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Advance Directive in Alabama: Living Will, Health Care Proxy and Witnesses
Alabama's advance directive for health care is a living will, a health care proxy, or both in one form. It needs two witnesses and no notary, and the witness rules are strict. Here is how it works, from the Natural Death Act.
By naveen · Updated · How we research our guides
What to know
- An Alabama advance directive for health care must be in writing, dated, signed by your parent and signed in front of two witnesses at least 19 years old; the Natural Death Act doesn't require a notary (Code of Ala. § 22-8A-4).
- Relatives by blood, adoption or marriage, anyone who would inherit, the health care proxy and anyone directly financially responsible for your parent's medical care can't be witnesses.
- It takes effect only when your parent can't direct their own care and two physicians document a terminal illness or injury or permanent unconsciousness.
- Without one, Alabama law sets a surrogate priority list for end-of-life decisions: a specifically authorized guardian, then the spouse, an adult child, a parent and an adult sibling (§ 22-8A-11).
- Retirement Checklist puts these documents in order alongside everything else your family needs to settle.
An Alabama advance directive is a living will, a health care proxy appointment, or both, signed by a competent adult in front of two witnesses who are at least 19 years old. Alabama law defines it as "A writing executed in accordance with Section 22-8A-4 which may include a living will, the appointment of a health care proxy, or both such living will and appointment of a health care proxy." Under Code of Ala. § 22-8A-4, any competent adult can sign one, and it must be signed "in the presence of two or more witnesses at least 19 years of age." The statute prints the form, titled "ADVANCE DIRECTIVE FOR HEALTH CARE (Living Will and Health Care Proxy)."
What documents does Alabama use?
Alabama uses a living will and a health care proxy, which can be combined in one advance directive, plus a health care power of attorney.
| Document | What it does | Statute |
|---|---|---|
| Living will | Directs whether your parent wants life-sustaining treatment and tube or IV food and water if terminally ill or injured, or permanently unconscious | Code of Ala. § 22-8A-4(a) |
| Health care proxy | Names someone to make those decisions; it can be part of the living will or a separate document | § 22-8A-4(b) |
| Health care power of attorney | Names an agent to make health care decisions, through a durable power of attorney | § 26-1A-404 |
In Alabama, "adult" means 19 or older for these documents. Tube or IV food and water "shall not be withdrawn or withheld pursuant to the living will unless specifically authorized therein," so the form asks your parent to initial yes or no on it separately. For life-sustaining decisions, a health care power of attorney must be "executed and accepted in substantially the same form as set forth in the Alabama Natural Death Act."
A financial power of attorney is separate and doesn't cover health care; see our Alabama power of attorney guide. For the general picture, see power of attorney vs. advance directive.
How do you sign an Alabama living will?
Under § 22-8A-4(c), the advance directive must be in writing, dated, and signed by your parent or by someone else "in the declarant's presence and by the declarant's expressed direction." It must be signed in front of two or more witnesses who are at least 19. The sections of the Natural Death Act we read don't require a notary.
If your parent names a proxy, the proxy has to accept in writing: the acceptance "shall be evidenced in writing and attached to the proxy designation." The statutory form has a signature line for each proxy saying "am willing to serve as the health care proxy."
Who can't witness an Alabama advance directive?
Under § 22-8A-4(c)(4), neither witness can be:
- the person who signed the directive for your parent;
- the health care proxy named in it;
- related to your parent by blood, adoption or marriage;
- entitled to any part of your parent's estate under Alabama's inheritance law or under a will or codicil;
- directly financially responsible for your parent's medical care.
That rules out family members, so it's worth lining up two unrelated adults before the signing. In the statutory form, each witness states: "I am witnessing this form because I believe this person to be of sound mind."
Who can serve as the health care proxy?
Any competent adult your parent chooses, with one statutory limit: "Under no circumstances shall the patient's health care provider or a nonrelative employee of the patient's health care provider make decisions in the capacity of a health care proxy." The same rule applies to an agent under a health care power of attorney.
The proxy follows your parent's instructions. Without specific directions, the proxy "shall make those decisions that conform as closely as possible to what the patient would have done or intended under the circumstances" (§ 22-8A-6). The form lets your parent choose how much room the proxy has, including "I want my health care proxy to make the final decision, even though it could mean doing something different from what I have listed on this form."
Divorce, dissolution or annulment revokes a former spouse's appointment as proxy unless the document or the court order says otherwise.
When does an Alabama advance directive take effect?
Under § 22-8A-4(d), it becomes effective when the attending physician determines your parent "is no longer able to understand, appreciate, and direct his or her medical treatment," and two physicians have examined your parent and documented a terminal illness or injury or permanent unconsciousness. Until then, your parent decides: "The desires of an individual shall at all times supersede the effect of an advance directive for health care."
The form reassures signers: "I know that even if I choose not to have life sustaining treatment, I will still get medicines and treatments that ease my pain and keep me comfortable." The directive has no effect during a known pregnancy, and it's your parent's responsibility to give a copy to their doctors. A provider who won't follow it must help transfer your parent to one who will, and keep up treatment in the meantime.
Where do you get the Alabama advance directive form?
The form is printed in the statute itself, § 22-8A-4(h), and an advance directive "shall be substantially in the following form, but in addition may include other specific directions." It opens: "You are not required to have an advance directive." It has sections for the living will, the optional health care proxy, your parent's signature, the two witnesses and the proxy's acceptance.
The Alabama Department of Senior Services' Legal Assistance Program helps adults 60 and older with advance directives on a "non-fee-generating basis."
What happens if your parent has no advance directive?
Alabama has a default for end-of-life decisions. Under § 22-8A-11, if there's no advance directive or no proxy is reasonably available, a surrogate can decide about life-sustaining treatment and tube feeding, with the attending physician, once two physicians certify a terminal illness or injury or permanent unconsciousness. In order of priority:
- a guardian whose court appointment specifically covers these decisions;
- the spouse, unless legally separated or a party to a divorce proceeding;
- an adult child;
- a parent;
- an adult sibling;
- the nearest other adult relative;
- if no relatives can be found, the treating physician with the facility's ethics committee, acting unanimously.
The surrogate must certify that each class at or above their level has consented or not objected, on a state form signed before two adult witnesses. Withholding tube feeding from someone permanently unconscious requires "clear and convincing evidence of the patient's desires." The sections we read don't set a family priority list for other medical decisions, which is one reason to name a proxy. See conservatorship and guardianship for the court route.
How do you revoke an Alabama advance directive?
Under § 22-8A-5, your parent can revoke it at any time by:
- destroying or defacing it in a way that shows they mean to cancel it;
- a written revocation, signed and dated;
- saying they want to revoke it in front of a witness 19 or older, who signs and dates a writing confirming it. That spoken revocation takes effect when the doctor or provider receives the writing.
A health care power of attorney can be revoked the same three ways under § 26-1A-404.
Should your parent record a living will with the probate judge?
It's optional. Under § 22-8A-14, your parent can record a living will with the judge of probate in the county where they live; the recording fee is five dollars ($5), plus any other recording fees set by law. A recorded living will isn't open to the public, but family, doctors, hospital and emergency staff can see it. Recording "shall have no bearing on the validity of the living will," and doctors aren't required to search probate records, so copies for the doctors still matter.
What about a portable DNAR order?
Alabama's medical order form is the Alabama Portable Physician Do Not Attempt Resuscitation Order, set by the State Board of Health. According to the Alabama Department of Public Health, "The completed DNAR must be made a part of the patient's medical record, and the DNAR order becomes portable to other health care providers." It's valid only when one consent section is completed, by your parent, a provider relying on the advance directive, the proxy or attorney in fact, or a surrogate, and a physician signs it. The sections of the Natural Death Act we read don't create a POLST form.
Frequently asked questions
Does a living will need to be notarized in Alabama?
No. Under Code of Ala. § 22-8A-4, an Alabama advance directive for health care must be in writing, dated, signed by your parent and signed in front of two witnesses who are at least 19. The Natural Death Act sections we read don't require a notary. Witnesses can't be relatives, heirs, the proxy or anyone paying for your parent's care.
Can a family member witness an Alabama living will?
No. A witness can't be related to your parent by blood, adoption or marriage, or be entitled to any part of their estate under a will or Alabama's inheritance law. The health care proxy, the person who signed for your parent and anyone directly financially responsible for their medical care are also excluded. A family member can still be the proxy.
Where can I get an Alabama advance directive form?
The form is printed in Code of Ala. § 22-8A-4(h), titled Advance Directive for Health Care (Living Will and Health Care Proxy). An advance directive must be substantially in that form and can add other specific directions. The Alabama Department of Senior Services' Legal Assistance Program helps adults 60 and older with advance directives.
Who makes medical decisions in Alabama if there's no advance directive?
For end-of-life decisions, a surrogate under § 22-8A-11. The order runs from a specifically authorized guardian to the spouse, an adult child, a parent, an adult sibling and the nearest other adult relative. The surrogate must certify that higher and equal classes consented or didn't object. Naming a proxy lets your parent choose instead.
Is an advance directive from another state valid in Alabama?
Yes, with one limit. Under § 22-8A-12, an advance health care directive executed in another state in compliance with that state's law or Alabama's is valid in Alabama. It can't authorize health care that Alabama law otherwise prohibits. If your parent splits time between states, an attorney can confirm what covers both.
Can my parent change their mind after signing?
Yes. Your parent can revoke it at any time by destroying it, by a signed and dated written revocation, or by telling a witness 19 or older who signs and dates a confirming note, effective when the doctor receives it.
Getting started
An advance directive only helps if it's signed while your parent can sign it, with two witnesses who aren't family or heirs, and if a copy reaches the doctor. The plan this site builds asks four questions, including which state your parents live in, and puts the steps that matter most for your family in order. It's free and takes about 90 seconds.
Related guides
Sources
- Code of Alabama § 22-8A-4, Natural Death Act: the living will, health care proxy, signing and witness rules, when it takes effect, and the statutory form; the same site has revocation (22-8A-5), the proxy's standard (22-8A-6) and out-of-state documents (22-8A-12).
- Code of Alabama § 22-8A-11: surrogates when there's no advance directive.
- Code of Alabama § 22-8A-14: recording a living will with the probate judge.
- Code of Alabama § 26-1A-404: health care powers of attorney.
- Alabama Department of Public Health, Advance directives: the portable DNAR order and surrogate certification.
- Alabama Department of Senior Services, Legal Assistance: free legal help for adults 60 and older.
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