New law solidifies end-of-life directives for Iowans

A new law will provide Iowans facing end-of-life care with greater certainty that their treatment choices will be followed.

The bill, signed into law this week by Gov. Terry Branstad, allows a patient's health care wishes to be honored through various health care settings with a formal one-page document.

That document, called an Iowa Physician's Order for Scope of Treatment, or IPOST, is a legal doctor's order that notes the patient's preferences for life-sustaining treatments such as CPR, artificial nutrition and more.

The bill arose in response to a need noted by Christine Harlander, Palliative Care coordinator at Mercy Medical Center and Stephanie Anderson, Director of Palliative Care and Hospice at St. Luke's Hospital, both in Cedar Rapids.

Along with Dr. Ralph Beckett and a committee of medical and community members, the two developed a pilot project to address the gap they observed in end-of-life care.

“It's really about allowing patients to speak with their physician about what they want and to have the health care community respect those choices they decide upon,” Anderson said.

The law goes into effect July 1.

Under current Iowa law, medical workers are required to “err on the side of life,” by providing life-sustaining treatment, such as CPR, Anderson said.

An “out of hospital do not resuscitate” provision in Iowa only allows the terminally ill to note if they do not want CPR or other treatment, such as mechanical ventilation administered, she said.

Anderson noted that many more Iowans besides the terminally ill will be able to use the IPOST, but not everyone.

The new law will apply to patients who are chronically and seriously ill and the frail elderly, she said.

Anyone 18 and older is encouraged to complete an advance directive - a written document that explains the health care you want to receive if you cannot make your own decisions.

Anderson said an advance directive is more about the philosophy of care a patient wishes to receive and is not a legal doctor's order as an IPOST will be.

In 2008, state lawmakers chose Linn County for a pilot IPOST project. The project was expanded in 2010 to include Jones Regional Medical Center in a more rural population.

Anderson said about 1,500 IPOSTS were used in Linn and Jones counties since the pilot began, with 100 percent compliance in following the orders.

“Overwhelmingly, the reception was very positive,” she said.

In 62 percent of cases, had that document been unavailable, care would have been provided that the patients did not want, she noted, adding that most patients have chosen “somewhere in the middle” between no care and full treatment.

Iowa is the 14th state to pass such a law; several other states are developing their own programs.

Anderson said the new law is not about saving health care dollars, nor is it about assisted suicide.

Tom Chapman, executive director of the Iowa Catholic Conference, said the pro-life group did not oppose the bill.

“It does not authorize euthanasia or mercy killing,” he said. “We felt this particular bill as drafted in Iowa is acceptable.”