Iowa Advance Directive Form: Living Will and DNR for Young Adults

Iowa Splits Advance Directives Into Two Separate Documents

Most states bundle end-of-life wishes and medical decision-making authority into a single advance directive. Iowa doesn't. The state uses two distinct legal instruments under two separate chapters of the Iowa Code:

1. Declaration Relating to Use of Life-Sustaining Procedures (Iowa Code Chapter 144A) — commonly called a "living will." This records your wishes about life-sustaining treatment if you develop a terminal condition.
2. Durable Power of Attorney for Health Care (Iowa Code Chapter 144B) — this names another person to make health care decisions for you if you lose the capacity to make them yourself.

Both are available as statutory forms through the Iowa State Bar Association and advocacy organizations. Both can be executed by a competent Iowa adult age 18 or older.

The Living Will (Chapter 144A)

Iowa's living will applies only in a specific circumstance: when an attending provider has determined that you have a terminal condition and that determination has been confirmed by another physician, advanced registered nurse practitioner, or physician assistant. It instructs providers to either continue or withdraw life-sustaining procedures that would only prolong the dying process — ventilators, feeding tubes, dialysis, and similar interventions.

Signing requirements:

• Must be signed by the declarant (or at the declarant's direction) and either witnessed by at least two individuals in each other's and the declarant's presence, with at least one witness not related to the declarant by blood, marriage, or adoption within the third degree, or acknowledged before a notarial officer
• A health care provider attending the declarant on the execution date, an employee of that provider, and anyone under 18 cannot be a witness
• Notarization is an alternative to witness execution; it is not required if the declaration is properly witnessed

Revocation: Can be revoked at any time and in any manner by which the declarant can communicate the intent to revoke. Revocation is effective as to the attending provider when communicated.

For most families of young adults with disabilities, the living will is a secondary concern. The health care POA matters more in day-to-day life because it covers all medical decisions — not just end-of-life scenarios.

The Health Care POA (Chapter 144B)

This is the document that gives a parent or trusted person authority to make medical decisions when your adult child cannot make or communicate those decisions. It covers everything from ER consent to medication changes to choosing a specialist.

The agent's authority only activates when an attending provider determines the principal lacks decision-making capacity — and it deactivates if capacity returns. The principal can revoke it at any time, regardless of their mental or physical state.

Why this matters for disability families: When a young adult turns 18, HIPAA locks parents out of medical information and medical staff can no longer consult parents about treatment decisions. A health care POA restores that access without a court proceeding, without stripping rights, and without the $1,500-to-$4,500 cost of a guardianship.

DNR Orders: A Different Category Entirely

A Do Not Resuscitate order in Iowa is a medical order — not a legal document you draft yourself. An attending provider issues the uniform out-of-hospital DNR order under Iowa Code § 144A.7A. Under HF 2305, effective July 1, 2026, an attending provider can include a physician, physician assistant, or advanced registered nurse practitioner.

Iowa also has a separate Physician Orders for Scope of Treatment (POST) form under Chapter 144D. It is a uniform medical-order form that may be relied upon across care settings and complements, rather than supersedes, valid advance directives. It covers:

• Resuscitation preferences (full CPR, DNR, or limited interventions)
• Level of medical interventions desired (comfort measures only, limited treatment, or full treatment)
• Preferences about artificially administered nutrition

The POST form must be signed by the patient (or the patient's legal representative) and the patient's physician, advanced registered nurse practitioner, or physician assistant. It is designed to be recognized across care settings, including a hospital, nursing facility, home, or emergency department.

Which Documents a Young Adult Actually Needs

For a college-bound young adult without significant disabilities, a health care POA is usually sufficient. It ensures parents can step in during a medical emergency without needing a court order.

For a young adult with an intellectual or developmental disability, the framework typically includes:

• Health care POA — names the parent or trusted person as the medical decision-maker during periods of incapacity
• Living will — optional and depends on the family's end-of-life care philosophy; not relevant to most day-to-day medical situations
• HIPAA authorization — a separate release allowing specific people to access medical records even when the health care POA isn't activated (useful for routine care coordination)

A DNR order is issued by an attending provider, while a POST form is a separate clinician order; either is appropriate only when the individual's medical condition warrants that conversation. Neither is part of standard transition planning.

Executing the Documents

Both the living will and health care POA should be signed on or after the young adult's 18th birthday. The signing requires capacity — the person must understand what they're agreeing to. For young adults with intellectual disabilities, this means working with the individual to explain the document in plain language and confirming they understand they're giving another person authority over specific medical decisions.

If there's genuine doubt about whether the young adult has the capacity to sign these documents, that's the point where families need to evaluate whether a guardianship petition is necessary. Iowa Code § 633.551(4) requires courts to consider whether POAs and other less restrictive alternatives can meet the person's needs before granting guardianship.

The Iowa Adult Guardianship & Alternatives Guide walks through the complete decision framework, including a capability evaluation worksheet that helps families determine which legal tools match their young adult's actual needs.

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