If your mother had a stroke tomorrow and was unable to speak for herself, who would decide whether to keep her on life support? In many Iranian-American families, this question is never asked out loud. We don't like to talk about death. We either believe it brings bad luck or assume the family will 'just know' what to do. But hospitals don't run on family intuition. They run on paperwork.
Here's a statistic that should make you think twice. According to a Pew Research Center survey of 8,750 U.S. adults in September 2025, only 31% said they had created a living will or advance healthcare directive. This suggests that approximately two out of three Americans have no written instructions whatsoever. For immigrant families, the gap is likely wider still. Among US residents who spoke Persian at home, 209,814 out of 563,439 — around 37.2% — reported having a less than "very good" command of English in the 2023 American Community Survey (Migration Policy Institute, 2023). If you cannot fully read the hospital forms, you are far less likely to complete them.
With an estimated 750,000 Iranian Americans in the US, including 445,000 immigrants (Pew Research Center, 2024), this is a conversation that many families need to have — and soon. A living will attorney can help you set out your wishes in writing before a crisis forces others to guess what you would have wanted.
Key takeaways
- According to a 2025 Pew survey of 8,750 people, only 31% of U.S. adults reported having a living will or advance directive.
- A living will and a healthcare power of attorney are two distinct documents, and most families require both.
- In the case of In re Guardianship of L.A.C. (2024 OK 2), the Supreme Court of Oklahoma ruled that clear and convincing evidence was required in order to revoke an advance directive.
- Delaware law (16 Del. C. § 2516(a)), an out-of-state directive may be recognized, but the rules differ widely, so location matters.
Table of Contents
What a living will actually is (and what it isn't).
First, let's clear up the biggest source of confusion. A living will is not the same as a regular will. A regular will specifies who will inherit your money and property when you die. A living will allows you to make decisions about your future healthcare in the event that you become unable to communicate them yourself, for example if you are in a coma or deeply sedated.
It informs doctors of the type of care you want. Would you want a breathing machine? Or a feeding tube? Would you want life-sustaining treatment, which keeps your body functioning when there is little hope of recovery, or would you prefer to be kept comfortable and allowed to die naturally?
Then there's the second document that many people confuse with it. A healthcare power of attorney appoints someone to make medical decisions on your behalf when you are unable to do so yourself. Together, these two documents are often referred to as an advance directive for healthcare decisions. A living will states your wishes. The power of attorney specifies who will speak on your behalf. Most families need both documents.
You may also hear about a Do Not Resuscitate (DNR) order, which is a doctor's instruction to medical staff not to perform CPR if your heart stops. This is usually signed when someone is seriously ill and works alongside, not instead of, your advance decision.
Why this hits Iranian families harder
In our culture, elders are respected and important decisions are made together as a family. That's a strength. However, this can also create a dangerous gap. When nobody has been legally appointed and nobody knows what the deceased would have wanted, families can fall into conflict at the worst possible moment — standing exhausted and grieving in a hospital hallway.
The language barrier makes matters worse. Although we don't have specific completion numbers for Iranians, researchers have studied similar immigrant communities. For example, in a study of patients aged 55 and over in a Northern Californian health system from 2013 to 2017, Chinese patients who preferred a language other than English and needed an interpreter had an advance directive completion rate of just 5.1%, compared to 20.6% among non-Hispanic white patients (study authors, 2013–2017). These patients are only a rough point of comparison, not a measure of Iranian Americans. Nevertheless, the pattern is hard to ignore: when forms aren't in your language, they don't get filled out.
And the stakes are high. In a 2024 U.S. Department of Justice settlement, the New Jersey Judiciary was accused of failing to provide interpreters and translate essential documents for individuals with limited English proficiency. They also agreed to pay $89,718 in damages to an individual who alleged they had been retaliated against (U.S. Department of Justice, 2024). Settlements like this show that access to language services in legal matters is treated as more than a courtesy — it is something you can ask for and should expect.
Do you need an Iranian lawyer who speaks Farsi? Heritage Web can put you in touch.
How to create a living will for your parents
Many of my readers aren't thinking about their own future — they're worried about their aging parents. If you're looking for advice on creating a will for your parents, start with the conversation, not the paperwork. Here's a realistic order of things to do.
- Talk to them calmly in Farsi first. Choose a quiet moment and avoid bringing it up during a holiday dinner. Ask them what matters to them: comfort, dignity or religious considerations, for example. This is their decision, not yours.
- Confirm that they have legal capacity. The person signing must understand what they are agreeing to. If someone is too confused to understand the directive they have signed, it can be challenged later.
- Appoint a surrogate decision maker. Choose someone who is level-headed and can honor your parents' wishes, even under pressure. It does not have to be the oldest child.
- Make sure you put it in writing properly. Each state has its own rules regarding signatures and witnesses. Make sure you get the right form for where your parents live.
- Share it. Give copies to the doctor, the hospital and the named surrogate. A document locked away in a drawer is of no use to anyone.
One more thing: Federal law already requires hospitals to ask about these documents. The Patient Self-Determination Act (42 U.S.C. §§ 1395cc and 1396a) requires Medicare and Medicaid providers to have advance-directive policies in place, provide adults with written information about their state-law rights, record whether a directive exists and not discriminate based on whether you have one (Office of the Law Revision Counsel, 1990). The federal rules at 42 C.F.R. § 489.102 set out these written information, record-keeping and staff education duties in detail (Electronic Code of Federal Regulations, 2026). So, when your parent is admitted, staff should ask. Don't wait for them to — bring the document yourself.
The rules change depending on where you live.
This is where things get tricky. There is no single national form. What constitutes a valid directive in California may differ from what's required in Illinois or Delaware.
Take witnessing. Some states have modernized. Vermont now permits remote witnesses by live video or even telephone, and allows digital signatures for advance directives, under a change effective April 1, 2024 (18 V.S.A. § 9703; Vermont General Assembly, 2024). Illinois Public Act 103-0301, effective January 1, 2024, folded living wills and healthcare powers of attorney into its electronic estate-planning rules and recognizes qualifying electronic signatures and electronic witnessing (755 ILCS 6; Illinois General Assembly, 2024). Delaware, too, bars denying a directive legal effect just because it's electronic, and permits real-time audiovisual witnessing of a healthcare power of attorney (16 Del. C. § 2508, § 2516(c); Delaware General Assembly, 2025).
What if your parents signed a directive back in another state, or even abroad, before moving? Delaware's adoption of the 2023 Uniform Health-Care Decisions Act, implemented September 30, 2025, says an out-of-state directive is valid if it follows the law of the state named in it, the state where it was made, or Delaware law (16 Del. C. § 2516(a); Delaware General Assembly, 2025). That's helpful — but not every state is so forgiving. Check the rules where you live before assuming an old document still works.
There's also the question of who decides if there is no document at all. In Delaware, a default order of surrogates is set: first an adult named by the patient, then a spouse or domestic partner, then an adult child or parent, and so on (16 Del. C. § 2512(b), Delaware General Assembly, 2025). If you don't appoint someone, state law like Delaware's may supply a decision-maker for you, and that person may not be who you would have chosen.
What happens if you don't have one?
Without a directive and without a named surrogate, families can end up in probate court guardianship — a legal process where a judge appoints someone to make decisions for an incapacitated adult. It's slow, public, and expensive. In 2021 alone, 35 reporting states recorded 92,117 new adult guardianship petitions, and 34 reporting states recorded 51,157 new conservatorship petitions (Tompkins, Connors and Robinson, 2021). Those aren't nationwide totals, but they show how common these court battles are.
Disputes can still happen even when a directive exists. In the case of In re Guardianship of L.A.C. (2024 OK 2), the Oklahoma Supreme Court ruled that an incapacitated person retains the right to revoke an advance directive; however, this revocation must be proven by clear and convincing evidence. In this case, the court found no evidence of revocation and ruled that a feeding tube conflicted with the directive (Oklahoma Supreme Court, 2024). The lesson? A clear, properly documented advance directive protects your wishes. A vague or contested one invites a courtroom battle.
Healthcare facilities face real penalties for ignoring these rules, too. In Rio Hondo Healthcare, Inc. (DAB CR6317, July 19, 2023), an administrative law judge upheld an $11,225 civil money penalty against a facility that couldn't show it sent advance-directive information with a patient transferred to a VA hospital in 2020 (HHS Departmental Appeals Board, 2023). The paperwork matters — to you and to them.
Getting help in your own language
You shouldn't have to do this alone, and you don't have to. The gaps in legal help are enormous. A 2021 survey of adults in low-income households found that people received no or insufficient help for 92% of civil legal problems that had a significant impact on their lives (Legal Services Corporation, 2021). While this figure was not specific to Iranian-Americans, it shows how easily families can fall through the cracks.
The good news is that community resources exist. The Iranian American Bar Association, for example, has more than 1,500 members across ten chapters, and community legal education is among the work it lists (Iranian American Bar Association, 2026). Organizations such as the Pars Equality Center run pro bono clinics — its Fremont immigration clinics had served 93 individuals by January 2024 (Pars Equality Center, 2024). However, their work focuses on immigration rather than directives.
If you work with a living will attorney who speaks Farsi, your parents can ask questions in their native language. They can explain whether or not they want to be resuscitated without worrying that anything will get lost in translation. This peace of mind is invaluable.
Bear in mind that laws vary from state to state, and the examples given here are general. This article provides general information and does not constitute legal advice. If you require guidance on a specific situation, please consult a qualified attorney.
Your next step
Don't leave this until "someday". The best time to set out your wishes, or those of your parents, is while everyone is healthy and able to think clearly. Start the conversation this week. Then have the correct documents drawn up for your state, appoint a substitute decision-maker, and share copies with your doctors.
Get in touch with a lawyer from Iran who speaks Farsi and understands your culture. Submit your case details via Heritage Web's secure referral form. Having one honest conversation now could spare your family a courtroom appearance later.
Find an Iranian trusts and estates law lawyer
Sources
- In re Guardianship of L.A.C.
- Patient Self-Determination Act
- 42 C.F.R. § 489.102
- Migration Policy Institute — Migration Policy Institute, 2023
- Tompkins, Connors and Robinson
- Electronic Code of Federal Regulations
- HHS Departmental Appeals Board
- Pew Research Center
- Legal Services Corporation
- Delaware General Assembly
- U.S. Department of Justice
- 16 Del. C. § 2512
- Pars Equality Center
- 18 V.S.A. § 9703
- Public Act 103-0301
