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:
- 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.
- 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 any Iowa adult age 18 or older.
The Living Will (Chapter 144A)
Iowa's living will applies only in a specific circumstance: when two physicians have determined that you have a terminal condition and that life-sustaining procedures would only prolong the dying process. It instructs providers to either continue or withdraw artificial life support — ventilators, feeding tubes, dialysis, and similar interventions.
Signing requirements:
- Must be signed by the declarant (or at their direction) in the presence of two adult witnesses
- Witnesses cannot be the declarant's health care provider, an employee of the provider, or anyone who would inherit under the declarant's will
- Notarization is not required but strengthens the document
Revocation: Can be revoked at any time by oral statement, written revocation, or physically destroying the document.
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 physician 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.
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DNR Orders: A Different Category Entirely
A Do Not Resuscitate order in Iowa is a medical order — not a legal document you draft yourself. It's issued by a physician based on a conversation with the patient (or their authorized decision-maker) about whether cardiopulmonary resuscitation should be attempted if the patient's heart or breathing stops.
Iowa uses the POST (Physician Orders for Scope of Treatment) form as the standardized framework for DNR and other end-of-life treatment orders. The POST form 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 both the patient (or their health care agent/guardian) and a physician. It travels with the patient across care settings — hospital, nursing facility, home, and EMS.
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/POST form is a clinical decision made with a physician and is appropriate only when the individual's medical condition warrants that conversation. It's not 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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