You may have heard about a new kind of health care directive in Iowa, called a Physician Orders for Scope of Treatment (IPOST) form. Here, we discuss what an IPOST form is and when you need one.
An IPOST form is a doctor’s order that helps you keep control over medical care at the end of life. Like a Do Not Resuscitate (DNR) order, the form tells emergency medical personnel and other health care providers whether or not to administer cardiopulmonary resuscitation (CPR) in the event of a medical emergency. An IPOST form may be used in addition to -- or instead of -- a DNR order. The IPOST form may also provide other information about your wishes for end-of-life health care, as explained just below.
A health care professional can help you create an IPOST form if you enter a medical facility or health care setting -- such as a hospital, nursing home, or hospice care in a facility or at home. To be legally valid, an IPOST form must be signed by a qualified health care provider, such a physician or nurse practitioner. (Iowa Statutes § 144D.2.) You or your legally appointed health care decisionmaker must also sign the IPOST.
If a member of the medical staff does not ask you whether you want to create a IPOST form, you may ask for one.
The IPOST form is usually printed on brightly colored paper so it will easily stand out in your medical records. The form travels with you if you move from one health care setting to another. You can change it or cancel it at any time.
An IPOST form differs from a DNR order in one important way: The IPOST form also includes directions about life-sustaining measures in addition to CPR, such as intubation, antibiotic use, and feeding tubes. The IPOST form helps medical providers understand your wishes at a glance, but it is not a substitute for a properly prepared living will and durable power of attorney for health care.
Taken together, a living will and durable power of attorney for health care provide more information than an IPOST form, including details about your health care agent, more complete health care wishes, and your preference for organ donation. Therefore, if you have an IPOST form, you do not need a DNR order, but you should still complete a living will and durable power of attorney for health care to provide a full set of wishes about your care.
You need to consider an IPOST only if you're facing a life-threatening medical condition. If you're healthy, you need only a living will and durable power of attorney for health care to provide a full set of wishes for your treatment in the event of an unexpected accident or medical crisis.
On the other hand, a patient diagnosed with a terminal illness or frailty that requires care in a medical setting -- or ongoing care at home -- may need an IPOST in addition to traditional health care directives. That’s because a living will and durable power of attorney for health care may not be enough to prevent medical personnel from resuscitating a patient in an emergency. For that, it's important to have a medical order such as an IPOST or DNR order. If you feel strongly that you don’t want emergency measures at the end of life -- or if you’re caring for someone who feels that way -- find out about making an IPOST in addition to traditional health care directives.
For details about making essential health care directives, see Iowa Living Wills and Durable Powers of Attorney for Health Care: What You Need to Know.
For general information about how to document your health care wishes, see the Living Wills & Medical Powers of Attorney section of Nolo.com.