decisions for yourself. This is in contrast to a health care directive, which only goes into effect in the event of terminal illness or permanent unconsciousness.

In other words, your attorney-in-fact can make decisions for you during medical situations which would not be serious enough to make your health care directive operative. For this reason, it can be a good idea to create both a POA and an advance directive as part of your estate plan.

Chapter 144A of the Iowa statutes provides that you may revoke your health care directive in any manner and at any time that you are able to do so. Your mental or physical condition has no effect on your ability to revoke.

If it is your wish to revoke your health care directive, you should make sure that your attending physician is aware of the revocation. If possible, you should inform them of the revocation directly. At that point, it is their duty to enter this change into your medical record.

An effective way of performing a revocation is to create a new health care directive. This is because the new document will revoke all prior documents.

Whenever you create a new health care directive, you should inform the important people in your life of the change. Make sure to distribute copies to your loved ones, any important health care providers, and your attorney-in-fact (if you have one).