To the Editor.
—The recent Law and Medicine article1 described the New York State Surrogate Decision-Making Committee program. A State Substitute Medical Decision-Making Board was established in Iowa by 1989 legislation, using the New York rules as a guide. The Iowa law also allows counties to appoint local boards, but is broader than the New York law. It can be applied to anyone who is unable to understand the nature and consequences of proposed medical care, and thus cannot give informed consent, and who does not have a guardian or family members.The rules in Iowa have been in effect for about 18 months. Seven counties have established local boards. Where there is no local board, the state board has jurisdiction and now has acted on 12 cases. The cases have involved people who ranged in age from 36 to 95 years and have included residents of nursing homes