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Advance Directives

MercyOne will follow the medical treatment decisions you or your advocate make after consulting with a physician, provided that your decisions meet accepted medical practice and current ethical standards.

Our policy extends to withholding and withdrawing of medical treatment — for example, respirators, medically provided food or water or antibiotics. We will provide measures to treat pain and make patients comfortable, even if the decision is to withhold or withdraw other medical treatment.

An Advance Directive is a document that explains your wishes regarding treatment in case you are not able to make health care decisions.

Iowa law recognizes two kinds of Advance Directive documents:

  • A Durable Power of Attorney for Health Care is a document that allows you to name another person (called an agent or attorney-in-fact) to make health care decisions for you if you are unable to speak for yourself. If your wishes are not known, your attorney-in-fact or agent must make decisions that are in your best interests.
  • A Living Will is a document that lets you tell your physician which life-sustaining procedures should be withheld or withdrawn if you have a terminal condition and are unable to speak for yourself.

Health Care Power of Attorney Living Will & Power of Attorney

Both documents take affect only when you cannot make health care decisions for yourself. Both documents must be signed by you and two witnesses, or notarized.

We would be happy to provide you with the forms for either a Durable Power of Attorney for Health Care or a Living Will. We will answer your questions, and help you to complete an Advance Directive, at no charge. You can revoke (cancel) your Advance Directive at any time by informing your physician verbally or in writing, or by asking a member of your health care team to do so.

Federal law requires that MercyOne asks you whether or not you have an advance directive when you are admitted to the hospital. If you already have a living will or durable power of attorney for health care, please provide MercyOne with a copy, and it will become part of your medical record.

Download The Forms

You can download the forms using the buttons above or by visiting the Iowa State Bar Association website at www.iowabar.org.

You can also write to request forms at: Iowa Bar Association, 625 East Court Avenue, Des Moines, IA 50309.

Our chaplains are available to explain the process, answer your questions, properly notarize your signature and make sure that a copy of your advance directives is placed in your chart.

Advance care planning

Many people believe during emergencies or at the end of life, their loved ones know their wishes regarding medical treatments, life-saving measures, and who should speak for them when they are unable. Unfortunately, this isn’t always true. Advance Care Planning takes the guesswork out of these future decisions by putting your wishes in writing as an advance directive.

MercyOne provides free assistance in the preparation and distribution of your advance directives. Take advantage of this program today for peace of mind tomorrow.

An advance directive is a like a set of instructions for your future medical care. It’s designed to help you and your loved ones during situations when you might be too sick to talk to medical providers about what you want. Think of an advance directive as a way to tell both loved ones and medical professionals your wishes in advance.  MercyOne has an advance care planning document you can download below for more information or to print for others.

There are usually two parts to an advance care plan:

Who speaks for you

You choose someone you trust to make choices if you cannot. This is normally in the form of what’s called a Durable Power of Attorney for Health Care (DPOAH).

What kind of care you want

You can say what treatments you would or wouldn’t want in certain situations. Typically this is in a document called a Living Will and may or may not contain other documents depending on your situation. This might include life saving measures such as CPR (more information available below).

The team at MercyOne is ready to help you complete your advance directives. It’s easy to get started.

Peace of mind

Documenting your preferences for medical treatments, life support, and pain management ensure your control over your health care, even in the face of illness.  This brings immense peace of mind and lessens anxieties surrounding future medical decisions.

Reduce the burden

During difficult times, loved ones may experience emotional distress and be unsure about your wishes. A clear plan not only honors your wishes, but helps everyone make informed decisions with greater confidence. It provides guidance,  eliminates confusion and potential disagreements.

Strengthen bonds

Having open conversations to discuss your health care preferences fosters deeper understanding and respect with those you love. By being proactive, you create a sense of unity and preparedness, allowing everyone to navigate challenging situations with clarity and compassion.

Advance directives should include the documents listed below. We’ve provided links to many of these documents to help you find them quickly. Don’t worry if you don’t know how to fill them out or have questions. The MercyOne team is here to help.

Living Will

This legal document defines the types of medical treatment you do or do not want. Some living will documents are very personal, covering a wide range of topics from your preferences for pain management, medical treatments, life support, and more. If you are unable to communicate, would you like your hand held? Would you like bedside prayers? These are the sorts of questions you can answer in your living will. Five Wishes is a popular tool that helps you answer many of these questions and may be available to you through MercyOne at no charge. Ask your MercyOne health care team what options are available.

Durable Power of Attorney for Health Care (DPOAH)

This document legally designates an individual as your health care agent, to speak on your behalf if you are unable to communicate. The form not only allows you to designate an agent, but to limit the type and scope of decisions they can make.  Without the Durable Power of Attorney for Health Care, your next of kin, such as a spouse or adult son or daughter, will be given the responsibility.

Iowa Physician Orders for Scope of Treatment (IPOST)

Those who have a critical illness, are older adults, frail, or in the last stages of an illness should consider supplementing their advance directive with an IPOST. An IPOST is a medical order signed by your health care provider clearly defining your preferences for life-sustaining treatments, such as artificially administered nutrition, CPR, or machine-assisted breathing. Ask your health care team if an IPOST is right for you.

Get started now

This self-guided video and companion worksheet can help you complete an advance directive for yourself or assist a loved one. This video will also help you prepare to meet with an advance care planning facilitator if you prefer an in-person appointment.

MercyOne provides free assistance in obtaining/completing advance directives and guiding you in your advance care planning journey. Our pastoral care team and other trained facilitators have a variety of tools at their disposal to ensure your plan is completed accurately and efficiently. We will also notarize your signature, if necessary, and make sure that a copy of your advance directives are placed in your chart.

Take advantage of this free program by calling MercyOne today using the numbers below. During your call, the MercyOne team will explain the process, answer your questions, and work with you to schedule an appointment. This is a free service provided by MercyOne to assist you and your family if difficult times arise.

If you are unsure of which number to call from the selections below, start with the MercyOne Population Health number and tell them where you are located. They will make sure you are talking to the right team.

Important documents and downloads

MercyOne has gathered the following links for your convenience. If these links aren’t working properly, please reach out to the MercyOne team using the phone numbers above and we’ll make sure you get what you need. Be sure to ask your MercyOne health care team what other options, such as Five Wishes, might be available to you.

This project is supported by the Health Resources & Services Administration (HRSA) of the U.S. Department of Health & Human Services (HHS) under grant number D0440232, Rural Patient Outreach through Advance Care Planning, for $199,279. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. For more information, please visit HRSA.gov.

Advance Directives and Power of Attorney

MercyOne Genesis is committed to sustaining life despite disabilities or advancing age. For example, if your heart or breathing should stop, we will try to revive you. Often this might include the use of machines or other artificial means. However, there are times when efforts to prolong your life could be futile or more burdensome than you want. Therefore, we will try to revive you unless it is futile, or you have given clear directions not to do so.

You, the patient, have the right to be informed about your condition and accept or refuse the treatment available. When you are awake and thinking clearly, you yourself can tell us what treatment you want.

However, there may be times when you are not able to speak for yourself. There are several ways you can still have your wishes followed if that should happen.

  • You can give written directions in advance. You may do this on a form called a "Durable Power of Attorney for Health Care Decisions." This form lets you name the person who will speak for you. It lets the person you name make choices only when you are unable to speak for yourself. You can write down special directions for the person to follow in choosing treatment for you on this form. A form for this can be obtained from the Iowa or Illinois State Bar Associations. You may want to talk with your lawyer when you fill it out.
  • Another form is called a "Living Will." A Living Will only give your preferences when you are terminally ill. (Terminally ill means that while some form of medical treatment may help you live a little longer, treatment will not prevent the illness from causing your death within a short time.)
  • You may talk with your family. If there is no dispute about what you have directed, your doctors will generally accept their decisions.
  • You may talk with your doctors. You can let them know what you want done if you become unable to speak for yourself. When you were admitted to MercyOne Genesis Medical Center, you were asked if you have a "Durable Power of Attorney for Health Care Decisions" or a "Living Will." These are sometimes called "Advance Directives." Information about these documents can be provided to you. We want to do everything we can to understand and follow your wishes. But there could be a directive that your doctor or the policy of MercyOne Genesis Medical Center believes to be contrary to our values. If your doctor or the hospital cannot in good conscience carry out a directive, we will assist you, or the person making the decisions for you, in transferring your care. If you want more information about MercyOne Genesis Medical Center's policies, please ask your nurse or doctor.

Forms

Note: These are legal forms. You should talk with a legal expert when filling them out. Nothing on this page constitutes legal or medical advice.