Living will requirements in Iowa

Which document is this, really

In Iowa, the living will has a plain statutory name: the Declaration, created under the state’s Life-Sustaining Procedures Act. It is a written statement of the life-sustaining treatment you do and do not want once you are in a terminal condition and cannot speak for yourself. Iowa keeps a second, entirely separate statute for naming someone to decide on your behalf: the Durable Power of Attorney for Health Care. The person you name in it is your attorney-in-fact.

These are two different pieces of paper, from two different chapters of the code, and neither one substitutes for the other. What is easy to miss is how closely the two chapters otherwise match each other. Both ask for the same signing choice, two witnesses or a notary, and both disqualify roughly the same people from witnessing. Where they part ways is narrower than you would expect from a two-document state: a short addition to who cannot witness the power of attorney, and which chapter a couple of rules, like the pregnancy limit, actually live in.

This is the pairing Myend’s Healthcare Directive prepares for Iowa: a Declaration for your treatment wishes, and a Durable Power of Attorney for Health Care for your attorney-in-fact, each formatted the way Iowa expects it.

Who can make an Iowa advance directive

Iowa’s Declaration is open to any adult, defined in the statute as an individual 18 years of age or older, and the same age line runs through the Durable Power of Attorney for Health Care. Being an adult is not, on its own, the whole test. What the law actually asks for at the moment you sign is that you understand what the document says, what it does, and what it means to hand a decision to someone else. That understanding, not a diagnosis or a doctor’s note, is what makes the signature count.

Signing it so it counts

Iowa runs two signing ceremonies, one for each document, and the two are close enough to each other that it is easy to assume they are identical. They are not quite. Read each one on its own terms.

The Declaration

1. 1You sign

   You sign the Declaration yourself, or someone signs it at your direction and in your presence if you are physically unable to sign it.

2. 2Two witnesses, or a notary

   Sign in front of two witnesses who watch you sign and watch each other, or skip the witnesses and have the signature acknowledged before a notarial officer instead. Either route makes the Declaration valid on its own.

3. 3If you use witnesses

   Neither witness can be the health care provider attending you on the day you sign, an employee of that attending provider, or anyone under 18. Iowa adds one more condition: at least one of your two witnesses must not be related to you by blood, marriage or adoption within the third degree of consanguinity.

The Durable Power of Attorney for Health Care

Naming your attorney-in-fact is a separate signing, on its own paper, and Iowa offers it the identical choice: two witnesses, in each other’s presence and yours, or a notarial officer instead. The witness list carries over the same three categories, health care provider, that provider’s employee, anyone under 18, and the same third-degree relatedness rule. The Durable Power of Attorney for Health Care adds one name of its own to the barred list: the person you are naming as your attorney-in-fact cannot also serve as a witness to the document that names them.

Naming your attorney-in-fact

The Durable Power of Attorney for Health Care is where you name your attorney-in-fact, the person who makes health care decisions for you once the document’s conditions are met. Iowa’s list of who cannot fill that role is short and specific. Your attorney-in-fact cannot be a health care provider attending you on the day you sign, and cannot be an employee of that attending provider, unless the employee is related to you by blood, marriage or adoption within the third degree of consanguinity. Outside of that pair of exceptions, anyone you trust can serve.

When it takes effect

Your Declaration becomes operative once your attending physician determines that you are in a terminal condition and a second physician confirms that determination. Your attending physician has to record the determination in your medical record. Until then, your own expressed wishes control, whatever the Declaration says.

The Durable Power of Attorney for Health Care has a statutory trigger of its own. Your attorney-in-fact may make a particular health care decision only if you are unable to make that decision yourself, in the judgment of your attending physician or attending physician assistant. That judgment is made decision by decision rather than once and for all, and if you object to a decision to withhold or withdraw care, Iowa presumes you are able to make it. Iowa’s own printed form says the same thing in its opening paragraph.

If you are pregnant

Iowa’s Declaration is set aside during pregnancy, but the limit is narrower than a blanket rule for the whole nine months. The statute ties it to viability: the Declaration is not in effect for as long as the fetus could still develop to the point of live birth with continued life-sustaining treatment. Once that is no longer medically true, the Declaration applies as written. This limit is written into the Declaration’s own chapter, so it belongs to the Declaration specifically.

Changing or cancelling it

You can revoke your Declaration at any time, whatever your mental or physical condition, in any manner you are able to use to communicate that you mean to revoke it. The revocation takes effect once your attending physician or physician assistant is told, and they have to record it in your medical record.

The Durable Power of Attorney for Health Care has its own revocation section, and it is just as open. You can revoke it at any time and in any manner you are able to use to communicate that intent, whatever your mental or physical condition: tell your attorney-in-fact orally or in writing, or tell a health care provider while that provider is treating you. It binds a provider once they are told, and they have to document it in your records. Iowa presumes you have the capacity to revoke. Two more rules work without you doing anything: a valid new Durable Power of Attorney revokes any earlier one unless it says otherwise, and if you named your spouse and the marriage is later dissolved, that power is revoked, coming back only if you remarry each other.

Making sure it is found

The most reliable way to make sure either document is used when it matters is the same in Iowa as anywhere: give a copy of your Declaration and your Durable Power of Attorney for Health Care to your attorney-in-fact, your physician, and the hospital you are most likely to use, and keep the signed originals somewhere your family knows to look. A document nobody can find at the moment it is needed works the same as no document at all.

If you signed your directive or your power of attorney somewhere else, Iowa recognizes a document validly executed in another state or jurisdiction under that state’s own law, and it also recognizes a veteran’s advance directive that meets the federal Department of Veterans Affairs requirements.

This is not a POLST

Iowa is generally understood to run a medical order program known as IPOST, Iowa Physician Orders for Scope of Treatment. It is not the same kind of document as your Declaration. A POLST-style order like IPOST is a set of specific medical orders, signed by a clinician working with someone who is already seriously ill, meant to travel with that person between hospital, nursing facility, home and ambulance. A Declaration, by contrast, is something you put in place in advance, for a future you cannot yet see. Myend prepares the Declaration and the Durable Power of Attorney for Health Care. It does not, and cannot, produce a POLST-style order, because that has to come from a treating clinician.

What is different about Iowa

Iowa hands you two documents, then gives them nearly the same signing rule, down to the same unusual test for who counts as a close enough relative to witness.

Most two-document states pull the Declaration and the power of attorney apart on signing, sometimes sharply. Iowa does the opposite: both the Declaration and the Durable Power of Attorney for Health Care ask for the same two witnesses or a notary, disqualify roughly the same people, and apply the same rule that at least one witness cannot be related to you within the third degree. The one real addition on the power-of-attorney side is narrow and specific, the named attorney-in-fact cannot witness their own appointment, which is the kind of detail a reader skimming for differences between the two documents could easily miss.

The pregnancy limit is the other place Iowa breaks from a simple pattern. Rather than suspending the Declaration for the whole pregnancy outright, the way a few neighboring states write it, Iowa ties the limit to viability: the Declaration stands aside only for as long as the fetus could still develop to the point of live birth. That is a real condition, not a formality, and it means the Declaration can come back into force before the pregnancy itself ends.

None of this makes Iowa a hard state to plan in. It is a state where reading one document’s signing section tells you almost everything about the other, with two exceptions worth remembering: who can witness the power of attorney, and which chapter the pregnancy limit actually sits in.

Common questions

Sources and review