What Health Care Decisions can a Guardian Make?
A guardian can make the health care decisions that the court says the guardian can make. Usually a guardian who can make health care decisions can decide whether and what kind of these services that the ward needs:

• emergency medical services,
• professional care,
• counseling,
• treatment or other services.

There are some limits. The guardian will not be able to make certain health care decisions if:

• the ward signed a valid Durable Healthcare Power of Attorney (HCPOA) or
• the ward signed a valid Living Will.

The person named in the HCPOA would have the right to make health care decisions and not the guardian. The living will says what kind of life sustaining procedures the ward wants. The ward's wishes must be followed.

A guardian is required to get prior court approval in a number of situations. These situations include:

• changing the ward's permanent residence if the new residence would be more restrictive of the ward's liberties;
• arranging for major elective surgery or any other non-emergency major medical procedure; and
• consenting to the withdrawal of life sustaining procedures.

How to Ask for Court Approval
The guardian must file a written application with the court. A hearing will be set. A notice of the hearing will be sent to the ward and other interested parties.

The guardian must give the court:

• complete details of the procedure or decision, including all risks and benefits;
• a written application asking the court to approve the procedure.

The court may appoint an attorney to represent the ward if the court decides it is in the ward's best interest. Based on the information given to the court, the court will make its decision and enter an order.

If the court approves, the guardian may carry out the decision. If the court does not approve it, the guardian will have to find other ways to meet the ward's needs.

Changing the Ward's Residence
The ward should be able to live in the least restrictive setting possible. This means a place that gives the ward the most freedom and choices that the ward can handle. The guardian can decide that the ward should be moved to a more restrictive setting. The guardian must ask the court to approve the change before the move takes place. For example, if the ward has been living in his or her home and the guardian decides it would be best for the ward to live in a nursing home, the guardian must get court approval before moving the ward.

The ward may need to be moved because of an emergency. Court approval is not necessary in that case. Court approval would be needed if a change in placement becomes permanent.

Major Elective Surgery and Non-Emergency Major Medical Procedures
Iowa law does not include a list of specific surgeries or procedures that require prior court approval. The statute states that the court must approve "major elective surgery" or any other "non-emergency major medical procedure." These words are not defined in the statute. This makes it difficult to decide when court approval is needed. As the risk to the ward from the procedure or surgery increases, the need for court approval would also increase. The guardian should seek court approval before making any decision about a significant medical procedure or surgery. In the case of an emergency, the guardian will not need prior court approval.

The statute also excludes two specific procedures from the need to get prior court approval. Court approval is not needed for:

• routine physical examinations and procedures under anesthesia, if the anesthesia is required because of the physical or mental disability of the ward; and
• routine dental examinations and procedures under anesthesia, if the anesthesia is required because of the physical or mental disability of the ward.

Consenting to Stop or not Give Life Sustaining Procedures
Decisions about stopping or not giving life sustaining procedures should be made by the ward, if possible. The guardian may make the decision if:

• the guardian gets court approval; and
• the guardian has a written agreement with the doctor; and
• the ward has not signed a valid Living Will; and
• the ward cannot make the decision.

Iowa has a specific law which deals with the stopping or not giving of life sustaining procedures. Guardians must follow those rules. For more information about these issues, please look at the article "Making Decisions to Limit Medical Procedures."

Funding for this information was provided by the Iowa Governor's Developmental Disabilities Council.