Iowa Living Will

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This document represents the Living Will and Advance Directive for Healthcare for the undersigned, [YOUR NAME]. It is designed to express my wishes and instructions regarding medical treatment and end-of-life care should I become incapacitated and unable to communicate my healthcare decisions.

I. Declaration of Personal Information

Name:	[YOUR NAME]
Date of Birth:	[YOUR DATE OF BIRTH]
Address:	[YOUR COMPANY ADDRESS]
Social Security Number:	[YOUR SOCIAL SECURITY NUMBER]

II. Appointment of Healthcare Representative

I, with this written statement, am appointing the person mentioned hereafter to act as my Healthcare Representative. This individual will hold the responsibility and authority to make crucial healthcare decisions in place of myself if I, under unfortunate circumstances, become incapable of competently making these decisions on my own. This delegation of decision-making power, thus, is solely applicable to such situations where I am rendered unable to decide for myself.

Name:	[HEATHCARE REPRESENTATIVE'S NAME]
Relationship:	[HEALTHCARE REPRESENTATIVE'S RELATIONSHIP]
Address:	[HEALTHCARE REPRESENTATIVE'S ADDRESS]
Phone Number:	[HEALTHCARE REPRESENTATIVE'S PHONE NUMBER]

In the circumstance where my primary Healthcare Representative is either unable or unwilling to perform his/her duties, I hereby designate the following individual to serve as my alternate:

Name:	[ALTERNATE HEALTHCARE REPRESENTATIVE'S NAME]
Relationship:	[ALTERNATE HEALTHCARE REPRESENTATIVE'S RELATIONSHIP]
Address:	[ALTERNATE HEALTHCARE REPRESENTATIVE'S ADDRESS]
Phone Number:	[ALTERNATE HEALTHCARE REPRESENTATIVE'S PHONE NUMBER]

III. General Treatment Preferences

In terms of my wishes and preferences related to the medical treatment and care that I wish to receive, the specifics are as follows:

1. The use of life-sustaining treatment and artificial life support, including mechanical ventilation, if I am permanently unconscious with no reasonable chance of recovery.

2. The use of feeding tubes or intravenous feeding in the case of a persistent vegetative state.

3. My preferences for pain management and palliative care, prioritizing comfort even over extending life.

IV. Specific Medical Treatment Directions

I provide the following specific directions concerning my healthcare in the event I am unable to communicate my wishes:

Condition	Treatment Preference
Terminal Illness	Immediate and aggressive treatment Palliative care only
Persistent Vegetative State	Maintain life support Do not maintain life support
Severe Dementia	All available treatment Comfort measures only

V. Signature and Affirmation

By signing below, I affirm that this document accurately represents my wishes and consent to the medical treatment and interventions outlined above:

[YOUR NAME]

[DATE SIGNED]

VI. Witnesses

This document was signed in the presence of:

Witness 1:

[WITNESS 1'S NAME]

[DATE SIGNED]

Witness 2:

[WITNESS 2'S NAME]

[DATE SIGNED]

This document was prepared on the expressed instructions of [YOUR NAME], and to the best of my knowledge reflects their wishes and instructions regarding their healthcare.

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