It’s never too early to complete an advance directive

By Audrey Posten, North Iowa Times Editor

Life can change in an instance. That’s why it’s never too early to put an advance directive or a living will in writing, said Melissa Whelan, a social worker with St. Croix Hospice, who spoke at an advance directives open house at Turner Pointe Assisted Living in McGregor June 23.

An advance directive is a document through which an individual specifies the actions medical personnel can take if illness or incapacitation prevents the person from making his or her own decisions.

“Any adult should have an advance directive completed. It’s not only for the dying,” said Whelan, who specializes in advance directive planning. “Life is fragile. You could end up in a position any time where a physician will have to make a decision. The law requires all interventions unless otherwise specified.”

The first step, Whelan said, is to determine what you want and document it.

Whelan said there are several ways to document your wishes, most notably through forms that can be found on the Iowa State Bar Association website at iowabar.org. Click on “public resources” on the main menu, then select “legal forms.” Two forms on that site include a living will and a medical power of attorney.

A living will, Whelan said, has nothing to do with a person’s estate. Rather, it says, if a person has an incurable or irreversible condition, no measures (like a feeding tube, respirator, etc.) are to be used to sustain life. It can be signed in the presence of two witnesses or a notary public.

A power of attorney gives a person the authority to act on behalf of another person when he or she becomes unable to voice their own desires.

“Make sure they know what you want. It’s easier when you have been open and said what you want for your medical care,” Whelan said. “[The power of attorney] can verbally say it if the document is not on you.”

When designating a power of attorney, Whelan said it’s important to tab someone who is easily accessible.

“Situations can happen at any time, and care teams need to work quickly,” she mentioned.

Whelan said she recommends people have documents for both a living will and a medical power of attorney.

Another document that can be filled out is an Iowa Physician Orders for Scope of Treatment (IPOST), which allows a person to communicate their preference for life-sustaining treatments, such as resuscitation, general scope of treatment, artificial nutrition and more.

“It’s more specific than a living will,” Whelan stated.

In this case, a physician signs the document rather than a notary.

Whelan said many medical institutions also have documents, and often push for one to be filled out, even for procedures like a routine knee surgery. Gundersen put out a document around 15 years ago that’s more of a narrative, Whelan explained, in that it breaks things down and even gives a person the opportunity to say things to their family members. However, that can be overwhelming at times, Whelan warned.

Once documents have been completed, it’s vital the originals are easily accessible, Whelan stated. Keep them on your person, if possible. Copies should be given to physicians, any medical specialists, the most likely emergency room you would be taken to, an attorney and the power of attorney. You should also document who you’ve given documents to, she added.

These documents never expire, Whelan said, but they can be changed at any time; just make sure any old copies are destroyed, so as not to cause confusion.

Whelan said younger adults are sometimes wary of completing advance directives, as they don’t want to prevent some life-saving measures from being performed.

“But it doesn’t mean, if there’s an accident, that an EMT won’t do CPR,” she commented, noting that it’s only applicable if survival depends upon measures like artificial respiration or feeding tubes.

Through the whole advance directive process, Whelan said it is important to think of family members, making it easier for them to carry out your wishes.

“It’s hard to make decisions for someone else, so it’s responsible to have [an advance directive],” she said. “It’s not an easy conversation, but the more you have and the more open you are, the easier they get.”

“Society is going in the direction of having these conversations,” Whelan added. “People want their loved ones to know what they want.”