Iowa Living Will Requirements

Iowa law recognizes the right of a competent adult to execute a written declaration at any time directing that life-sustaining procedures be withheld or withdrawn. The declaration is given operative effect only once the declarant's condition is determined to be terminal and the declarant is unable to make treatment decisions.

Iowa defines terminal condition as an incurable or irreversible condition that, without life-sustaining procedures, will in the attending physician's opinion result in death within a relatively short period of time, OR a state of permanent unconsciousness from which, to a reasonable degree of medical certainty, there can be no recovery.

A qualified patient under Iowa law is an adult who has executed a declaration, or an out-of-hospital do-not-resuscitate order, and who has been determined by the attending physician to be in a terminal condition.

A declaration must be signed by the declarant, or by another adult at the declarant's direction, must contain the date of execution, and must be witnessed OR acknowledged. Two qualifying witnesses is one valid path; acknowledgment before a notarial officer under Iowa Code Chapter 9B is an equally valid, independently sufficient alternative, not a fallback.

If you use witnesses instead of a notarial officer, Iowa requires at least two adult witnesses who sign in the presence of each other and the declarant. At least one witness must not be related to the declarant by blood, marriage, or adoption within the third degree of consanguinity. A witness may not be a health care provider attending the declarant on the date of execution, an employee of that attending health care provider, or an individual under 18.

A declaration may be revoked at any time and in any manner by which the declarant is able to communicate the intent to revoke, regardless of mental or physical condition. Revocation is effective as to the attending physician or physician assistant only once communicated to them, and must be recorded in the declarant's medical record.

If an attending physician is unwilling to comply with a determination of terminal condition or with a declaration, the physician must take all reasonable steps to transfer the patient to another physician who will honor it.

Iowa law provides that a declaration is not in effect for a qualified patient known to the attending physician to be pregnant, for as long as the fetus could develop to the point of live birth with continued application of life-sustaining procedures. This does not impair any other existing rights or responsibilities regarding withholding or withdrawal of life-sustaining procedures.

A physician, health care provider, or person acting under a physician's direction is not subject to civil or criminal liability, or guilty of unprofessional conduct, for withholding or withdrawing life-sustaining procedures in good-faith compliance with the chapter, absent actual notice of revocation.

Iowa's statutory declaration form is optional, not mandatory: the declaration may, but need not, follow the suggested wording. An attending physician or health care provider may presume, absent actual notice to the contrary, that a declaration complies with the chapter and is valid.

A declaration or similar document validly executed in another state or jurisdiction is deemed valid and enforceable in Iowa, to the extent it is consistent with Iowa law. A declaration executed by an armed-forces veteran that complies with federal VA advance-directive requirements is also deemed valid and enforceable.

Federal law requires Medicare- and Medicaid-participating hospitals, nursing homes, and other facilities to inform patients in writing of their right under Iowa law to make an advance directive, including stating their own treatment wishes.

Federal HIPAA regulations govern how a health care provider may disclose protected health information to individuals involved in implementing an advance directive, including a person acting on the declarant's behalf.

Health care providers receiving federal funding cannot condition care, or otherwise discriminate against individuals, based on whether they have executed an advance directive.

Chapter 144B is a completely separate Iowa statute letting you name an attorney in fact to make health care decisions for you generally, not limited to terminal-condition scenarios. This is a separate function from the living-will declaration covered on this page: naming an agent gives someone else decision-making authority, rather than stating your own wishes directly. For full agent-designation guidance, see Iowa Healthcare Power of Attorney.

Iowa's definition of life-sustaining procedure excludes the provision of nutrition or hydration EXCEPT when required to be provided parenterally or through intubation. In practice, ordinary feeding is never withheld under a declaration, but IV or tube-delivered nutrition and hydration is automatically included within the general life-sustaining-procedure instruction, with no separate initialed election required.

Iowa's Revised Uniform Anatomical Gift Act (Chapter 142C) lets you authorize organ and tissue donation, consistent with any anatomical gift declarations made under that chapter. Chapter 142C includes Section 142C.12B, titled 'Effect of anatomical gift on advance health care directive,' directly addressing how an anatomical gift interacts with a declaration.

Iowa's definition of life-sustaining procedure excludes the administration of medication or performance of any medical procedure deemed necessary to provide comfort care or to alleviate pain, meaning such care must always continue regardless of a declaration's other instructions.

When an attending physician who has been given a declaration determines the declarant is in a terminal condition, that determination must be confirmed by another physician before the declaration is given operative effect. The attending physician must record the determination in the declarant's medical record.