Iowa Living Will Form: Requirements Under Chapter 144A and How to Make It Legally Valid

Iowa Living Will Form: Requirements Under Chapter 144A and How to Make It Legally Valid

You've told your family what you want. But without a legally executed living will under Iowa Code Chapter 144A, those conversations carry zero legal weight in an emergency room. Your attending physician isn't bound by verbal wishes — they need a signed directive in writing.

Iowa's living will (formally called a "Declaration Relating to the Use of Life-Sustaining Procedures") instructs your medical team to withhold or withdraw life-sustaining treatment if you develop a terminal condition and can no longer participate in decisions about your care.

Here's exactly what Iowa law requires and where families commonly make mistakes.

What "Terminal Condition" Means Under Iowa Law

Iowa defines a terminal condition narrowly: an incurable or irreversible condition that, to a reasonable degree of medical certainty, will result in death within a relatively short period of time — or a comatose state from which there can be no recovery.

Two physicians must confirm this diagnosis in writing before your living will takes effect. Until that confirmation happens, your living will remains dormant and has no legal force.

This is different from a medical power of attorney, which activates whenever you lose decision-making capacity (even temporarily). A living will only applies to terminal or permanently comatose patients.

The Nutrition and Hydration Restriction

This catches many families off guard. Under Chapter 144A, your living will cannot direct the withholding of nutrition and hydration unless two conditions are met:

1. The nutrition or hydration is administered parenterally (through an IV) or through intubation (a feeding tube).
2. You specifically authorized the withholding of tube-fed nutrition in writing within your declaration.

If your living will doesn't explicitly address tube feeding, Iowa law defaults to continuing it. Comfort care — including oral food and water, pain medication, and basic medical procedures to keep you comfortable — can never be withheld under a living will.

The Pregnancy Clause

Iowa imposes an automatic suspension of living will directives during pregnancy. Under Sections 144A.7(3) and 144A.6(2), if you are known to be pregnant and the fetus could develop to the point of live birth with continued life-sustaining treatment, your living will is given no effect.

This applies regardless of what your written directive says. If pregnancy is a concern, discuss this limitation with your attorney-in-fact so they understand their authority is paused during that period.

How to Execute a Valid Living Will in Iowa

Iowa's execution requirements mirror those for the medical power of attorney. You need one of these:

Two adult witnesses. Both must be at least 18 years old, sign in your presence and each other's. Neither can be your designated health care agent, your attending physician, or an employee of your physician. At least one must be unrelated to you by blood, marriage, or adoption within three degrees of consanguinity.

Notarization. Sign before a licensed Iowa notary. Witnesses aren't required if you go this route.

Most Iowans use the combined Iowa Form 123, which bundles the living will with the Durable Power of Attorney for Health Care. The Iowa State Bar Association recommends this combined approach so both documents are executed together.

Common Mistakes That Invalidate the Document

Having a family member and your health care agent witness. If your designated agent signs as a witness, the entire document may be challenged. Same if both witnesses are related to you — at least one must be unrelated.

Leaving it in a safe deposit box. If your living will can't be located during a medical emergency, it can't be followed. Iowa has no state registry for advance directives, so physical distribution is essential.

Not addressing nutrition and hydration. If you want to refuse tube feeding in a terminal situation, you must write that instruction explicitly into your declaration. A general statement about refusing "life-sustaining treatment" doesn't cover it under Iowa law.

Assuming hospitals will have a copy. Unless your physician has scanned your living will into your electronic medical record, the emergency department won't know it exists. You need to deliver copies proactively.

What Happens If a Provider Refuses to Follow Your Living Will

Under Chapter 144A, if your attending physician or facility won't comply with your directive, they're legally required to make reasonable efforts to transfer you to a provider who will. They can't simply override your documented wishes and continue treatment indefinitely.

Your designated health care agent (if you have one) has the legal authority to enforce compliance and arrange a transfer if needed.

Revoking Your Living Will

You can revoke your living will at any time, regardless of your mental or physical condition. Tell your attending physician — either orally or in writing — and they must note the revocation in your medical record. If you have copies distributed to family members or other providers, collect and destroy those too.

The Iowa Advance Directive & Living Will Kit includes the complete Chapter 144A declaration with plain-English instructions for each section, a witness eligibility checklist, and a distribution tracker so you know exactly who has copies of your executed documents.

See more Iowa guides →