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SF 2198

A bill for an act relating to the authority of an attorney in fact under a durable power of attorney for health care.

2025-2026 Regular Session

The bill requires an attorney in fact to follow the principal’s expressed health care wishes, allow necessary nutrition/hydration, and act in the principal’s best interests if desi

Signed by Governor.
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Bill Summary · SF 2198

Overview

Senate File 2198 (SF 2198) from the 2025-2026 Iowa Legislature relates to the authority of an attorney in fact under a durable power of attorney for health care. The bill amends section 144B.6, subsection 2, to clarify and expand how an attorney in fact (the person designated to make health care decisions) must exercise that authority, with specific references to the principal’s desires, declarations, and best interests when the principal’s wishes are unknown.

Purpose and Intent

  • Ensure the attorney in fact exercises authority in a manner that adheres to the principal’s stated desires as expressed in the durable power of attorney for health care, including declarations made pursuant to related provisions.
  • Affirm that certain life-sustaining declarations (pursuant to the life-sustaining procedures Act, chapter 144A) do not automatically prohibit hydration or nutrition when parenteral or intubation-based support is required, and do not otherwise restrict the attorney’s authority unless the document specifically states limitations.
  • Establish that the attorney in fact’s authority is not restricted by verbal statements made to others outside the attorney in fact, unless the durable power of attorney for health care explicitly provides limitations.
  • Provide a test for unknown desires: the attorney in fact should act in the principal’s best interests, considering the principal’s overall medical condition and prognosis.

Key Provisions

  • Amends Section 144B.6, subsection 2, to:
    • Require the attorney in fact to act in accordance with the principal’s expressed desires in the durable power of attorney for health care.
    • Clarify that a declaration made under the life-sustaining procedures Act (chapter 144A) does not imply an intent to prohibit necessary hydration or nutrition when required by parenteral administration or intubation and does not restrict otherwise.
    • State that the attorney in fact’s authority is not limited by the principal’s verbal statements to others, unless the principal’s declaration or a separate section of the durable power of attorney explicitly imposes limitations.
    • Emphasize that if the principal’s desires are unknown, the attorney in fact must act in the principal’s best interests, considering the principal’s overall medical condition and prognosis.
  • The text clarifies terminology and alignment with related sections (144A.3) and life-sustaining procedures Act provisions.

Who/What Is Affected

  • Principals who execute a durable power of attorney for health care and designate an attorney in fact.
  • Attorneys in fact who are responsible for making health care decisions on behalf of the principal.
  • Health care providers who follow the directives contained in the durable power of attorney for health care and related declarations.

Procedural and Timeline Aspects

  • The bill was introduced in 2026, passed both chambers of the Iowa General Assembly (Senate and House) with unanimous support (Senate: 47-0; House: 93-0).
  • It was substituted for HF 2570, approved by both chambers, and signed by the Governor on April 9, 2026.
  • The effective date is not explicitly stated in the summary text provided, but the amendment becomes part of Code 2026 upon enactment.

Practical Impact and Considerations

  • Provides clearer guidance for attorneys in fact to align decisions with the principal’s expressed wishes while allowing for necessary actions in life-sustaining contexts.
  • Prevents misinterpretation of life-sustaining declarations as prohibiting essential medical interventions, except where explicitly limited by the principal.
  • Reinforces the prioritization of the principal’s best interests when explicit desires are unknown, potentially guiding difficult medical decisions.

If you’d like, I can provide a plain-language example scenario illustrating how the new provisions would apply in a common health care decision.

Compiled from official sources — confirm details with the bill’s official record.

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