A Step Forward for Advance Directives
New rules make it easier to communicate final health care decisions.
Under an Iowa law that took effect in July, patients and their families can more easily communicate end-of-life care decisions.
Iowa Physician's Orders for Scope of Treatment, or IPOST, is a form that details a patient's end-of-life treatment choices. As a patient's care may move between home, clinic, hospital, nursing home, and hospice care, the IPOST form is designed to be portable and honored in any treatment setting.
Cindy Edge, RN, BSN, Mary Greeley Medical Center HOMEWARD Hospice manager, says the new form was created to simplify communications between patients and their families and various medical providers about a medically fragile, chronically or terminally ill patient's treatment preferences.
"It's intended to provide a smooth transition from one medical setting to another and remove the additional burden of having to re-establish those directives every time the patient receives care in a different location. IPOST travels with the patient as part of their medical records. IPOST makes clear to everyone involved that this is what the patient wants."
IPOST is meant to enhance advance directive planning. Advance directive planning should include a durable power of medical attorney, a person chosen by the patient to make those decisions in their stead.
While those who are chronically or terminally ill or elderly are strongly advised to have advance care directives in place, says Edge, anyone over the age of 18 should consider it.
"We know that life isn’t predictable, and things can change even for young healthy adults in an instant. People should think about it as part of their estate planning process."
Edge offers these guidelines when thinking about end-of-life care decisions.
- Communicate often and thoroughly. "Talk to your family members about what you would want should you be unable to make medical care decisions for yourself. High profile news stories like the Terri Schiavo case provide a good platform for discussing how to avoid painful family decisions later on. Talk to your physician about the medical aspects of your wishes."
- Be specific. "Don't assume anything. Consider different scenarios. Do you want to be on life support? For how long? Do you want a feeding tube, or not? Do you want a do-not-resuscitate order? Don't leave tough decisions to your loved ones. The more detailed you can make your living will, the less burden you place on your family later when you can no longer speak for yourself."
- Choose one person wisely. "The person chosen to be your medical power of attorney should be someone who is familiar with your wishes and is willing to carry them out for you should the need arise. Someone who expresses doubts or discomfort about it isn't the right person. It should only be one person with one alternate, not a group of people. Family members making medical decisions by committee often leads to disagreements and in the worst case scenarios, court cases and permanent family discord."
For more information about advanced directives or IPOST, speak with your physician. A free power of attorney for health care form (advance directive) is available from the Iowa State Bar Association (look under "Public" on the menu bar).
You can download an IPOST, get one from your primary care physician or HOMEWARD Hospice. More information is also available from the Iowa Department of Public Health.
Watch the video
Dr. Larry Otteman, an oncologist with McFarland Clinic and co-medical director for HOMEWARD Hospice, is featured in this video that provides important details about advance directives.