Advance Planning: Discussing Your Healthcare Wishes

April 16 is National Healthcare Decisions Day (NHDD) — a day to inspire, educate and empower the public and providers about the importance of advance care planning. Founded in 2008, NHDD is an initiative to encourage patients to express their wishes regarding healthcare, and for providers and facilities to respect those wishes, whatever they may be.

EveryStep’s chief medical director, Dr. Tom Mouser, recently discussed advance care planning on the Iowa Medical Society’s Doc 2 Doc podcast.

“Advance care planning is kind of a big term — kind of like financial planning,” says Dr. Mouser. “If you were to go up to anybody on the street and ask the blanket question, ‘Have you made financial plans,’ they would probably say ‘yes.’ However, they may have just talked generally about finances with their significant other or just temporary plans to get through the month.”

True financial planning involves setting specific goals to achieve a desired outcome. In the same way, advance care planning involves making healthcare wishes and desires known and documented before a crisis occurs.

Two important forms of advance care planning are the durable power of attorney and in Iowa, the Iowa Physician Orders for Scope of Treatment (IPOST).

“If there’s not a durable power of attorney, it can be very difficult identifying who has the legal authority to make healthcare decisions if a loved one is unable to do so themselves. If there is not a spouse, these decisions can fall to children,” says Dr. Mouser. “That can lead to a lot of challenging dynamics for those who are trying to identify what their loved one would want. Love is very powerful and will spark a lot of emotion and even guilt unless you can refer to what their loved one shared as a result of advance care planning and [designating a durable power of attorney].”

The IPOST form facilitates a more robust conversation about a loved one’s wishes. “The IPOST form is an actionable order for a physician and provides an actionable way to honor those wishes that were expressed,” says Dr. Mouser. The IPOST form must be signed by a physician.

Advance care discussions and directives are often misunderstood. There are many myths, including:

  1. There is only one type of power of attorney. False. Power of attorney for financial matters does not, by default, provide power of attorney for healthcare. These are typically separate legal documents.
  2. It is inappropriate to begin advance directive planning before you need it. False. Discuss advance care planning before you become ill.
  3.  An advance directive means “don’t treat.” False. Advance directives do not say, “don’t treat me.” They say, “treat me the way I want to be treated.”
  4. Once you name someone your healthcare proxy, you lose control of your own care. False. If you retain the capacity to make decisions, you retain control of your medical destiny.
  5. A lawyer is required to complete an advance directive. False. A lawyer may be helpful, but is not required. Each state has its own requirements regarding number of witnesses or the need for notary seals.
  6. Doctors and other healthcare providers are not obligated to follow advance directives. False. Doctors and other healthcare providers are obligated to follow advance directives.
  7. Advance directives are legal tools for old people. False. The stakes may actually be higher for younger people if tragedy strikes.
  8.  The doctor can be the durable power of attorney for healthcare. False. No member of the healthcare team can be the durable power of attorney for healthcare.

Dr. Mouser says he has often sat with patients or family members who are literally in tears of joy because they had an advance planning discussion. “It’s been so reassuring to them to know for sure what their loved one would want or value. Sometimes the most powerful words are the words that came directly from their own lips.”

For more information on advance care planning, visit

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