Alabama Living Will Requirements: Witnesses, Proxy, and Revocation

To make a valid living will in Alabama, you must be a competent adult who puts your treatment wishes in writing, dates and signs the document (or has someone sign for you in your presence and at your direction), and has two qualifying witnesses sign it. Alabama’s Natural Death Act, found in Chapter 8A of Title 22 of the Code of Alabama, combines the living will and the health care proxy appointment into a single advance directive, and no notarization is required.¹

What Alabama’s Advance Directive Actually Covers

Alabama does not use two separate documents. One form serves as both your living will, where you record your preferences about life-sustaining treatment and artificially provided nutrition and hydration, and your health care proxy designation, where you name someone to make decisions if you cannot.¹

The Natural Death Act includes a statutory form you can use as a template. You are not limited to what appears on that form; you can add specific instructions that address situations important to you. Sticking close to the statutory language is the safest way to avoid later arguments about whether your document is enforceable. Creating a directive is optional. Nothing in Alabama law requires you to have one.

Signing and Witness Requirements

For the document to be valid, it must be in writing, dated, and signed. You can sign it yourself, or if you cannot physically sign, someone else can sign for you in your presence and at your direction.¹

Two witnesses must also sign. Both must be at least 19 years old. Alabama disqualifies several categories of people from serving as witnesses:

The person who signed the directive on your behalf, if someone else signed for you.
The person you named as your health care proxy.
Anyone related to you by blood, marriage, or adoption.
Anyone entitled to a portion of your estate.
Anyone directly financially responsible for your medical care.

These exclusions are meant to keep witnesses free of financial or decision-making conflicts. Alabama does not require the document to be notarized. Witness signatures alone are enough.¹

Who You Can Name as Your Health Care Proxy

Your proxy must be a competent adult. Alabama specifically bars your health care provider and any nonrelative employee of your health care provider from serving in this role, so you cannot name your treating physician or a nurse at the facility caring for you (unless that person is a relative).¹

The proxy’s authority extends to decisions about providing, withholding, or withdrawing life-sustaining treatment and artificially provided nutrition and hydration. Their job is to follow the instructions you wrote into the directive where those instructions cover the situation. Where you were silent or a circumstance arose that you did not anticipate, the proxy uses judgment to decide what you would have chosen. That is why the practical choice matters as much as the legal one. Someone who has never discussed your values with you is making educated guesses. Pick a person you have actually talked to about this.

When the Directive Actually Takes Effect

Signing does not activate anything. Two medical conditions have to be met before your directive controls your care.

First, your attending physician must determine that you are no longer able to understand and direct your own medical treatment. Second, your attending physician and a second doctor qualified in the relevant diagnosis must both personally examine you and confirm that you either have a terminal illness or injury or are in a state of permanent unconsciousness. Both findings must be documented in your medical record.¹

Under Alabama’s definitions, terminally ill or injured means death is imminent or the condition is hopeless without life-sustaining treatment. Permanent unconsciousness means awareness, thought, and social interaction are absent and will not return. Brief unconsciousness during surgery or a temporary inability to communicate does not trigger the directive. As long as you can comprehend and communicate your preferences, your real-time decisions control, and advanced age by itself is not grounds to question your competency.²

Changing or Revoking Your Directive

You can revoke your directive at any time while you remain competent. Section 22-8A-5 of the Natural Death Act provides for revocation, and a spoken objection from a competent patient overrides anything previously written down.

If you want to change the terms rather than cancel altogether, the cleanest route is to execute a new advance directive. An amendment would still have to satisfy the same signing and witness rules, so drafting a fresh document avoids any confusion about which version is current. Once you sign the new one, tell your proxy and your physicians and collect or replace any old copies you handed out. A provider who acts on an outdated directive without knowing it was revoked is protected from liability, so getting the current version into the right hands is on you.²

What Happens If You Don’t Have One

If you become incapacitated with no directive in place, Alabama law names a surrogate for you in a set priority order: a court-appointed guardian with authority over life-sustaining treatment decisions, then a spouse (unless legally separated or divorcing), then an adult child, a parent, an adult sibling, the next closest adult relative, and finally an ethics committee process if no relatives can be located.³

The surrogate has the same authority a proxy would over life-sustaining treatment and nutrition decisions. But the list runs by legal relationship, not by who actually knows you. A relative you have not spoken to in years still outranks a close friend who could recite your preferences from memory. That gap is the practical reason most people create a directive: it lets you pick the person, not the statute.

Out-of-State Directives

If you already have a valid advance directive from another state, Alabama honors it. Under Section 22-8A-12 of the Natural Death Act, a directive that complies with the law of the state where it was signed is enforceable in Alabama to the same extent as one signed here. You do not need to redraft an Alabama-specific version just because you moved or travel through the state.

If you divide your time between Alabama and another state, having a lawyer check the document against both states’ rules is worth the small effort. Differences in witness qualifications, mandatory language, or document format can slow things down at exactly the moment when the directive needs to work smoothly.

1
Alabama Legislature. Alabama Code 22-8A-4 – Advance Directive for Health Care; Living Will and Health Care Proxy
2
Alabama Legislature. Alabama Code 22-8A-7 – Competency of Declarant; Liability of Participating Physician, Facility, Etc.
3
Alabama Legislature. Alabama Code 22-8A-11 – Surrogate; Requirements