Health Care Power of Attorney Requirements in Iowa

At a glance

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(8)). 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. Effective July 1, 2026, §§ 144B.1(4) and 144B.6(1) make the agent's authority depend on the principal being unable, in the judgment of the attending provider, to make the health care decision. Section 135J.1 defines that provider as a physician, physician assistant, or advanced registered nurse practitioner. 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(5)–(6), 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(5)) — 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 Iowa law (§ 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 verbal instructions given to someone other than the attorney in fact, or instructions in another document, do not restrict the agent unless the durable power of attorney states in a separate section that it is limited and includes those limits. 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 that communicates your intent, regardless of 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 attending provider — a physician, physician assistant, or advanced registered nurse practitioner — judges you cannot decide for yourself (§§ 135J.1, 144B.1(4), 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(5)).

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 provider judges that you cannot make the decision yourself. That provider may be a physician, physician assistant, or advanced registered nurse practitioner (§§ 135J.1, 144B.1(4), 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 Code 2026 publication and 2026 Iowa Acts chapters 1009 and 1071, accessed 2026-08-20.

• Iowa Code § 144B.1 — definitions, including "durable power of attorney for health care," the attending-provider trigger, the exclusion of nutrition or hydration except when provided parenterally or through intubation, and principal as a person age eighteen or older. Current amendments: https://www.legis.iowa.gov/docs/publications/iactc/91.2/CH1071.pdf
• Iowa Code § 135J.1 — "attending provider" includes a physician, physician assistant, or advanced registered nurse practitioner. https://www.legis.iowa.gov/docs/publications/iactc/91.2/CH1071.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, updated to use "attending provider." https://www.legis.iowa.gov/docs/publications/iactc/91.2/CH1071.pdf
• Iowa Code § 144B.6(1) — the agent's priority over a guardian and the attending-provider incapacity trigger for the agent's authority. https://www.legis.iowa.gov/docs/publications/iactc/91.2/CH1071.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/iactc/91.2/CH1009.pdf
• 2026 Iowa Acts ch. 1071 (H.F. 2305) — amended §§ 144B.1, 144B.5(1), and 144B.6(1) effective July 1, 2026, replacing the physician/physician-assistant trigger with an attending-provider trigger. https://www.legis.iowa.gov/docs/publications/iactc/91.2/CH1071.pdf