Iowa: Living Will and Advance Health-Care Instruction Requirements
The short answer
Iowa's Life-sustaining Procedures Act lets a competent adult sign a dated declaration directing life-sustaining procedures to be withheld or withdrawn. The adult uses either at least two qualified witnesses—present with one another and the declarant—or an Iowa notarial acknowledgment; another person may sign at the declarant's direction. The declaration controls only after an attending provider finds a terminal condition, a second physician, ARNP, or physician assistant confirms it, and the declarant cannot decide. A known pregnancy suspends the declaration while continued life support could allow the fetus to develop to live birth. Revocation may occur at any time and in any communicated manner, regardless of mental or physical condition.
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This is the general rule in Iowa. Ezel applies current Iowa law to your specific facts and answers with citations to the statutes.
| Governing law and document | Iowa Life-sustaining Procedures Act, Iowa Code ch. 144A. A standalone 'declaration' governs withholding/withdrawal of life-sustaining procedures; it is separate from ch. 144B's durable health-care POA and from out-of-hospital DNR clinician orders. Optional declaration form at § 144A.3(5) |
|---|---|
| Who may make an instruction | A competent adult, age 18+, may execute at any time (§§ 144A.2(1), 144A.3(1)). No post-diagnosis oral declaration route appears. Pre-1992 declarations have a saving rule (§ 144A.12) |
| Oral, written, and signature form | Written document, dated and signed by declarant or by another person acting at declarant's direction (§ 144A.3(2)). Witness path requires signing in declarant's and both witnesses' presence; notary path uses acknowledgment. No electronic-specific execution route appears |
| Witness, notary, and disqualifications | Choose 2+ witnesses OR Iowa notarial acknowledgment (§ 144A.3(2)). Witnesses are together with declarant; 1+ must not be related within third degree. Disqualified: health-care provider attending declarant that day, that provider's employee, and anyone under 18. No heir, agent, or facility-specific witness bar |
| Covered conditions and trigger | Operative only if condition is terminal and declarant cannot make treatment decisions (§ 144A.3(1)). Terminal means incurable/irreversible and, without life-sustaining procedures, death within relatively short time OR permanent unconsciousness with no recovery (§ 144A.2(18)). Attending provider finds condition; second physician, ARNP, or physician assistant confirms; determination recorded (§ 144A.5 as amended by 2026 H.F. 2305) |
| Treatment, nutrition, hydration, and comfort | Declaration directs withholding/withdrawal of 'life-sustaining procedures': mechanical/artificial support that only prolongs dying in terminal condition. Term excludes nutrition/hydration except parenteral or intubated delivery, and excludes medication/procedures necessary for comfort or pain relief (§ 144A.2(12)). Optional form requests withdrawal of procedures merely prolonging dying and not necessary for comfort/freedom from pain (§ 144A.3(5)) |
| Pregnancy and other statutory limits | Known pregnancy: declaration not in effect while fetus could develop to live birth with continued life-sustaining procedures; subsection preserves existing rights/responsibilities concerning withholding/withdrawal (§ 144A.6(2), current wording under H.F. 2305). Chapter does not authorize mercy killing/euthanasia or deliberate life-ending act/omission beyond natural dying (§ 144A.11(6)) |
| Revocation, notice, and registry | Revoke anytime and in any manner communicating intent, regardless of mental/physical condition; effective as to attending provider when declarant or recipient of revocation communicates it, and provider records it (§ 144A.4 as amended by H.F. 2305). Declarant supplies declaration to provider (§ 144A.3(3)). No advance-directive registry appears in current chapter |
| Provider duties, recognition, and effect | Attending provider unwilling to make/comply with condition finding or declaration takes all reasonable transfer steps; provider-policy refusal similarly requires facility transfer (§ 144A.8, current wording under H.F. 2305). Good-faith/statutory compliance immunity and reasonable-medical-standard protection (§ 144A.9). Foreign declaration valid if compliant there and consistent with Iowa; VA-compliant veteran directive also valid (§ 144A.3(4)) |
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Iowa's living will is a declaration under the Life-sustaining Procedures Act,
Chapter 144A. It is separate from the durable health-care power of attorney in
Chapter 144B and from an out-of-hospital DNR order signed by a clinician. This
page covers the adult's own Chapter 144A treatment declaration.
Requirements one by one
A competent adult signs a dated declaration
Under § 144A.3(1), a competent adult—age 18 or older—may direct that life-
sustaining procedures be withheld or withdrawn. The declaration is signed by the
adult or by another person acting at the adult's direction and must contain the
execution date.
Iowa offers two alternative execution paths. The signer may use at least two
witnesses who are present with one another and the declarant when the declarant
or directed signer signs. Or the declaration may be acknowledged before an Iowa
notarial officer. The statute provides no electronic-specific execution route.
The witness path has one relative limit and three disqualifications
At least one witness must not be related to the declarant by blood, marriage, or
adoption within the third degree of consanguinity. A provider attending the
declarant on the execution date, an employee of that provider, and a person under
18 cannot witness. Iowa does not add a general heir, named-agent, or nursing-
facility witness bar to this declaration.
Execution and operation are separate
The declaration receives operative effect only when the declarant's condition is
terminal and the declarant cannot make treatment decisions. Under current
§ 144A.5, as amended by 2026 H.F. 2305, the attending provider makes the
terminal-condition determination, a second physician, advanced registered nurse
practitioner, or physician assistant confirms it, and the attending provider
records it.
The terminal-condition definition in § 144A.2 covers an incurable or irreversible condition
that, without life-sustaining procedures, will lead either to death within a
relatively short time or to permanent unconsciousness from which recovery is not
medically expected. A qualified patient who can still decide retains the right
to do so; the declaration governs only when the patient cannot.
Artificial feeding is included only when parenteral or intubated
A Chapter 144A life-sustaining procedure uses mechanical or artificial means to
sustain, restore, or replace a spontaneous vital function and, for a terminal
patient, merely prolongs dying. The definition excludes nutrition and hydration
except when delivered parenterally or through intubation. It also excludes
medication and procedures needed for comfort care or pain relief.
The optional statutory form therefore directs withholding or withdrawal of
procedures that merely prolong dying and are not needed for comfort or freedom
from pain. It does not create a broad instruction about ordinary food and drink.
Known pregnancy suspends the declaration under a live-birth test
Current § 144A.6(2) states that the declaration of a qualified patient known
to the attending provider to be pregnant is not in effect while the fetus could
develop to the point of live birth with continued life-sustaining procedures.
The subsection also says it does not impair existing rights or responsibilities
concerning withholding or withdrawal.
The chapter separately says it does not authorize mercy killing, euthanasia, or
an affirmative or deliberate life-ending act or omission beyond permitting the
natural process of dying.
Revocation is broad and condition-independent
Under current § 144A.4, the declarant may revoke at any time and in any manner
that communicates the intent, without regard to mental or physical condition.
Revocation becomes effective as to the attending provider when communicated by
the declarant or by someone to whom the declarant communicated it. The attending
provider places the revocation in the medical record.
Under § 144A.3(3), the declarant is responsible for providing the declaration to the attending
provider, who may presume it compliant and valid absent actual contrary notice.
Current Chapter 144A creates no advance-directive registry.
An unwilling provider must take transfer steps
Under current § 144A.8, an attending provider unwilling to make or comply
with the required determination or to follow the declaration takes all reasonable
steps to transfer the patient to another provider. If institutional policy
precludes compliance, the provider takes all reasonable steps to transfer the
patient to a facility where the chapter can be carried out.
§ 144A.9 provides civil, criminal, and professional-discipline
protection for specified persons acting under the chapter without actual notice
of revocation and protects physician actions consistent with reasonable medical
standards. § 144A.11 supplies the chapter's no-presumption and natural-dying
boundaries. A foreign declaration valid where executed is recognized only to the
extent consistent with Iowa law; a VA-compliant veteran directive is also valid.
What trips people up
- The December 2025 Code PDF is not the whole current picture. H.F. 2305 was
approved May 2, 2026 and broadened who may serve as attending provider and who
may confirm terminal condition. - The declaration is not effective when signed. It controls only after the
terminal-condition and decision-incapacity requirements are met. - The pregnancy rule is mandatory within its terms. The statute does not let
a checkbox override the live-birth suspension. - Nutrition and hydration are not all-or-nothing. Chapter 144A reaches them
as life-sustaining procedures only when provided parenterally or through
intubation. - Revocation does not repeat signing formalities. Any communicated manner
works regardless of mental or physical condition.
Common questions
Does an Iowa living will need a notary?
Not if it has at least two qualified witnesses. Witnesses and an Iowa notarial
acknowledgment are alternative execution paths.
Who determines that the declaration controls?
The attending provider finds a terminal condition, another physician, ARNP, or
physician assistant confirms it, and the declarant must also be unable to make
treatment decisions.
Can the declaration address artificial nutrition and hydration?
Yes, but Chapter 144A includes nutrition and hydration in life-sustaining
procedures only when they are delivered parenterally or through intubation.
Can the declaration be revoked orally?
Yes. Any manner communicating intent works, but the revocation becomes effective
as to the attending provider when it is communicated to that provider.
Statutes and sources
- Iowa Code chapter 144A (Iowa Code 2026) — unchanged declaration execution,
definitions, treatment scope, immunity, general provisions, and foreign-
declaration recognition.
https://www.legis.iowa.gov/docs/ico/chapter/144A.pdf - 2026 H.F. 2305, enrolled with governor's action — approved May 2, 2026;
current attending-provider, confirmation, pregnancy wording, revocation, and
transfer amendments.
https://www.legis.iowa.gov/docs/publications/LGE/91/Attachments/HF2305_GovLetter.pdf
Source links
Every statute quoted above, linked, with the date we checked it.
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