Iowa: Health Care Power of Attorney Requirements

Iowa keeps the health care power of attorney in its own short statute, the
Durable Power of Attorney for Health Care (Iowa Code chapter 144B). It is
separate from Iowa's living will, which lives in a different chapter — the
Life-Sustaining Procedures Act (chapter 144A). This page is about chapter 144B:
naming an attorney in fact (the agent) to make medical decisions for you if
you later cannot make them yourself. Iowa is not a Uniform Health Care Decisions
Act state, so its rules do not track California's or Minnesota's word for word.

Requirements one by one

Governing law and document

Chapter 144B governs. A document is a valid durable power of attorney for health
care if it "substantially complies with the requirements of this chapter"
(§ 144B.2). Iowa publishes an optional fill-in form at § 144B.5(1), which
says a directive "may, but need not, be in the following form." You are free to
use a different document as long as it meets the chapter's requirements. Chapter
144B handles only the agent appointment; if you also want to record treatment
wishes for a terminal condition, that is a separate living-will declaration under
chapter 144A.

Who can sign

The signer (the principal) must be "age eighteen or older" (§ 144B.1(7)).
The document must "contain the date of its execution," and it is signed either by
the principal or "by another person acting on behalf of the principal at the
principal's direction" while the principal and the witnesses are present
(§ 144B.3(1)(b)). That direction-and-presence rule lets someone who cannot
physically sign still execute a valid directive. A much older document — one made
before May 8, 1991 — remains valid if it specifically authorizes health care
decisions and is signed by the principal (§ 144B.2).

Witnesses or notary

Iowa gives you a choice. Under § 144B.3(1)(b), the dated document must be
"witnessed or acknowledged by one of the following methods": (1) "signed by at
least two individuals who, in the presence of each other and the principal,
witnessed the signing"; or (2) "acknowledged before a notarial officer within
this state as provided in chapter 9B." Two qualified witnesses and a notary are
interchangeable — you do not need both.

Who can't witness or serve

If you use witnesses, four kinds of people are disqualified under § 144B.3(2):
"a health care provider attending the principal on the date of execution," an
"employee of a health care provider attending the principal," "the individual
designated ... as the attorney in fact," and anyone "less than eighteen years of
age." On top of that, § 144B.3(3) requires that at least one witness be someone
"who is not a relative of the principal by blood, marriage, or adoption within
the third degree of consanguinity."

Separately, § 144B.4 says who may not serve as the agent: your attending
health care provider, and that provider's employee "unless the individual to be
designated is related to the principal ... within the third degree." Notice what
Iowa does not add — there is no bar on the operator or staff of a care
facility serving as witness or agent, and no special extra-witness rule for a
patient in a nursing facility, both of which some other states impose.

When the agent can act

The agent's power is springing, and Iowa offers no way to make it effective
immediately. By definition the directive authorizes decisions only "if the
principal is unable, in the judgment of the attending physician or attending
physician assistant, to make health care decisions" (§ 144B.1(3)), and § 144B.6(1)
repeats that the agent "has authority to make a particular health care decision
only if the principal is unable, in the judgment of the attending physician or
attending physician assistant, to make the health care decision." Even then, if
"the principal objects to a decision to withhold or withdraw health care, the
principal shall be presumed to be able to make a decision." A willing, available
agent also has priority over a court-appointed guardian, unless a court finds
the agent is acting contrary to the principal's wishes (§ 144B.6(1)).

Agent's powers and limits

Once the power is in effect, the agent may consent to, refuse, or withdraw
consent to "any care, treatment, service, or procedure to maintain, diagnose, or
treat" a physical or mental condition (§§ 144B.1(4)–(5), 144B.5), and may review
the principal's medical records (§ 144B.7). Two limits stand out. First, "health
care" in this chapter "does not include the provision of nutrition or hydration
except when they are required to be provided parenterally or through intubation"
(§ 144B.1(4)) — so the agent's authority over feeding reaches only artificial
nutrition and hydration, never ordinary food and water. Second, the optional
form lets the agent consent to "stopping health care which is necessary to keep
me alive," but only "where otherwise consistent with the law of this state"
(§ 144B.5(1)), and the chapter may never be construed to authorize "mercy killing
or euthanasia" (§ 144B.12(2)).

A 2026 amendment refined how you cabin the agent's authority. Effective July 1,
2026, 2026 Iowa Acts ch. 1009 changed § 144B.6 so that a limit on the agent's
authority binds only if the durable power of attorney itself spells it out: the
agent's authority "shall not be restricted by the principal's desires expressed
verbally to a person other than the attorney, or in another document, unless the
document authorizing the durable power of attorney states in a separate section
that the durable power of attorney is limited, and includes the limitations on
the attorney's authority." In plain terms, if you want to restrict what your
agent can do, put the restriction in the directive — an offhand instruction to a
relative or a note in another document will not tie the agent's hands.

How to revoke

Revocation is easy and informal. Under § 144B.8(1), you may revoke "at any time
and in any manner by which [you are] able to communicate the intent to revoke,
without regard to mental or physical condition" — by telling the agent orally or
in writing, or by telling a health care provider who is treating you. A
provider is only bound "upon [the revocation's] communication to the provider."
You are "presumed to have the capacity to revoke" (§ 144B.8(2)), and signing a
new valid health care POA revokes any earlier one unless it says otherwise
(§ 144B.8(3)). And if you named your spouse and later divorce, § 144B.12(3)
revokes that appointment automatically (reinstated only if you remarry that
person).

Out-of-state directives

A directive you signed elsewhere travels. Under § 144B.3(4), a durable power of
attorney for health care "executed in another state or jurisdiction in
compliance with the law of that state or jurisdiction shall be deemed valid and
enforceable in this state, to the extent the document is consistent with the laws
of this state." A veteran's advance directive that meets federal VA requirements
is also recognized.

What trips people up

• You do not need a notary if you have two witnesses. Iowa treats
  notarization and two qualified witnesses as equal alternatives (§ 144B.3(1)(b)).
  Many people assume a health care directive must be notarized; in Iowa it is one
  option, not a requirement.
• Two relatives can't be your only witnesses. A relative may be one witness,
  but at least one witness must be unrelated within the third degree of
  consanguinity (§ 144B.3(3)). Using two close relatives fails the witness path.
• There is no "effective immediately" box. Unlike states that let you switch
  a health care POA on right away, Iowa's agent can act only once your attending
  physician or physician assistant judges you cannot decide for yourself
  (§§ 144B.1(3), 144B.6(1)). And if you object to a withhold-or-withdraw decision,
  you are presumed able to decide.
• Put any limits in the directive itself. As of July 1, 2026, a restriction
  on your agent's authority controls only if the document states, in a separate
  section, that it is limited (2026 Iowa Acts ch. 1009). Telling a family member
  what you don't want, or writing it in some other paper, will not bind the agent.
• Your agent's feeding authority is narrow. The agent's power over "nutrition
  or hydration" reaches only artificial feeding (parenteral or through a tube),
  not ordinary food and drink (§ 144B.1(4)).

Common questions

Does an Iowa health care power of attorney have to be notarized?
No. You can either have two qualified witnesses sign it or have it acknowledged
before an Iowa notary — your choice (§ 144B.3(1)(b)).

Can my agent start making decisions while I'm still competent?
No. Iowa has no immediate-effect option. Your agent can act only after your
attending physician or physician assistant judges that you cannot make the
decision yourself (§§ 144B.1(3), 144B.6(1)).

Can my agent override a guardian a court appoints?
Generally yes. A willing, available agent has priority over a court-appointed
guardian in health care matters, unless a court specifically finds the agent is
acting against your wishes (§ 144B.6(1)).

Will the directive I signed in another state work in Iowa?
Yes, if it was validly executed under that state's law, so long as it is
consistent with Iowa law (§ 144B.3(4)).

Statutes and sources

All quotations are from the official Iowa Legislature publication of Iowa Code
chapter 144B (Iowa Code 2026) and the enrolled Senate File 2198, accessed
2026-07-16.

• Iowa Code § 144B.1 — definitions, including "durable power of attorney for
  health care," the exclusion of nutrition/hydration from "health care" except
  when provided parenterally or through intubation, and "principal" as a person
  age eighteen or older.
  https://www.legis.iowa.gov/docs/ico/chapter/144B.pdf
• Iowa Code § 144B.2 — a directive is valid if it substantially complies with
  the chapter; pre-May 8, 1991 documents.
  https://www.legis.iowa.gov/docs/ico/chapter/144B.pdf
• Iowa Code § 144B.3 — execution requirements (dated; two witnesses or a
  notary), disqualified witnesses, the non-relative witness rule, and recognition
  of out-of-state and veterans' directives.
  https://www.legis.iowa.gov/docs/ico/chapter/144B.pdf
• Iowa Code § 144B.4 — individuals ineligible to serve as attorney in fact.
  https://www.legis.iowa.gov/docs/ico/chapter/144B.pdf
• Iowa Code § 144B.5(1) — the optional statutory form and its life-support
  consent language.
  https://www.legis.iowa.gov/docs/ico/chapter/144B.pdf
• Iowa Code § 144B.6(1) — the agent's priority over a guardian and the
  physician-judged-incapacity trigger for the agent's authority.
  https://www.legis.iowa.gov/docs/ico/chapter/144B.pdf
• Iowa Code § 144B.8 — revocation at any time and in any manner; a new
  directive revokes a prior one.
  https://www.legis.iowa.gov/docs/ico/chapter/144B.pdf
• Iowa Code § 144B.12 — no authorization of mercy killing or euthanasia;
  divorce revokes a spouse-agent.
  https://www.legis.iowa.gov/docs/ico/chapter/144B.pdf
• 2026 Iowa Acts ch. 1009 (S.F. 2198) — amended § 144B.6 effective July 1,
  2026; a limit on the agent's authority binds only if the directive states, in a
  separate section, that it is limited.
  https://www.legis.iowa.gov/docs/publications/LGE/91/SF2198.pdf