Read the full stored bill text
May 02, 2026
The Honorable Paul Pate
Secretary of State of Iowa
State Capitol
Des Moines, Iowa 50319
Dear Mr. Secretary,
I hereby transmit:
STATE OF IOWA
KIM REYNOLDS
GOVERNOR
House File 2305, an Act relating to health care decisions related to palliative care,
hospice programs, life-sustaining procedures, out-of-hospital do-not-resuscitate orders,
durable power of attorney for health care, and probate court guardianship reports.
The above House File is hereby approved on this date.
Sincerely,
cc: Secretary of the Senate
C lerk of the House
STATE CA PITOL D ES MOIN ES, IOWA 50319 515.281.5211 WWW.GOVE R NO R .IOWA.GOV
ID
! ~:~ l c ;· 1~-~N i:~t{-1\. i-~--- -i\.Ssi~K113 f~).r t ~:~ l
~L"" .... ,, ..... ,,-....................... """''"""'"""""'""""""""'""""'"'""'""""'""'"'"""""'""""""'I ---·-- . ·-- ~-~----------------------·---· -_,~ .. ·-
House File 2305
AN ACT
RELATING TO HEALTH CARE DECISIONS RELATED TO PALLIATIVE CARE,
HOSPICE PROGRAMS, LIFE-SUSTAINING PROCEDURES,
OUT-OF-HOSPITAL DO-NOT-RESUSCITATE ORDERS, DURABLE POWER OF
ATTORNEY FOR HEALTH CARE, AND PROBATE COURT GUARDIANSHIP
REPORTS.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
Section 1. Section 135J.1, Code 2026, is amended to read as
follows:
135J.l Definitions.
For the purposes of this chapter unless otherwise defined:
1. ''Attending physiciaR providerH means a physician liceHsee
pursuaHt to chapter 148 or a physiciaH assistaHt liceHsee
pursuaHt to chapter 1480, physician assistant, or an advanced
registered nurse practitioner who is licensed in this state.
2. ''Attorney in factH means the same as defined in section
144B.l.
-2.... 3. ~Core servicesH means physician services, nursing
services, medical social services, counseling services,
and voluHteer services provided by volunteers. These eet'"e
services, as well as others deemed necessary by the hospice
in delivering safe and appropriate care to its case load the
hospice's hospice patients, can be provided through either
direct or indirect arrangement by the hospice.
-3.. 4. ''JJepartmentH means the department of inspections,
appeals, and licensing.
House File 2305, p. 2
5. "Guardian" means the same as defined in section 633.3.
" 6 " . t . t" " . ,, ,;i• ,;i .......- . Hospice pa ien or patient means a uiagaoseu
terminally ill person an individual with an anticipated life
expectancy of six months or less, as certified by the attending
pfiysieiaa provider, who, alone or in eoajttaetioa witfi a ttait of
eare as eefiaee in sttbseetioa 9, has voluntarily requested and
received admission into .efte a hospice program. If tfie patient
is ttaable to reqttest aemission, a family member may volttatarily
reqttest aae receive aemissioa on tfie patient's befialf. An
individual may make this request in conjunction with a unit
of care, the individual's attorney in fact, the individual's
guardian, or the majority of the guardians if the individual
has more than one guardian with equal responsibilities
appointed.
5-o 7. ''Hospice patient's family" means the immediate kin of
-efie a hospice patient, including a spouse, parent, stepparent,
brother, sister, stepbrother, stepsister, child, or stepchild.
Additional relatives or individuals with significant personal
ties to the hospice patient may be included in the hospice
patient's family.
-6-o 8. ''Hospice program" means a centrally coordinated
program of home and inpatient care provided directly or through
an agreement under the direction of an identifiable hospice
administration providing palliative care directed at symptom
management and supportive medical and other health services
to terminally ill hospice patients and their families. A
licensed hospice program shall utilize a medically directed
interdisciplinary team and provide care to meet the physical,
emotional, social, spiritual, and other special needs which
are experienced during the final stages of illness, dying, and
bereavement. Hospice care shall be available twenty-four hours
a day, seven days a week.
h 9. "Interdisciplinary team" means the hospice patient
and the hospice patient's family, the attending pfiysieiaa
provider, and all of the following individuals trained to serve
with a licensed hospice program:
a. A licensed physician pursuant to chapter 148.
b. A licensed registered nurse pursuant to chapter 152.
c. An individual with at least a baccalaureate degree in the
House File 2305, p. 3
field of social work providing medical-social services.
a. ~raiHed fiospice volttHteers Volunteers.
e. As deemed appropriate by the hospice, physician
assistants, providers of special services including but not
limited to a spiritual counselor, a pfiarmacist pharmacists, or
professionals in the fields of mental health may be included
on the interdisciplinary team.
&.- 10. ''Falliative care" means specialized medical care
directed at maHagiHg symptoms experieHced by tfie fiospiee
provided to a patient, as well as addressiHg related Heeds
of tfie patieHt aHd family as tfiey experieHce tfie stress of
tfie dyiHg process who has been diagnosed by the patient's
attending provider with a serious illness. Palliative care is
stress and symptom management care, based on the needs of the
patient rather than the patient's diagnosis, provided by an
interdisciplinary team. The intent of palliative care is to
enhance the quality of life for the fiospiee patient and family
unit, aHd is Hot treatmeHt directed at ettre of tfie termiHal
illHess. Palliative care may be provided at any stage of a
patient's serious illness, regardless of the patient's age, and
may be provided in conjunction with curative treatment for the
serious illness.
11. "serious illness" means a health condition that
carries a high risk of mortality and either negatively impacts
an individual's daily functioning or quality of life, or
excessively strains the individual's caregivers.
12. "Terminal condition" means the same as defined in
section 144A.2.
9-o 13. "unit of care" means -Hte- a hospice patient and -Hte- a
hospice patient's family within a hospice program.
~ 14. "~"8lt:Jnteer services" "Volunteer" means tfie services
provided by iHdividttals an individual who ft.a¥e has successfully
completed a training program developed by a licensed hospice
program and who provides services.
Sec. 2. Section 135J.3, Code 2026, is amended to read as
follows:
13SJ.3 Basic requirements.
A licensed hospice program shall include:
1. A planned program of hospice care, the medical components
House File 2305, p. 4
of which shall be under the direction of an attending physiciaa
provider.
2. Centrally administered, coordinated hospice core
services provided in home, outpatient, or institutional
settings.
3. A mechanism that assures the rights of the patieat aad
family a unit of care.
4. Palliative care Symptom management provided to a hospice
patieat aad family unit of care under the direction of an
attending physiciaa provider.
5 . An interdisciplinary team which develops, implements,
and evaluates the hospice plan of care for the patieat aad
family a unit of care.
6. Bereavement services.
7. Accessible hospice care twenty-four hours a day, seven
days a week in all settings.
8 . An ongoing system of quality assurance and utilization
review.
Sec. 3. NEW SECTION. 135J.3A Patient incapable of making a
treatment decision.
1. a . A request for admission and placement in a hospice
program for a patient who has a terminal condition, and
who is comatose, incompetent, or otherwise physically or
mentally incapable of communication, and who has not expressed
their desire for palliative care or a hospice program, may
be made by the patient's attorney in fact or the patient's
guardian. If the patient has more than one guardian with
equal responsibilities appointed, the decision agreed to by a
majority of guardians. If a majority consensus is not achieved
by the guardians, a court order shall be required.
b. If a patient does not have an attorney in fact or a
guardian, the request may be made by an individual, in the same
order of priority prescribed in section 144A.7, subsection 1,
paragraph ~b~, who shall be guided by the express or implied
intentions of the patient and who is reasonably available,
willing, and competent to make a request.
2. This section shall not apply to a guardian appointed
under chapter 2320.
Sec. 4. Section 144A.2, Code 2026, is amended to read as
House File 2305, p. 5
follows:
144A.2 Definitions.
Except as otherwise provided, as used in this chapter:
1. ''Adult-means an individual eighteen years of age or
older.
2. ''Advanced registered nurse practitioner-means the same as
defined in section 152.1.
~ 3. ''Attending physician provider-means the pfiysiciaH
selectee by, or assigHee to, tfie patieHt wfio fias primary
respoHsibility for tfie treatmeHt aHe care of tfie patieHt same
as defined in section 135J.l.
3... 4. ''Attendin~ physician assistant-meaHs tfie pfiysiciaH
assistaHt selectee by, or assigHee to, tfie patieHt wfio fias
primary respoHsibility for tfie treatmeHt aHe care of tfie
patieHt ''Attorney in fact- means the same as defined in section
144B.l.
5. ~Close adult friend-means a friend of a patient to whom
all of the following apply:
a. The individual is at least eighteen years of age.
b. The individual has shown special care and concern for the
patient.
c. The individual maintains regular contact with the patient
and is familiar with the patient's health, activities, and
beliefs.
d. The individual has provided an affidavit to the patient's
attending provider that states that the individual is willing
and able to be involved in the patient's care.
4-. 6. ''Declaration-means a document executed in accordance
with the requirements of section 144A.3.
-S. 7. ''Department- means the department of health and human
services.
-6.... 8. ''Emergency medical care provider-means emergency
medical care provider as defined in section 147A.l.
=!-... 9. ''Health care provider-means a person, including an
emergency medical care provider, who is licensed, certified, or
otherwise authorized or permitted by the law of this state to
administer health care in the ordinary course of business or in
the practice of a profession.
&. 10. ''Hospital- means hospital as defined in section
House File 2305, p. 6
135B.l.
9-.- 11. a. ''Life-sustaining procedure " means any medical
procedure, treatment, or intervention, including resuscitation,
which meets both of the following requirements:
(1) Utilizes mechanical or artificial means to sustain,
restore, or supplant a spontaneous vital function.
(2) When applied to a patient in a terminal condition, would
serve only to prolong the dying process.
b. ''Life-sustaining procedure" does not include the
provision of nutrition or hydration except when required
to be provided parenterally or through intubation, or the
administration of medication or performance of any medical
procedure deemed necessary to provide comfort care or to
alleviate pain.
-i-&o 12. "out-of-hospital do-not-resuscitate order" means
a written order signed by a pfiysieiaR an attending provider,
executed in accordance with the requirements of section
144A.7A and issued consistent with this chapter, that directs
the withholding or withdrawal of resuscitation when an adult
patient in a terminal condition is outside the hospital.
Ho 13. "Physician" means a person licensed to practice
medicine and surgery or ost eopathic medicine and surgery in
this state.
~ 14. "Physician assistant" means a person licensed to
practice as a physician assistant in this state.
~ 15. "Qualified patient" means a patient who has
executed a declaration or an out-of-hospital do-not-resuscitate
order in accordance with this chapter and who has been
determined by the patient's attending pfiysieiaR provider to be
in a terminal condition.
~ 16. ''Resuscitation" means any medical intervention that
utilizes mechanical or artificial means to sustain, restore,
or supplant a spontaneous vital function, including but not
limited to chest compression, defibrillation, intubation, and
emergency drugs intended to alter cardiac function or otherwise
to sustain life.
~ 17. "Terminal condition" means an incurable or
irreversible condition that, without the administration
of life-sustaining procedures, will, in the opin ion of
House File 2305, p. 7
the attending physiciaH provider, result in death within
a relatively short period of time or a state of permanent
unconsciousness from which, to a reasonable degree of medical
certainty, there can be no recovery.
Sec. 5. Section 144A.3, subsections 3 and 5, Code 2026, are
amended to read as follows:
3. It is the responsibility of the declarant to provide
the declarant's attending physiciaH or health care provider
with the declaration. An attending physiciaH or fiealtfi care
provider may presume, in the absence of actual notice to the
contrary, that the declaration complies with this chapter and
is valid.
5. A declaration executed pursuant to this chapter may, but
need not, be in the following form:
DECLARATION
If I should have an incurable or irreversible condition that
will result either in death within a relatively short period
of time or a state of permanent unconsciousness from which,
to a reasonable degree of medical certainty, there can be no
recovery, it is my desire that my life not be prolonged by
the administration of life-sustaining procedures. If I am
unable to participate in my health care decisions, I direct
my attending physiciaH provider to withhold or withdraw
life-sustaining procedures that merely prolong the dying
process and are not necessary to my comfort or freedom from
pain.
Sec. 6. Section 144A.4, Code 2026, is amended to read as
follows:
144A.4 Revocation of declaration.
1. A declaration may be revoked at any time and in any
manner by which the declarant is able to communicate the
declarant's intent to revoke, without regard to mental or
physical condition. A revocation is only effective as to the
attending pfiysiciaH or atteHdiHg pfiysiciaH assistaHt provider
upon communication to such pfiysiciaH or pfiysiciaH assistaHt
attending provider by the declarant or by another to whom the
revocation was communicated.
2. The attending physiciaH or atteHdiHg physiciaH assistaHt
provider shall make the revocation a part of the declarant's
House File 2305, p. 8
medical record.
Sec. 7. Section 144A.S, Code 2026, is amended to read as
follows:
144A.5 Determination of terminal condition.
When an attending ~aysieiaa provider who has been provided
with a declaration determines that the declarant is in a
terminal condition, this decision must be confirmed by another
physician, advanced registered nurse practitioner, or physician
assistant. The attending ~aysieiaa provider must record efta-t:.
the determination in the declarant's medical record.
Sec. 8. Section 144A.6, subsection 2, Code 2026, is amended
to read as follows:
2. The declaration of a qualified patient known to the
attending ~aysieiaa provider to be pregnant shall not be in
effect as long as the fetus could develop to the point of live
birth with continued application of life-sustaining procedures.
However, the provisions of this subsection do not impair any
existing rights or responsibilities that any person may have
in regard to the withholding or withdrawal of life-sustaining
procedures.
Sec. 9. Section 144A.7, subsections 1 and 2, Code 2026, are
amended to read as follows:
1. a. Life-sustaining procedures may be withheld or
withdrawn from a patient who is in a terminal condition and who
is comatose, incompetent, or otherwise physically or mentally
incapable of communicationL and who has not made a declaration
in accordance with this eaa~ter section 144A.3 if there is
consultation and written agreement for the withholding or the
withdrawal of life-sustaining procedures between the attending
~aysieiaa provider, another physician, advanced registered
nurse practitioner, or physician assistant, and the patient's
attorney in fact, the patient's guardian appointed pursuant to
chapter 633, or the patient's guardian who has obtained court
approval in accordance with section 2320.401, subsection 4,
paragraph ''an. If the patient has more than one guardian with
equal responsibilities appointed, the decision agreed to by
a majority of the guardians. If a majority consensus is not
achieved by the guardians, a court order shall be required.
b. If a patient does not have an attorney in fact, a
House File 2305, p. 9
guardian appointed pursuant to chapter 633, or a guardian
who has obtained court approval in accordance with section
232D.401, subsection 4 , paragraph ~a ~, the decision may be
made by any of the follow ing individuals, who shall be guided
by the express or implied intentions of the patient, in the
following order of priority if no individual in a prior elass
the previous priority is reasonably available, w illing, and
competent to aee make the decision:
a. ~fie attorney in faet designated to make treatment
decisions for the patient should suefi person be diagnosed as
sufferiag from a termiaal eonditioa, if the desigaatioa is ia
writiag aad complies with efiapter 144B.
b. ~fie guardiaa of the persoa of the patieat if oae has beea
appoiated, provided eourt approval is obtained ia aeeordaaee
with seetioa 2329.401, subseetioa 4, paragraph ''a ~, or seetioa
633.635, subseetioa 3, paragraph ~b ~, subparagraph (1). ~his
paragraph does aet require the appeiatmeat of a guardiaa ia
order fer a treatmeat deeisioa to be made under this seetioa.
e. J.!l The patient"s spouse.
a. J..ll An adult child of the patient or, if the patient
has more than one adult child, the decision agreed to by a
majority of the adult children w ho are reasonably available for
consultation with the patient"s attending provider.
e.- J.ll A parent of the patientT or pareats if the patient
has more than one parent, the decision agreed to by both
parents if both are reasonably available for consultation w ith
the patient"s attending provider.
?.- J..!l. An adult sibling of the patient or, if the patient
has more than one adult sibling, the decision agreed to by a
majority of the adult siblings who are reasonably available for
consultation with the patient's attending p rovider.
(5) The decision agreed to by a majority of the patient's
adult relatives, including but not limited to grandchildren,
grandparents, aunts, uncles, nieces, nephews, stepchildren,
stepparents, and stepsiblings who are reasonably available for
consultation with the patient"s attending provider.
(6) A close adult friend.
2. When a decision is made pursuant to this section to
withhold or withdraw life-sustaining procedures, there shall
House File 2305, p. 10
be a witness present at the time of the consultation with the
patient's attending provider when tfi-a-e the decision is made.
Sec. 10. Section 144A.7A, subsections 1 and 3, Code 2026,
are amended to read as follows:
1. If an attending physieiaft or atteAdiAg physieiafi
assistaftt provider issues an out-of-hospital do-not-resuscitate
order for an adult patient under this section, the physieiafi
attending provider shall use the form prescribed pursuant to
subsection 2, include a copy of the order in the patient's
medical record, and provide a copy to the patient or an
individual authorized to act on the patient's behalf.
3. The out-of-hospital do-not-resuscitate order form shall
include all of the following:
a. The patient's name.
b. The patient's date of birth.
c. The name of the individual authorized to act on the
patient's behalf, if applicable.
d. A statement that the patient is in a terminal condition.
e. The physieiaA's or physieiafi assistaftt's attending
provider's signature.
f. The date the form is signed.
g. A concise statement of the nature and scope of the order.
h. Any other information necessary to provide clear and
reliable instructions to a health care provider.
Sec. 11. NEW SECTION. 144A.7B Procedure in absence of
out-of-hospital do-not-resuscitate order.
1. a. Resuscitation may be withheld or withdrawn from a
patient who has a terminal condition, and who is comatose,
incompetent, or otherwise physically or mentally incapable of
communication, and who has not executed an out-of-hospital
do-not-resuscitate order, if there is consultation and
written agreement for the withholding or the withdrawal of
resuscitation between the attending provider and another
physician, advanced registered nurse practitioner, or physician
assistant, and the patient's attorney in fact, the patient's
guardian appointed pursuant to chapter 633, or the patient's
guardian who has obtained court approval in accordance
with section 232D.401, subsection 4, paragraph ~a-. If the
patient has more than one guardian appointed with equal
House File 2305, p. 11
responsibilities, the decision agreed to by a majority of the
guardians. If a majority consensus is not achieved by the
guardians, a court order shall be required.
b. If a patient does not have an attorney in fact, a
guardian appointed pursuant to chapter 633, or a guardian
who has obtained a court approval in accordance with section
2320.401, subsection 4, paragraph ''an, the decision may be made
by an individual, in the same order of priority prescribed in
section 144A.7, subsection 1, paragraph ~bn, who shall be guided
by the express or implied intentions of the patient and who
is reasonably available, willing, and competent to make the
decision.
2. When a decision is made pursuant to this section to
withhold or withdraw resuscitation, a witness shall be present
at the time of the consultation with the patient's attending
provider when the decision is made.
3. This section shall only apply to a patient located in a
health care facility as that term is defined in section 135C.l,
a health facility as that term is defined in section 135P.l, or
a hospice facility certified by the centers for Medicare and
Medicaid services of the United States department of health and
human services.
Sec. 12. Section 144A.8, subsection 1, Code 2026, is amended
to read as follows:
1. An attending paysieiaa provider who is unwilling to
comply with the requirements of section 144A.5, or who is
unwilling to comply with the declaration of a qualified
patient in accordance with section 144A.6 or an out-of-hospital
do-not-resuscitate order pursuant to section 144A.7A, or who is
unwilling to comply with the provisions of section 144A.7 or
144A.7A shall take all reasonable steps to effect the transfer
of the patient to another paysieiaa provider.
Sec. 13. Section 144B.l, Code 2026, is amended to read as
follows:
144B.l Definitions.
For purposes of this chapter, unless the context otherwise
requires:
1. ''Attending provider# means the same as defined in section
135J.1.
House File 2305, p. 12
±-. 2. ''Attorney in fact" means an individual who is
designated by a durable power of attorney for health care as an
agent to make health care decisions on behalf of a principal
and has consented to act in that capacity.
ti 3. ''Designee" means a person named in a declaration
under chapter 144C.
-3. 4. ''Durable power of attorney for health care means a
document authorizing an attorney in fact to make health care
decisions for the principal if the principal is unable, in the
judgment of the attending physieiaH or atteHdiHg physieiaH
assistaHt provider, to make health care decisions.
-4-.. 5. ''Health care" means any care, treatment, service,
or procedure to maintain, diagnose, or treat an individual's
physical or mental condition. ''Health care" does not include
the provision of nutrition or hydration except when they are
required to be provided parenterally or through intubation.
5-o 6. ''Health care decision" means the consent, refusal of
consent, or withdrawal of consent to health care.
-6-o 7. ''Heal th care provider" means a person who is
licensed, certified, or otherwise authorized or permitted by
the ±-aw laws of this state to administer health care in the
ordinary course of business or in the practice of a profession.
=t-. 8. 'Principal" means a person age eighteen or older who
has executed a durable power of attorney for health care.
Sec. 14. Section 144B.5, subsection 1, Code 2026, is amended
to read as follows:
1. A durable power of attorney for health care executed
pursuant to this chapter may, but need not, be in the following
form:
I hereby designate ......•. as my attorney in fact (my
agent) and give to my agent the power to make health care
decisions for me. This power exists only when I am unable, in
the judgment of my attending physieiaH or atteHdiHg physieiaH
assistaHt provider, to make those health care decisions. The
attorney in fact must act consistently with my desires as
stated in this document or otherwise made known.
Except as otherwise specified in this document, this document
gives my agent the power, where otherwise consistent with the
±-aw laws of this state, to consent to my physieiaH or physieiaH
House File 2305, p. 13
assistant attending provider not giving health care or stopping
health care which is necessary to keep me alive.
This document gives my agent power to make health care
decisions on my behalf, including to consent, to refuse to
consent, or to withdraw consent to the provision of any care,
treatment, service, or procedure to maintain, diagnose, or
treat a physical or mental condition. This power is subject
to any statement of my desires and any limitations included in
this document.
My agent has the right to examine my medical records and to
consent to disclosure of such records.
Sec. 15. Section 144B.6, subsection 1, Code 2026, is amended
to read as follows:
1. Unless the district court sitting in equity specifically
finds that the attorney in fact is acting in a manner contrary
to the wishes of the principal or the durable power of attorney
for health care provides otherwise, an attorney in fact who
is known to the health care provider to be available and
willing to make health care decisions has priority over any
other person, including a guardian appointed pursuant to
chapter 633, to act for the principal in all matters of health
care decisions. The attorney in fact has authority to make
a particular health care decision only if the principal is
unable, in the judgment of the attending pfiysieian er attending
pfiysieian assistant provider, to make the health care decision.
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.
Sec. 16. Section 144C.2, subsection 16, Code 2026, is
amended to read as follows:
16. -Licensed hospice program~ means a licensed hospice
program as defined described in section 135J.1.
Sec. 17. Section 633.635, Code 2026, is amended by adding
the following new subsection:
NEW SUBSECTION. 6. Notwithstanding subsections 2 and 3, a
guardian may make a decision for a protected person pursuant to
sections 135J.3A, 144A.7, and 144A.7B without court approval.
Sec. 18. Section 633.669, subsection 1, paragraph b, Code
2026, is amended by adding the following new subparagraphs:
House File 2305, p. 14
NEW SUBPARAGRAPH. (11) The protected person's wishes
related to withholding or withdrawal of life-sustaining
procedures pursuant to chapter 144A or 1440.
NEW SUBPARAGRAPH. (12) The protected person's wishes
related to placement in a hospice program in the event of a
terminal condition.
Sec. 19. Section 633.669, subsection 1, paragraph c, Code
2026, is amended by adding the following new subparagraphs:
NEW SUBPARAGRAPH. (9) The protected person's wishes
related to withholding or withdrawal of life-sustaining
procedures pursuant to chapter 144A or 1440.
NEW SUBPARAGRAPH. (10) The protected person s wishes
related to placement in a hospice program in the event of a
terminal condition.
AMY SINC IR
Speaker of House President of the Senate
I hereby certify that this bill originated in the House and
is known as House File 2305, Ninety-first General Assembly.
Approved n, -iM ' 2026