Health care directive in Iowa: form, signing and who decides
The form, who can witness, who can be your agent and who decides if you have no directive in Iowa.
Checked against official sources: October 31, 2026.
Short answer
Durable power of attorney for health care
- How to sign
- Notarized or signed by two adult witnesses
- Who decides without a directive
- Yes
The document and its form
- Document
- Durable power of attorney for health care
- Official form
- Durable power of attorney for health care - optional statutory form (Iowa Code 144B.5)Published by Iowa LegislatureVersion: Iowa Code 2026 (section last amended 2022 Iowa Acts ch. 1066)
You do not have to use it.
- Living will
Declaration (Life-sustaining Procedures Act)
The living will is a separate document.
A declaration tells your attending provider to withhold or withdraw life-sustaining procedures if you are in a terminal condition and cannot take part in treatment decisions. Another physician, advanced registered nurse practitioner or physician assistant must confirm the terminal condition. It is signed like the health care power of attorney (two qualified witnesses or a notary). You are responsible for giving it to your attending provider or health care provider.
Law: Iowa Code § 144B.5; Iowa Code §§ 144A.3, 144A.5 (as amended by 2026 Iowa Acts, House File 2305)
Signing rules
- How to sign
The document must say it authorizes your attorney in fact to make health care decisions, must be dated, and must be either signed by two qualified witnesses or acknowledged before a notarial officer in Iowa. The same signing rules apply to a declaration (living will).
- Who signs
Signed by you, or by another person on your behalf at your direction, and dated.
- Notary
- A notary or witnesses (your choice)
- Witnesses
- 2 (instead of a notary)
- Who cannot witness
Two witnesses must sign in the presence of each other and of you, having seen the document signed. A witness cannot be a health care provider attending you on the date you sign, an employee of that provider, the person you name as attorney in fact, or anyone under 18. At least one witness must not be related to you by blood, marriage or adoption within the third degree.
Law: Iowa Code §§ 144B.3, 144A.3
Who can be your agent and what the agent can do
- Who cannot be your agent
A health care provider attending you on the date you sign cannot be your attorney in fact. An employee of that provider also cannot, unless related to you by blood, marriage or adoption within the third degree.
Law: Iowa Code 144B.4
- When the agent starts
Your attorney in fact can make a health care decision only when your attending provider (a physician, physician assistant or advanced registered nurse practitioner) judges that you are unable to make it. If you object to withholding or withdrawing care, you are presumed able to decide. A known, available attorney in fact has priority over anyone else, including a guardian, unless a court finds the attorney in fact is acting against your wishes.
Law: Iowa Code 144B.6(1), as amended by 2026 Iowa Acts, House File 2305, eff. July 1, 2026
- Decisions an agent cannot make
The attorney in fact must act according to your wishes as stated in the durable power of attorney for health care, in a declaration (living will), or otherwise made known to the attorney in fact, and if those are unknown, in your best interests. Since July 1, 2026, wishes you expressed only verbally to someone other than your attorney in fact, or in another document, do not restrict the attorney in fact unless your declaration, or a separate section of the durable power of attorney for health care stating that it is limited, says so.
Law: Iowa Code 144B.6(2), as amended by 2026 Iowa Acts, Senate File 2198
Revoking and conflicting documents
- Revoking your agent
You can revoke a durable power of attorney for health care at any time and in any way you can communicate, whatever your mental or physical condition, for example by telling your attorney in fact or a health care provider who is treating you, orally or in writing. A new valid durable power of attorney for health care revokes the earlier one unless it says otherwise.
- Revoking your instructions
You can revoke a declaration (living will) at any time and in any way you can communicate. It is effective once your attending provider is told, by you or by someone you told.
- Telling others
A revocation is effective as to a health care provider once the provider is told, and the provider must record it in your treatment records.
- Divorce ends a spouse's authority
- Yes · Divorce rules in Iowa (Divorce Law Map)
- Conflicting documents
Since July 1, 2026, your attorney in fact must follow wishes stated in your declaration (living will), but other documents and verbal statements to other people do not limit the attorney in fact unless the declaration, or a separate section of the durable power of attorney for health care stating that it is limited, says so.
Law: Iowa Code 144B.6(2), as amended by 2026 Iowa Acts, Senate File 2198
Law: Iowa Code §§ 144A.4, 144B.8, 144B.12(3)
If you have no directive
- Who decides without a directive
This applies to decisions to withhold or withdraw life-sustaining procedures for a person in a terminal condition who cannot communicate and has no declaration. The decision needs consultation and written agreement between your attending provider, another physician, advanced registered nurse practitioner or physician assistant, and your attorney in fact or guardian; if you have neither, the first available person in this order decides, guided by your wishes, with a witness present at the consultation. A 'close adult friend' must give your attending provider an affidavit. Since July 1, 2026, a guardian may make this decision without court approval. The same order applies to withholding resuscitation in a health care facility or hospice when there is no out-of-hospital do-not-resuscitate order.
- Attorney in fact under a durable power of attorney for health care, or a guardian
- Spouse
- Adult children (decision agreed to by a majority of those reasonably available)
- Parents (both, if both are reasonably available)
- Adult siblings (majority of those reasonably available)
- Other adult relatives, such as grandchildren, grandparents, aunts, uncles, nieces, nephews, stepchildren, stepparents and stepsiblings (majority of those reasonably available)
- A close adult friend
Other states, registry and medical orders
- Signed in another state
A health care power of attorney or living will signed in another state under that state's law is valid in Iowa to the extent it is consistent with Iowa law. A document that meets federal Department of Veterans Affairs advance directive requirements is also valid.
Law: Iowa Code 144A.3(4), 144B.3(4)
- POLST (medical orders)
Physician Orders for Scope of Treatment
Law: Iowa Code § 144D.2
Free notice: revoke or change a health care directive
Free help in Iowa
- Iowa Legal Aid (serves low-income Iowans and people 60 and older)
- Iowa Judicial Branch: Guardianships, Adult (FAQ)
- Iowa Judicial Branch: Court forms
- Iowa Judicial Branch: Civil court fees and fee deferral
- Find free legal aid at LawHelp.org
Report abuse or exploitation
Iowa Department of Health and Human Services - Child or Dependent Adult Abuse Reporting (Adult Protective Services) · 1-800-362-2178
Questions about powers of attorney in Iowa
How do I sign a health care directive in Iowa?
The document must say it authorizes your attorney in fact to make health care decisions, must be dated, and must be either signed by two qualified witnesses or acknowledged before a notarial officer in Iowa. The same signing rules apply to a declaration (living will).
Who decides my health care if I have no directive in Iowa?
This applies to decisions to withhold or withdraw life-sustaining procedures for a person in a terminal condition who cannot communicate and has no declaration. The decision needs consultation and written agreement between your attending provider, another physician, advanced registered nurse practitioner or physician assistant, and your attorney in fact or guardian; if you have neither, the first available person in this order decides, guided by your wishes, with a witness present at the consultation.