Default Health-Care Surrogate Priority in Iowa
At a glance
| When the default route opens | Terminal condition, inability to communicate, and no relevant declaration for life-support or facility-resuscitation decision; no prior agent or guardian before family route (HF 2305 §§ 9, 11). |
|---|---|
| Care or setting covered | § 144A.7 life-sustaining procedures; new § 144A.7B resuscitation in listed facilities; § 135J.3A hospice admission/placement (HF 2305 §§ 3, 9, 11). |
| Guardian or appointed agent | Health-care attorney-in-fact or authorized guardian precedes family; equally responsible guardians use majority, then court if tied (HF 2305 §§ 3, 9, 11, 17). |
| Family and partner order | Spouse; majority of available adult children; both available parents; majority of available adult siblings; majority of available adult relatives (HF 2305 § 9, amending § 144A.7(1)(b)). |
| Friend or other nonfamily person | Close adult friend after relatives; must show special care, regular contact, knowledge of patient, and affidavit to attending provider (§ 144A.2(5), § 144A.7(1)(b)(6), HF 2305 §§ 4, 9). |
| Decision within one class | Majority among children, siblings, and broader adult relatives; both parents when both are available; equally responsible guardians use majority (HF 2305 §§ 3, 9, 11). |
| Who is available and eligible | Move down if prior priority is not reasonably available, willing, and competent; close friend's affidavit documents eligibility (HF 2305 §§ 4, 9). |
| Decisions limited or excluded | Life-support route requires terminal condition, incapacity, written clinician agreement and witness; pregnancy exception in § 144A.7(3) (HF 2305 § 9; § 144A.7(3)). |
| No surrogate or disputed authority | Guardian tie requires court order; without listed family or friend, these provisions give no further class; § 144A.7B is limited to specified facilities (HF 2305 §§ 9, 11). |
Requirements one by one
Life-sustaining decisions
After 2026 HF 2305 § 9, Iowa Code § 144A.7 applies to a terminal patient who cannot communicate and has no relevant declaration. Withdrawal or withholding requires consultation and written agreement involving the attending provider, another specified clinician, and the agent or guardian when one exists. If neither exists, the statute uses the family order in subsection (1)(b). A witness must be present for the consultation under subsection (2). The unchanged § 144A.7(3) suspends subsections (1)–(2) during the stated pregnancy condition.
The new order ranks a spouse, adult children by available majority, both available parents, adult siblings by available majority, available adult relatives by majority, and a close adult friend. The friend must satisfy the special-care, contact, knowledge, and affidavit tests added in HF 2305 § 4. Each step yields only if the preceding priority is not reasonably available, willing, and competent.
Related hospice and resuscitation routes
HF 2305 § 3 created § 135J.3A for a request to admit and place a terminal patient in hospice when the patient cannot communicate and has not expressed a hospice or palliative-care wish. An agent or guardian acts first; otherwise the same § 144A.7(1)(b) order applies. The new § 144A.7B in HF 2305 § 11 uses that order for resuscitation decisions without an out-of-hospital DNR order in specified health-care and hospice facilities. It requires written agreement with the attending provider and another specified clinician and a witness at consultation.
What trips people up
The 2026 compiled § 144A.7 PDF still shows a family order ending with siblings. HF 2305 § 9, effective July 1, 2026, added adult relatives and a close adult friend and revised within-class votes. HF 2305 § 17 also lets a chapter 633 guardian make the specified hospice, life-support, and facility-resuscitation decisions without additional court approval; equally responsible guardians must obtain a court order if they cannot reach a majority.
Common questions
Can any close friend decide? No. Under amended § 144A.2(5), the friend needs special care and concern, regular contact, familiarity with the patient's health, activities, and beliefs, and an affidavit to the attending provider.
Does this order cover every medical choice? Section 144A.7 concerns life-sustaining procedures. The new §§ 135J.3A and 144A.7B separately cover the specified hospice and facility resuscitation decisions.
Statutes and sources
Verbatim official excerpts, official URLs, and access dates are in the source fields above.
Source links
Every statute quoted above, linked, with the date we checked it.
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