Iowa Healthcare Directive

In Iowa, an advance directive is not one form. State law splits it in two. A living will, called a declaration under the Life-Sustaining Procedures Act (Iowa Code chapter 144A), records your end-of-life wishes. A durable power of attorney for health care (Iowa Code chapter 144B) names an agent to make medical decisions when you cannot. Most people sign both.

Use this guide as a plain-language map, not legal advice or a fill-in form. Medical directives carry real weight, so many people have an Iowa attorney draft or review them. Settled is not a law firm. This page explains the rules so you can ask better questions and pair your health care documents with the Iowa power of attorney guide for money and property.

The Two Documents Iowa Uses

Iowa keeps medical and financial planning in separate documents, and it keeps the two medical documents apart too. Each answers a different question.

• A living will, or declaration, says what you want to happen if you reach a terminal condition and can no longer speak for yourself. It is about life-sustaining procedures, and it does not name a decision-maker. This lives in Iowa Code chapter 144A.
• A durable power of attorney for health care names an attorney in fact, your health care agent, to make medical decisions for you when a doctor judges you cannot make them yourself. It reaches far more than end-of-life care. This lives in Iowa Code chapter 144B.

Signing both covers both jobs. The declaration puts your end-of-life wishes in writing, and the durable power of attorney gives a trusted person authority to act on everything else. You can also fold specific instructions into the durable power of attorney so your agent knows what you want.

The Iowa Living Will (Declaration)

A living will in Iowa is a declaration under the Life-Sustaining Procedures Act. Under Iowa Code section 144A.3, a competent adult may sign one at any time to direct that life-sustaining procedures be withheld or withdrawn. It takes effect only if two things are true: a doctor determines your condition is terminal, and you can no longer make treatment decisions. Until then, you stay in charge of your own care.

Iowa gives you two ways to sign it. The declaration must be dated and either:

• Signed before two witnesses. Both watch you sign, in your presence and in each other's presence. At least one witness must not be a relative by blood, marriage, or adoption within the third degree. Your attending health care provider, that provider's employees, and anyone under 18 cannot witness it.
• Acknowledged before a notary (a notarial officer under Iowa Code chapter 9B).

A "terminal condition" under Iowa Code section 144A.2 means an incurable, irreversible condition that will cause death within a relatively short time without life-sustaining procedures, or a state of permanent unconsciousness with no reasonable hope of recovery. Life-sustaining procedures are treatments that use mechanical or artificial means to sustain a failing body function and that would only prolong dying. Comfort care and pain relief are never withheld, and nutrition and hydration are handled separately unless they must be given by tube or IV.

Before your declaration governs, a second doctor has to agree. Under Iowa Code section 144A.5, once your attending physician finds you are in a terminal condition, another physician must confirm it, and the finding goes in your medical record.

The Durable Power of Attorney for Health Care

A durable power of attorney for health care does what a living will cannot: it names a person to decide. Under Iowa Code section 144B.2, the document authorizes an attorney in fact to make health care decisions once it meets the chapter's requirements. "Durable" means it survives your loss of capacity, which is the whole point.

The signing rules follow the living will closely. Under Iowa Code section 144B.3, the document must be dated and either signed before two witnesses (in your presence and each other's) or acknowledged before an Iowa notary. At least one witness must not be a close relative within the third degree. Your attending health care provider, that provider's employees, your named agent, and anyone under 18 cannot serve as a witness.

Iowa also limits who can hold the job. Under Iowa Code section 144B.4, your attending health care provider and that provider's employees cannot be your agent, unless the person is a relative within the third degree. Choose someone close to you but not on your care team.

Your agent's authority is not automatic. It begins only when your attending physician or physician assistant judges that you cannot make a health care decision yourself. And you keep the final word while you can speak. Under Iowa Code section 144B.6, if you object to a decision to withhold or withdraw care, you are presumed able to make that decision. An available, willing agent also outranks a court-appointed guardian on health care choices, so naming an agent can head off a guardianship fight. Your agent may review your medical records to make informed calls, under Iowa Code section 144B.7.

Who Decides If You Have No Directive

If you never sign a directive and never name an agent, Iowa still has an answer for end-of-life decisions. Under Iowa Code section 144A.7, when a patient is in a terminal condition and cannot communicate, the attending physician and one person from a priority list can agree in writing to withhold or withdraw life-sustaining procedures. That person acts on the patient's known or likely wishes. The order runs:

Two limits shape this list. A witness must be present when the decision is made, and it does not apply to a pregnant patient whose fetus could reach live birth with continued treatment. The lesson for planning is plain: this list is a backstop, not a substitute for your own choice. It may hand the decision to someone you would not have picked, or split it among several adult children who disagree. Naming your own agent keeps the choice with the person you trust.

Changing or Revoking Your Directive

Neither Iowa document expires. Each stays in force until you revoke it.

• The living will. Under Iowa Code section 144A.4, you can revoke your declaration at any time and in any way that shows your intent, no matter your physical or mental condition. The revocation reaches your attending physician once it is communicated, and the doctor notes it in your record.
• The durable power of attorney. Under Iowa Code section 144B.8, you can revoke it any time you can communicate the intent, by telling your agent or a treating provider, orally or in writing. You are presumed to have the capacity to revoke. A new durable power of attorney for health care cancels an earlier one unless it says otherwise.

One automatic rule matters for married couples. Under Iowa Code section 144B.12, if you named your spouse as your agent and the marriage later ends in divorce, that appointment is revoked. If you remarry the same person, it comes back unless you already revoked it. After any divorce, sign a new durable power of attorney so you are not left without an agent.

Limits Iowa Puts on Medical Directives

A few guardrails apply no matter what your documents say.

• Pregnancy. Under Iowa Code section 144A.6, a declaration does not take effect for a patient known to be pregnant while the fetus could develop to live birth with continued treatment. The same limit runs through the surrogate rules.
• No coercion. Under Iowa Code section 144B.11, no facility or insurer can require you to sign a durable power of attorney for health care as a condition of care, treatment, or coverage.
• Life insurance is protected. The same section says withholding or withdrawing care under a health care agent's direction cannot void or impair a life insurance policy.
• No euthanasia. Under Iowa Code section 144B.12, nothing in the chapter authorizes mercy killing or euthanasia. These documents let you refuse unwanted treatment. They do not permit anything more.

IPOST: A Portable Medical Order

An Iowa healthcare directive is a planning document you sign while healthy. IPOST is a different tool. The Iowa Physician Orders for Scope of Treatment form, under Iowa Code chapter 144D, is an actual medical order that a physician, nurse practitioner, or physician assistant signs with a seriously ill or frail patient. It travels across care settings, from home to ambulance to hospital, and tells providers what treatment to give or withhold right now.

The statute is clear about how the two relate: an IPOST complements a valid advance directive and does not replace it. If you are healthy, a living will and a durable power of attorney for health care are the documents to sign. IPOST is a conversation for later, usually when a serious illness makes day-to-day treatment orders useful. Ask your doctor about it if that describes your situation.

A Planning Sequence

Use this order as a checklist, then confirm the details with an Iowa attorney or your provider.

1. Decide whether you want a living will, a health care agent, or both. Most people choose both.
2. Choose your attorney in fact and a backup, and ask them first. Keep your care providers off the list.
3. Write your end-of-life wishes into the declaration, and add any specific instructions to the durable power of attorney.
4. Sign each document before two qualified witnesses or an Iowa notary, with at least one unrelated witness.
5. Give signed copies to your agent, your doctor, and a close family member, and carry a card noting where the originals are.
6. Review both after any major change, especially marriage or divorce, and sign new ones if your wishes change.

Pair these medical documents with the rest of your plan. The Iowa power of attorney guide covers who manages your money and property if you cannot act, and the Iowa probate guide explains what happens to your estate after death. For the full set of Iowa estate pages, start at the Iowa estate directory.

This guide is general information about Iowa medical directives, not a substitute for advice from a licensed Iowa attorney. Confirm anything that affects your situation with your health care provider or a lawyer, because these documents decide who speaks for you when you cannot speak for yourself.

Sources:

• Title: Iowa Code chapter 144A, Life-Sustaining Procedures Act. Publisher: Iowa Legislature. Publication Date: Iowa Code 2026. URL: https://www.legis.iowa.gov/docs/code/144A.pdf
• Title: Iowa Code section 144A.2, Definitions. Publisher: Iowa Legislature. Publication Date: Iowa Code 2026. URL: https://www.legis.iowa.gov/docs/code/144A.2.pdf
• Title: Iowa Code section 144A.3, Declaration relating to use of life-sustaining procedures. Publisher: Iowa Legislature. Publication Date: Iowa Code 2026. URL: https://www.legis.iowa.gov/docs/code/144A.3.pdf
• Title: Iowa Code section 144A.5, Determination of terminal condition. Publisher: Iowa Legislature. Publication Date: Iowa Code 2026. URL: https://www.legis.iowa.gov/docs/code/144A.5.pdf
• Title: Iowa Code section 144A.7, Procedure in absence of declaration. Publisher: Iowa Legislature. Publication Date: Iowa Code 2026. URL: https://www.legis.iowa.gov/docs/code/144A.7.pdf
• Title: Iowa Code chapter 144B, Durable Power of Attorney for Health Care. Publisher: Iowa Legislature. Publication Date: Iowa Code 2026. URL: https://www.legis.iowa.gov/docs/code/144B.pdf
• Title: Iowa Code section 144B.3, Requirements. Publisher: Iowa Legislature. Publication Date: Iowa Code 2026. URL: https://www.legis.iowa.gov/docs/code/144B.3.pdf
• Title: Iowa Code section 144B.4, Individuals ineligible to be attorney in fact. Publisher: Iowa Legislature. Publication Date: Iowa Code 2026. URL: https://www.legis.iowa.gov/docs/code/144B.4.pdf
• Title: Iowa Code section 144B.6, Attorney in fact priority to make decisions. Publisher: Iowa Legislature. Publication Date: Iowa Code 2026. URL: https://www.legis.iowa.gov/docs/code/144B.6.pdf
• Title: Iowa Code section 144B.8, Revocation of durable power of attorney. Publisher: Iowa Legislature. Publication Date: Iowa Code 2026. URL: https://www.legis.iowa.gov/docs/code/144B.8.pdf
• Title: Iowa Code chapter 144D, Physician Orders for Scope of Treatment (IPOST). Publisher: Iowa Legislature. Publication Date: Iowa Code 2026. URL: https://www.legis.iowa.gov/docs/code/144D.pdf

It is not legal advice.