ADVANCE HEALTH-CARE DIRECTIVE

(Living Will & Durable Power of Attorney for Health Care)
State of Iowa

[Effective Date: [DATE]]

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
    A. Living-Will Declaration
    B. Durable Power of Attorney for Health Care
    C. Post-Death Directions
    D. Effectiveness & Duration
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block
XI. Revocation Statement (Optional)

I. DOCUMENT HEADER

This Advance Health-Care Directive (“Directive”) is executed by [FULL LEGAL NAME OF DECLARANT], an individual of legal age and sound mind residing at [ADDRESS] (“Declarant”).

RECITALS
A. Declarant desires to state treatment preferences if unable to make health-care decisions.
B. Declarant further desires to appoint an agent to make such decisions pursuant to Iowa Code chs. 144A & 144B.
C. Declarant executes this Directive to ensure that health-care providers (“Providers”) may rely on it in good faith without incurring liability.

Governing Law: This Directive shall be construed in accordance with the laws of the State of Iowa, including Iowa Code §§ 144A.1–144A.12 & §§ 144B.1–144B.12 (2023).

II. DEFINITIONS

For purposes of this Directive, capitalized terms have the meanings set forth below:

1. “Agent” – The person designated in § III.B to make health-care decisions for Declarant.
2. “Alternate Agent” – The successor(s) named in § III.B.3.
3. “Artificial Nutrition & Hydration” – Medically administered food or fluids via intravenous, gastrostomy, or similar means.
4. “Durable Power of Attorney for Health Care” – The appointment of an Agent that survives Declarant’s incapacity pursuant to Iowa Code ch. 144B.
5. “Life-Sustaining Procedure” – Any medical intervention that postpones death for a terminally ill or permanently unconscious patient, excluding pain relief or comfort care.
6. “Permanent Unconsciousness” – An irreversible condition in which Declarant is unaware of self or surroundings.
7. “Provider” – Any physician, advanced practice registered nurse, hospital, hospice, or licensed health-care facility.
8. “Terminal Condition” – An incurable or irreversible condition that, without life-sustaining procedures, will result in death within a relatively short time.

III. OPERATIVE PROVISIONS

A. Living-Will Declaration

1. Statement of Intent. If I am determined by my attending physician to be either (i) in a Terminal Condition, or (ii) in a state of Permanent Unconsciousness, and I lack decisional capacity, I direct that:
       a. ☐ [INITIAL] Life-Sustaining Procedures be withheld or withdrawn;
       b. ☐ [INITIAL] Artificial Nutrition & Hydration be withheld or withdrawn;
       c. ☐ [INITIAL] Relief from pain or discomfort always be provided, even if it may hasten death.

2. Pregnancy Exception (optional). If I am pregnant at such time, I direct that:
       ☐ [INITIAL] This Declaration remain effective
       ☐ [INITIAL] This Declaration be suspended until viability/fetal survival is considered.

[// GUIDANCE: Iowa does not mandate inclusion of a pregnancy exception; offer it for client preference.]

3. Organ & Tissue Donation (optional).
       ☐ [INITIAL] I hereby donate any needed organs/tissues.
       ☐ [INITIAL] I donate only: [SPECIFY].
       ☐ [INITIAL] I do not wish to donate.

B. Durable Power of Attorney for Health Care

1. Agent Designation. I appoint [FULL LEGAL NAME, ADDRESS, PHONE, EMAIL] as my primary Agent (“Attorney-in-Fact”) to make any and all health-care decisions on my behalf in accordance with this Directive and Iowa Code § 144B.3.

2. Scope of Authority. My Agent is authorized to:
       a. Consent to, refuse, or withdraw medical treatment, including Life-Sustaining Procedures;
       b. Access my medical records;
       c. Employ or discharge health-care Providers;
       d. Authorize admission to or discharge from health-care facilities;
       e. Take any lawful action consistent with my expressed wishes or, if unknown, my best interests.

3. Alternate Agent(s). If the primary Agent is unavailable, unwilling, or unable to act, I appoint in the following order:
       a. [ALTERNATE AGENT #1 NAME & CONTACT]
       b. [ALTERNATE AGENT #2 NAME & CONTACT]

4. Nomination of Guardian. If a court deems a guardian necessary, I nominate my Agent to serve in that capacity.

C. Post-Death Directions

I request that my Agent cooperate with my personal representative regarding funeral, burial, or cremation arrangements consistent with any separate written instructions.

D. Effectiveness & Duration

1. This Directive becomes effective upon execution and remains in effect unless revoked pursuant to § IX.B or automatically superseded by a later executed directive.
2. Providers may rely on photocopies or electronically transmitted copies of this Directive.

IV. REPRESENTATIONS & WARRANTIES

1. Declarant represents that:
       a. Declarant is at least 18 years of age and of sound mind;
       b. Execution is voluntary and free of undue influence;
       c. All signatures are genuine.

2. Agent represents (by signing acceptance below) that Agent:
       a. Is willing and eligible to serve;
       b. Will act in good faith consistent with Declarant’s wishes and Iowa law.

V. COVENANTS & RESTRICTIONS

1. Agent shall consult with health-care professionals and family members as practicable but shall not be bound by any person whose views conflict with this Directive.
2. No Agent or Provider may authorize involuntary commitment or psychosurgery absent separate statutory authority.

VI. DEFAULT & REMEDIES

1. Failure of any Provider to honor this Directive after receipt constitutes a breach of statutory duty, entitling the Agent or any interested party to seek:
       a. Declaratory or injunctive relief to enforce this Directive; and
       b. Recovery of reasonable attorneys’ fees and costs incurred in enforcement, limited to cases of willful or reckless disregard.

2. If all named Agents are unable or unwilling to serve, Providers shall comply with the Living-Will Declaration herein to the fullest extent permitted by Iowa Code ch. 144A.

VII. RISK ALLOCATION

1. Indemnification of Providers. Declarant agrees that Providers acting in good-faith reliance on this Directive shall be held harmless and indemnified from any civil liability or discipline, consistent with Iowa Code § 144A.11 (2023) (“provider_protection”).
2. Limitation of Liability. No Agent shall incur personal financial liability for decisions made in good faith pursuant to this Directive (“good_faith_standard”).

VIII. DISPUTE RESOLUTION

Because health-care decisions often require immediate action, any controversy concerning interpretation or application of this Directive shall first be addressed by consultation among Providers and the Agent. If unresolved, interested persons may petition an Iowa district court of competent jurisdiction for expedited declaratory relief. Arbitration, jury trial, and forum-selection provisions are intentionally omitted as not applicable.

IX. GENERAL PROVISIONS

A. Amendment & Waiver. This Directive may be amended only by a subsequent written instrument executed with the same formalities herein. No oral waiver is effective.

B. Revocation. Declarant may revoke this Directive at any time and in any manner that clearly communicates intent to revoke, including oral statements or physical destruction, effective upon communication to the attending physician or Agent.

C. Severability. If any provision is held invalid, the remaining provisions shall remain enforceable to the maximum extent permitted by law.

D. Integration. This Directive constitutes the entire advance directive of Declarant, superseding all prior inconsistent directives.

E. Electronic Signatures. Pursuant to Iowa Code § 554D.103 et seq., electronic signatures or counterparts are permitted if executed with two (2) qualified witnesses or a notary.

X. EXECUTION BLOCK

Declarant

[PRINT NAME], Declarant
Date: ___

Witnesses

(Choose EITHER two witnesses OR a notary. Witnesses must be competent adults, not related within the third degree, not entitled to Declarant’s estate, and not responsible for Declarant’s health-care.)

1. ______ Date: ___
   Printed Name & Address: ___________

2. ______ Date: ___
   Printed Name & Address: ___________

OR

Notary Acknowledgment (Iowa)

State of Iowa )
County of _)

On this ___ day of ____, 20__, before me, the undersigned, a Notary Public in and for said State, personally appeared [DECLARANT NAME], to me known (or proved) to be the person whose name is subscribed to this instrument, and acknowledged that (he/she) executed the same as (his/her) voluntary act and deed.

Notary Public for the State of Iowa
My Commission Expires: _______

Agent Acceptance

I, [AGENT NAME], accept my appointment as Agent under this Directive and agree to act in good faith and in accordance with its terms and Iowa law.

______ Date: _____
[AGENT NAME], Agent

(Repeat signature block for each Alternate Agent.)

XI. REVOCATION STATEMENT (Optional)

I, [DECLARANT NAME], hereby revoke the Advance Health-Care Directive dated ______.

______ Date: _____
Declarant

[Follow witness/notary requirements as above.]

[// GUIDANCE:
1. Insert client-specific preferences where brackets appear.
2. Advise clients to provide copies to primary physician, Agent, and family, and to carry a wallet card noting the Directive’s existence.
3. Review annually or upon major life events (marriage, divorce, diagnosis).
4. Confirm that the selected Agent is not also serving as a witness to avoid disqualification under Iowa Code ch. 144B.]