Health Care Power of Attorney Requirements in Alabama

At a glance

Alabama packages advance-care planning into a single document. The Advance Directive for Health Care, governed by the Alabama Natural Death Act at Ala. Code §§ 22-8A-1 to 22-8A-18, has two parts: a living will (your own instructions about life support) and a health care proxy designation (naming someone to decide for you). This page is about the second part — appointing the agent, whom Alabama calls your health care proxy. Two things about Alabama are worth knowing up front: the adult age here is 19, not 18, and the document is built around end-of-life decisions, so the proxy's authority is tied closely to life-sustaining treatment.

Requirements one by one

Governing law and form

Under § 22-8A-4(b), "[a] competent adult may execute at any time a living will that includes a written health care proxy designation appointing another competent adult" to make decisions about life-sustaining treatment and artificial nutrition and hydration. The proxy designation "may be a separate document or part of a living will." Alabama publishes a mandatory statutory form: § 22-8A-4(h) says the directive "shall be substantially in the following form," and the Alabama Department of Public Health distributes that form. You are not required to have a directive at all — but if you make one, it must track the statutory form and rules.

One step people miss: the proxy has to say yes in writing. "A proxy designation made pursuant to this section shall be accepted in writing by the individual being appointed," and "[t]he acceptance shall be evidenced in writing and attached to the proxy designation" (§ 22-8A-4(b)). The state form has a signature line for exactly this.

Witnesses or notary

Alabama requires two witnesses and no notary. Section 22-8A-4(c) says the directive must be "[i]n writing," "[s]igned by the person making the advance directive ... or by another person in the declarant's presence and by the declarant's expressed direction," "[d]ated," and "[s]igned in the presence of two or more witnesses at least 19 years of age." There is no notarization requirement; the notary block on the ADPH form is optional, added only for extra proof.

Who can't witness or serve

The two witnesses are tightly restricted. Under § 22-8A-4(c)(4), a witness may not be the person who signed for the declarant, the person "appointed as the health care proxy," a relative "by blood, adoption, or marriage," anyone "entitled to any portion of the estate," or anyone "directly financially responsible for declarant's medical care." Separately, there is a hard bar on who may serve as proxy: "[u]nder 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" (§ 22-8A-4(b)(4)).

When the agent can act

Your proxy's authority is springing, and Alabama sets a demanding trigger. Under § 22-8A-4(d), the directive "shall become effective when" two things are true: (1) the attending physician "determines that the declarant is no longer able to understand, appreciate, and direct his or her medical treatment"; and (2) "two physicians, one of whom shall be the attending physician," have personally examined you and documented the statutory finding that "the declarant has either a terminal illness or injury or is in a state of permanent unconsciousness." So the proxy's power over life-sustaining care does not switch on for ordinary, recoverable illness. Two further rules matter: the directive "shall have no effect during the course of the declarant's pregnancy" if the attending physician knows you are pregnant (§ 22-8A-4(e)), and your own contemporaneous wishes always win — "[t]he desires of an individual shall at all times supersede the effect of an advance directive" (§ 22-8A-7).

Agent's powers and limits

Within its scope, the proxy decides about "providing, withholding, or withdrawal of life-sustaining treatment and artificially provided nutrition and hydration" (§ 22-8A-4(b)), and must follow your instructions and intent — the duty § 22-8A-6 heads "Proxy to Comply with Instructions, Intent of Patient." Two limits are built in. First, tube feeding is opt-in: artificial nutrition and hydration "shall not be withdrawn or withheld pursuant to the proxy designation unless specifically authorized therein" (§ 22-8A-4(b)). Second, any authority to make general health care decisions that are not about life-sustaining treatment is "limited to those powers permitted under the Alabama Durable Power of Attorney Act, Section 26-1-2" (§ 22-8A-4(b)(2)) — so a broad, day-to-day medical agency rides on the separate durable-POA statute, not on the Natural Death Act alone. Where you have both a living will and a proxy, the proxy's decisions "take precedence over" the living will unless the document says otherwise (§ 22-8A-4(g)).

How to revoke

You keep control. Under § 22-8A-5, you may revoke "at any time" by any of three methods: destroying or defacing the document "in a manner indicating intention to cancel"; signing and dating a written revocation; or making "a verbal expression of the intent to revoke ... in the presence of a witness 19 years of age or older who signs and dates a writing confirming" it — with a verbal revocation effective "upon receipt by the attending physician or health care provider of the above mentioned writing." Note what is not on the list: Alabama's Act has no rule that divorce, annulment, or legal separation cancels a spouse you named as proxy. If your marriage ends, revoke and sign a new directive to change your proxy.

Out-of-state directives

Alabama honors directives from elsewhere. Section 22-8A-12 provides that "[a]n advance health care directive executed in another state in compliance with the law of that state or of this state is valid for purposes of this chapter" — though it does not authorize care that Alabama law otherwise forbids.

What trips people up

• The adult age is 19. In Alabama you must be 19 to make the directive, and each of the two witnesses must be 19 or older (§ 22-8A-3(1); § 22-8A-4(c)(4)).
• Your proxy must sign an acceptance. A designation is not enough — the person you name has to accept in writing, and that acceptance is attached to the document (§ 22-8A-4(b)).
• The proxy's power waits for a serious diagnosis. It activates only when you cannot direct your care and two physicians document a terminal condition or permanent unconsciousness (§ 22-8A-4(d)). For a routine, recoverable illness, the proxy's life-sustaining-treatment authority is not yet in effect.
• Tube feeding is opt-in. Your proxy cannot stop artificial nutrition and hydration unless your document specifically grants that power (§ 22-8A-4(b)).
• Divorce does not cancel your proxy. Unlike many states, Alabama's Act has no automatic revocation on divorce (§ 22-8A-5 lists the only three ways to revoke). A former spouse stays your proxy until you revoke.

Common questions

Does my Alabama advance directive need to be notarized? No. It must be signed and dated in front of two witnesses who are at least 19; a notary is not required (§ 22-8A-4(c)). Notarizing it is optional.

Can my spouse or child witness the document? No. A witness cannot be related to you by blood, adoption, or marriage, cannot be your proxy, and cannot be someone who would inherit from you or who is financially responsible for your medical care (§ 22-8A-4(c)(4)). Pick unrelated, disinterested witnesses.

Can my proxy make all my medical decisions right away? No. The proxy's authority over life-sustaining treatment turns on only after your doctor and a second physician document that you cannot direct your care and have a terminal condition or permanent unconsciousness (§ 22-8A-4(d)). Broader everyday decision-making comes only through the separate durable-power-of-attorney route (§ 22-8A-4(b)(2)).

Will a health care directive I signed in another state work in Alabama? Yes. A directive executed in another state in compliance with that state's law (or Alabama's) is valid in Alabama (§ 22-8A-12).

Statutes and sources

• Ala. Code § 22-8A-3 — definitions: "adult" (19+), "competent adult," "attending physician," "health care proxy," "advance directive for health care." https://alison.legislature.state.al.us/code-of-alabama?section=22-8A-3 (accessed 2026-07-16)
• Ala. Code § 22-8A-4 — the advance directive and health care proxy designation: competent-adult appointment, written acceptance, opt-in nutrition and hydration, § 26-1-2 cap on general decisions, provider/employee proxy bar, execution formalities (§ 22-8A-4(c)), effectiveness trigger (§ 22-8A-4(d)), pregnancy exception (§ 22-8A-4(e)), proxy precedence (§ 22-8A-4(g)), statutory form (§ 22-8A-4(h)). https://alison.legislature.state.al.us/code-of-alabama?section=22-8A-4 (accessed 2026-07-16)
• Ala. Code § 22-8A-5 — revocation at any time by destruction, signed writing, or witnessed verbal statement. https://alison.legislature.state.al.us/code-of-alabama?section=22-8A-5 (accessed 2026-07-16)
• Ala. Code § 22-8A-6 — proxy must comply with the patient's instructions and intent. https://alison.legislature.state.al.us/code-of-alabama?section=22-8A-6 (accessed 2026-07-16)
• Ala. Code § 22-8A-7 — the patient's own desires supersede the directive at all times; competency presumption for providers. https://alison.legislature.state.al.us/code-of-alabama?section=22-8A-7 (accessed 2026-07-16)
• Ala. Code § 22-8A-12 — a directive executed in another state under that state's law (or Alabama's) is valid in Alabama. https://alison.legislature.state.al.us/code-of-alabama?section=22-8A-12 (accessed 2026-07-16)