- A psychiatric advance directive (PAD) is a legal document that documents a person’s preferences for future mental health treatment, and allows appointment of a health proxy to interpret those preferences during a crisis.
- PADs may be drafted when a person is well enough to consider preferences for future mental health treatment.
- PADs are used when a person becomes unable to make decisions during a mental health crisis.
Iowa Q and A
Please note: the following 10 FAQs are designed to provide a quick and accessible guide to what your state’s statutes say – or do not say – about PADs. The FAQs do not attempt to provide a complete picture of the law in your state, nor can they take the place of legal advice. These answers are accurate as of September 2019.
1. Can I write a legally-binding psychiatric advance directive (PAD)?
Yes, by appointing an agent. Iowa’s Durable Power of Attorney for Health Care statute allows you to appoint an agent (called an “Attorney in fact”) to make healthcare decisions for you if you become incompetent to make those decisions yourself. “Health care” may include mental health care. A recommended form for this purpose, called a Durable Power of Attorney, is available here. The form is not mandatory but is recommended.
2. Can I write advance instructions regarding psychiatric medications and/or hospitalization?
The Iowa statute does not allow you to write advance instructions for your psychiatric care in a freestanding document. However, if you fill out a Durable Power of Attorney, you may wish to specify how you would like your Attorney in fact to make decisions for you. If there are particular matters that you wish your Attorney in fact to make clear to your treating physicians, it is advisable to discuss them with him/her and document them on, or on pages attached to, the Durable Power of Attorney.
3. Does anyone have to approve my advance instructions at the time I make them?
No. However, your form must either be acknowledged by a notarial officer in the state of Iowa or witnessed and signed by two adult witnesses at the same time as you sign it. Your witnesses must be people other than employees of your health care provider who are attending to you at that time. Your Attorney in fact cannot act as a witness. Finally, one of the witnesses must be someone other than a relative of yours.
4. Can I appoint an agent to make mental health decisions for me if I become incompetent?
Yes, as outlined above. Your Attorney in fact must be someone other than an employee of your health care provider, unless also a relative of yours.
5. If I become incompetent, can my agent make decisions for me about medications, and/or hospitalization?
Yes. The general rule is that your agent can make any health care decision that you could have made if you were able to. However, you should be aware that there are exceptions to this general rule: see question 9 below.
6. Does my agent have to make decisions as he/she thinks I would make them (known as “substituted judgment”), or does he/she have to make them in my “best interests”?
Your Attorney in fact must act according to any instructions you have documented and your wishes as far as he/she otherwise knows. If your wishes are not known, he/she must act in your best interests, taking into account your condition and prognosis.
7. Is there any rule that says that I can only make advanced instructions, only appoint an agent, or that I must do both?
Yes. As explained above, it is not possible to write advance instructions only. If you wish to create a PAD, you must use a Durable Power of Attorney, but the extent to which you also document your decisions is up to you.
8. Before following my PAD, would my mental health care providers need a court to determine I am not competent to make a certain decision?
No. The statute does not specify any particular procedure by which your PAD goes into effect. In practice, your PAD will be followed whenever your providers consider that you are unable to understand or communicate treatment decisions yourself.
9. Does the statute say anything about when my mental health providers may decline to follow my PAD?
Yes. Your provider could decline to follow the Attorney in fact’s instructions in an emergency. An “emergency” includes a situation in which a person is considered a danger to him/herself or others.
10. How long does my PAD remain valid?
Your Durable Power of Attorney remains valid until revoked. You may revoke it at any time, orally or in writing.