50-State Surveys › Living Will and Advance Health-Care Instruction Requirements by State
Living Will and Advance Health-Care Instruction Requirements by State
How may an adult state binding future treatment instructions in this state, what execution formalities apply, when do the instructions control, what treatment and pregnancy limits apply, and how may they be revoked?
49 of 51 jurisdictions verified
every entry statute-checked, oldest 2026-07-30
What this survey covers
A living will states an adult's own instructions for future health care. Some states use a narrow declaration about life-sustaining treatment in specified medical conditions. Others recognize broader individual health-care instructions, and many place the treatment instructions inside the same advance-directive form that can also appoint an agent. This survey covers the instruction, not the agent appointment.
The table follows the instruction from creation through execution, the medical findings that make it operative, the treatment choices and statutory limits it may contain, revocation and notice, and the provider and interstate-recognition rules that determine its legal effect. It does not cover POLST or MOLST forms, out-of-hospital DNR orders, or other clinician orders.
How to read the table
Start with the governing-law and form columns. They show whether the state uses a standalone living will, a combined advance directive, or a broader oral-or-written instruction. Then read the signature and witness columns together: an oral statement may be valid in one setting while a written declaration requires two witnesses or a notary, and a facility-specific witness may apply only to a patient in that facility.
Next, separate execution from operation. A document can be valid when signed but control treatment only after the statute's condition, incapacity, and clinician-finding tests are met. Treatment, artificial nutrition and hydration, and comfort care remain separate questions. The pregnancy column states only the statute's own limit and whom it binds.
Finish with revocation and provider effect. A state may allow oral revocation yet require communication to a physician before it becomes effective. A provider may have a duty to comply, a defined transfer route, or a medical-standard exception. Out-of-state validity is a separate rule and does not erase local limits on treatment.
What the completed table shows
The largest divide is document architecture. Alaska and Wyoming allow an adult's own instruction to be oral or written, with no instruction-only signature, witness, or notary requirement; Delaware likewise recognizes an instruction outside a signed paper form. At the other end, the District of Columbia uses a formal terminal-condition declaration with at least two fully qualified witnesses, while South Dakota requires a signed writing plus either two adult witnesses or a notary. Alaska Stat. § 13.52.010; Wyo. Stat. § 35-22-403; 16 Del. C. chapter 25; D.C. Code §§ 7-621 to -623; S.D. Codified Laws §§ 34-12D-1 to -3.
Operation is a separate axis. Alaska and Wyoming let the maker select the activating condition. North Dakota ordinarily uses a written incapacity certification without a universal terminal diagnosis. South Dakota requires an attending-physician finding of a terminal condition, imminent death, and inability to communicate, while the District's Natural Death Act uses two personally examining physicians and then preserves the qualified patient's current wishes over the declaration. N.D.C.C. § 23-06.5-03; S.D. Codified Laws § 34-12D-5; D.C. Code §§ 7-625 to -626.
Treatment and pregnancy rules do not track either formality or trigger. South Dakota requires the declaration to state artificial-nutrition-and-hydration preferences; North Dakota supplies a separate rule when the directive is silent; Wyoming treats tube or IV nutrition as a health-care decision but excludes assisted feeding. The District, Delaware, and Wyoming state no pregnancy-specific override in their governing instruction schemes, while Alaska, North Dakota, and South Dakota use materially different live-birth, harm, pain, clinician, and medical-judgment tests. Those differences are why the table keeps treatment, pregnancy, revocation, and provider effect in separate columns.
Why the dimensions stay separate
Texas uses a standalone directive to physicians. Its current statute permits a written directive by a competent adult, a narrower nonwritten directive by a competent adult who is already a qualified patient, and either two witnesses or a notarial acknowledgment for the written route. The statutory form separately addresses terminal and irreversible conditions, treatment and comfort choices, and pregnancy. Tex. Health & Safety Code §§ 166.031–166.049.
Florida defines a living will as either a witnessed writing or a witnessed oral statement, but its operative life-prolonging-procedure provisions separately address terminal condition, end-stage condition, persistent vegetative state, incapacity, and provider procedure. Fla. Stat. chapter 765.
Louisiana uses a narrower declaration for a terminal and irreversible condition. A written declaration requires two witnesses, while an oral or nonverbal declaration is available after diagnosis; the same subpart separately regulates revocation, an optional registry, treatment choices, out-of-state declarations, and pregnancy. La. R.S. 40:1151.1–1151.9.
These current statutes show that document architecture, communication form, execution, medical trigger, treatment choices, pregnancy limits, revocation, registry, provider duties, and interstate effect vary independently. Those are the nine dimensions frozen for this survey.
Get this answered for your state
This survey compares every state side by side. Ezel applies your state's law to your specific situation and answers with citations to the statutes.
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| State | Governing law and document | Who may make an instruction | Oral, written, and signature form | Witness, notary, and disqualifications | Covered conditions and trigger | Treatment, nutrition, hydration, and comfort | Pregnancy and other statutory limits | Revocation, notice, and registry | Provider duties, recognition, and effect |
|---|---|---|---|---|---|---|---|---|---|
| Alabama verified 2026-07-31 | Alabama Natural Death Act, Ala. Code §§ 22-8A-1–22-8A-18: written 'Advance Directive for Health Care (Living Will and Health Care Proxy).' It may contain a living will, proxy appointment, or both; the directive must be substantially in the § 22-8A-4(h) statutory form but may add specific directions (§§ 22-8A-3, -4). |
A 'competent adult': age 19+; alert, able to understand a lay description of medical procedures, and able to appreciate the consequences of providing, withholding, or withdrawing them (§ 22-8A-3). Another person may sign only in the adult's presence and at the adult's expressed direction (§ 22-8A-4(c)). |
Written, dated, and signed by the adult or a directed signer in the adult's presence (§ 22-8A-4(c)). The Natural Death Act provides no oral execution route or separate electronic-execution method. The written form separately presents terminal and permanent-unconsciousness choices (§ 22-8A-4(h)). |
2 witnesses age 19+, present for signing; no notary substitute in the Act (§ 22-8A-4(c)). Neither may be the directed signer, named proxy, relative by blood/adoption/marriage, intestate or will beneficiary, or person directly financially responsible for the adult's medical care. |
Attending physician determines the adult can no longer understand, appreciate, and direct treatment; plus 2 physicians who personally examined the adult, including the attending physician and 1 qualified/experienced diagnostician, document terminal illness or injury or permanent unconsciousness in the medical record (§ 22-8A-4(d)). |
May direct providing, withholding, or withdrawing life-sustaining treatment and artificially provided nutrition/hydration (§ 22-8A-4(a)). The statutory form gives separate yes/no choices for each treatment category under terminal illness/injury and permanent unconsciousness. Tube nutrition/hydration cannot be withheld or withdrawn unless specifically authorized; comfort and pain-relief treatment is excluded from 'life-sustaining treatment' (§§ 22-8A-3, -4). |
If the attending physician knows the adult is pregnant, the advance directive has no effect during the pregnancy; no viability, prognosis, or gestational exception is stated (§ 22-8A-4(e)). The Act does not authorize mercy killing, physician-assisted suicide, or another affirmative/deliberate act or omission to end life beyond natural dying (§ 22-8A-10). |
Revoke anytime by intentional destruction/defacement, signed dated writing by the adult or directed signer, or verbal expression before a witness age 19+ who signs/dates a confirmation (§ 22-8A-5). Verbal revocation is effective when the provider receives that writing; provider records receipt details. Optional private county-probate recording costs $5 plus other lawful fees, does not affect validity, and creates no provider search duty (§ 22-8A-14); no central registry. |
Adult supplies a copy; provider adds it to the medical record (§ 22-8A-4(f)). Current desires always supersede; good-faith statutory compliance is immune (§ 22-8A-7). Refusing provider promptly advises, permits and reasonably assists timely transfer, and maintains all life-sustaining treatment, resuscitation, nutrition, and hydration during transfer (§ 22-8A-8). A directive valid under the execution law of another state or Alabama is valid here, subject to Alabama prohibitions (§ 22-8A-12). |
| Alaska verified 2026-07-31 | Alaska Health Care Decisions Act, AS 13.52.010–.395. 'Individual instruction' is adult's direction about own health-care decision and, alone or with health-care POA, is an 'advance health care directive' (§§ 13.52.010(a), 13.52.390(1), (23)). Optional combined statutory form (§ 13.52.300); instruction remains distinct from agent appointment and DNR orders |
Adult may give instruction (§ 13.52.010(a)). Capacity means ability to receive/evaluate information and make/effectively communicate health-care decisions (§ 13.52.390(8)); individual is rebuttably presumed able to make decision and give/revoke directive (§ 13.52.100(b)). No emancipated-minor route in § 13.52.010(a) |
Instruction may be oral or written and limited to specified condition (§ 13.52.010(a)). No signature, date, delivery, acknowledgment, or electronic-specific form required for instruction alone. Optional combined form asks for signature/date and execution blocks, but § 13.52.010(l) preserves an otherwise-valid instruction even if accompanying health-care POA fails witnessing/other requirements |
No witness or notary for standalone individual instruction (§ 13.52.010(a), (l)). Two-personally-known-witness OR in-state-notary rule and witness disqualifications in § 13.52.010(b), (d), (e) govern durable health-care POA, not instruction-only validity. Do not import combined form's agent-appointment execution blocks into treatment instruction |
No universal incapacity, terminal, PVS, or clinician trigger; adult may make instruction effective now or on specified condition (§ 13.52.010(a)). Unless written directive specifies otherwise, primary physician determines capacity/recovery or other activating condition; court determines in mental-illness case unless emergency, then primary physician/other provider (§ 13.52.010(g)). Optional form offers terminal and permanent-unconsciousness choices (§ 13.52.300) |
Instruction may address any health-care decision, including provide/withhold/withdraw artificial nutrition/hydration when consistent with generally accepted standards (§ 13.52.390(18), (23)). Optional form offers prolong-life OR comfort-only choices for terminal condition/permanent unconsciousness, 4 feeding/hydration choices, pain-relief choice, and custom instructions (§ 13.52.300). Provider may refuse medically ineffective or standards-conflicting care (§ 13.52.060(f)) |
Withholding/withdrawal instruction cannot be given effect when patient is pregnant, lacks capacity, withdrawal likely causes her death, and continued procedures probably permit fetal development to live birth (§ 13.52.055); provider first takes reasonable pregnancy-check steps, and field emergencies are excluded. Chapter does not authorize mercy killing, assisted suicide, or euthanasia (§ 13.52.120(d)); optional form's pregnancy blank remains subject to § 13.52.055 |
Except mental-illness and anatomical-gift rules, revoke all/part of instruction anytime and in any manner communicating intent (§ 13.52.020(b)); later conflicting directive revokes earlier to conflict. Mental-illness revocation requires principal with capacity/competence and communication to provider (§ 13.52.020(c)). Informed provider/agent/guardian/surrogate promptly relays revocation to supervising provider/institution; provider records existence (§§ 13.52.020(d), 13.52.060(b)). No directive registry in chapter |
Provider/institution/facility complies with instruction and reasonable interpretation; conscience/policy or medically ineffective/accepted-standard refusal requires prompt notice, continuing care, and immediate transfer cooperation unless assistance refused (§ 13.52.060). Good-faith, accepted-standard immunity (§ 13.52.080). Directive made elsewhere is valid only if it complies with Alaska chapter, regardless where/when made (§ 13.52.010(k)); copy equals original (§ 13.52.110) |
| Arizona verified 2026-07-30 | Living Wills and Health Care Directives Act, A.R.S. Title 36, ch. 32. A § 36-3261 written 'living will' may be part of or instead of a health-care power of attorney, or may disqualify a surrogate. Arizona Attorney General publishes an optional form. |
An adult (§ 36-3261(A)). Standalone verification requires the signer to appear of sound mind and free from duress under the incorporated § 36-3221 rules. |
Written statement (§ 36-3261). If standalone: dated and signed or marked under § 36-3221; if physically unable, the notary or each witness verifies the adult directly indicated the document expressed the adult's wishes and intended to adopt it. No oral or electronic-specific execution path is stated. |
Notary OR at least one adult witness (§§ 36-3261(B), 36-3221). The notary/witness cannot be the agent or directly involved in current care. If exactly one witness is used, that person also cannot be related by blood/marriage/adoption or inherit from the adult. |
The living will may control health-care treatment decisions made on the adult's behalf (§ 36-3261), and providers locate/follow it when the adult cannot make or communicate treatment decisions (§ 36-3231(A)); no terminal diagnosis or two-physician certification is a statutory prerequisite. The optional state form supplies choices for terminal condition, irreversible coma, and persistent vegetative state. |
May control health-care treatment decisions generally (§ 36-3261). The optional state form addresses comfort care, CPR, artificially administered food/fluids, hospitalization, and maximal treatment. A default surrogate who is neither agent nor guardian cannot permanently withdraw artificial food or fluid (§ 36-3203(E)); that is a surrogate limit, not a limit on the adult's own express directive. |
No categorical pregnancy limit appears in the Living Wills and Health Care Directives Act. The optional state form lets the adult choose not to withhold/withdraw treatment during pregnancy if continued treatment could permit live birth. A surrogate cannot authorize an act or omission to which the patient could not lawfully consent (§ 36-3203(B)). |
Revoke by writing, oral notice to the surrogate or provider, a new directive, or any other act showing specific intent (§ 36-3202); no capacity condition or mandatory record notation is stated. Optional Arizona Healthcare Directives Registry filing. Nonregistration does not affect validity, and failure to notify the registry does not defeat an otherwise valid revocation (§ 36-3293). |
Provider must locate/follow the directive when the adult cannot decide (§ 36-3231), and must comply with surrogate decisions consistent with it (§ 36-3204). A conscience objector promptly discloses refusal and transfers care; treatment, food, or fluids with significant life-sustaining possibility continue until transfer (§§ 36-3204 to -3205). Good-faith reliance is protected. Another-state directive is valid if valid where/when adopted, subject to Arizona criminal law (§ 36-3208). |
| Arkansas verified 2026-07-31 | Arkansas Rights of the Terminally Ill or Permanently Unconscious Act, Ark. Code §§ 20-17-201–218: optional standalone written 'declaration' forms for terminal condition and permanent unconsciousness (§§ 20-17-202, -215). A declaration is also an advance directive under the Arkansas Healthcare Decisions Act, §§ 20-6-101–118; that Act separately recognizes broader oral or written individual instructions (§ 20-6-103) |
Formal declaration: individual of sound mind, age 18+, may execute anytime (§ 20-17-202(a)). Broader individual-instruction route includes an adult; this page excludes the Act's married-minor and emancipated-minor rules (§ 20-6-103(a)) |
Broader individual instruction may be oral or written and conditioned on a specified event (§ 20-6-103(a)). Formal declaration is written and signed by declarant or another at the declarant's direction; optional forms include signature date and address (§ 20-17-202(a)–(c)). No electronic-specific route appears |
For post-July 1, 2017 formal declarations: notarization without 2 witnesses OR compliance with Healthcare Decisions Act (§ 20-17-202(a)(3)). Witness route uses 2 competent adults, neither named proxy; at least 1 must be unrelated by blood/marriage/adoption and a non-heir, with an attestation clause (§§ 20-17-202(b)–(c), 20-6-103(c)) |
Formal declaration operates when communicated and attending physician plus another physician find either terminal condition and inability to decide about life-sustaining treatment, or permanent unconsciousness (§ 20-17-203). Terminal means incurable/irreversible and death within relatively short time without treatment; permanent unconsciousness means lasting absence of thought, feeling, sensation, and awareness (§ 20-17-201) |
Optional forms choose direct withholding/withdrawal or proxy decision, separately for terminal condition and permanent unconsciousness; each separately directs whether nutrition and hydration may or may not be withheld (§ 20-17-202(b)–(c)). Act preserves comfort, care, and pain-alleviation treatment including nutrition/hydration; a patient's request for them is honored, but artificial means requiring inserted apparatus need not be used unless specifically requested (§§ 20-17-204(a)(2), -206(b)) |
Known pregnancy: declaration not given effect while continued life-sustaining treatment possibly could allow fetus to develop to live birth (§ 20-17-206(c)). Act does not require care contrary to reasonable medical standards and does not authorize mercy-killing or euthanasia (§ 20-17-210(f)–(g)) |
Formal declaration may be revoked anytime/in any manner regardless mental or physical condition; effective when declarant or witness communicates it to attending physician/provider, who records it (§ 20-17-204). The Act creates no state declaration registry |
Provider receiving declaration adds it to medical record and advises declarant if unwilling (§ 20-17-202(d)); once operative, comply or follow Healthcare Decisions Act refusal/transfer rules (§§ 20-17-203, -207, 20-6-109). Good-faith/reasonable-standard immunity; foreign declaration valid if compliant there or in Arkansas (§§ 20-17-208, -212) |
| Colorado verified 2026-07-31 | Colorado Medical Treatment Decision Act, Colo. Rev. Stat. art. 18 (§§ 15-18-101–15-18-113): written 'Declaration as to Medical or Surgical Treatment.' No current statutory form; the former form was repealed in 2021. It may be combined with a medical power of attorney but must satisfy both laws (§ 15-18-104(7)). |
Any adult age 18+ who possesses 'decisional capacity'—ability to give informed consent/refusal or make an informed health-care-benefit decision (§§ 15-18-103(1), (6)–(8), 15-18-104(1)). A physically unable adult may direct another person to sign in the adult's presence (§ 15-18-105). |
Written and signed. The adult signs before 2 witnesses OR signs and acknowledges before a notary/other acknowledgment officer (§ 15-18-106). Directed signer must act in the adult's presence and at the adult's direction (§ 15-18-105). Article 18 does not separately require a date or create an oral or electronic execution route; oral communication is allowed for revocation only. |
Alternative routes: 2 witnesses OR notarial/authorized acknowledgment (§ 15-18-106). A directed signer, witness, or acknowledgment officer may not be the attending/other physician, an employee of the attending physician or treating facility, an estate claimant, or a known will beneficiary/heir (§§ 15-18-105–106). Article 18 states no age or relationship-only witness bar. |
Terminal condition or persistent vegetative state AND lack of decisional capacity (§§ 15-18-103–104). Attending physician plus 1 other physician examine and certify both findings in writing in the hospital record (§ 15-18-107). Attending physician makes reasonable notice effort; absent a validity challenge within 48 hours after certification, treatment follows the declaration. |
May direct withholding/withdrawal of life-sustaining procedures and separately address artificial nutrition/hydration (§ 15-18-104). Nutrition/hydration choices: discontinue, continue for a stated period, or continue. Life-sustaining procedure excludes nourishment and comfort/pain measures (§ 15-18-103(10)); nutrition/hydration may continue as needed for comfort and pain relief (§ 15-18-104(4)). |
Article 18 contains no pregnancy-specific suspension, viability test, or modification rule. It does not authorize euthanasia, mercy killing, or an affirmative/deliberate act or omission to end life beyond permitting natural death, and does not require treatment contrary to medical or nursing standards (§ 15-18-112(1)). |
The adult may revoke orally, in writing, or by burning, tearing, canceling, obliterating, or destroying the declaration (§ 15-18-109); Article 18 states no witness or delivery formality, while provider immunity ends with actual notice (§ 15-18-110). Optional statewide electronic storage: on request, a participating provider may upload after consultation and a provider-present electronic affidavit; that affidavit revokes same-type directives previously uploaded (§§ 25-54-101–102). |
After certification, notice effort, and 48 hours without a challenge, the attending physician shall follow the declaration (§ 15-18-107). Eligible relatives/representatives may seek immediate court review (§ 15-18-108); good-faith compliance is protected (§ 15-18-110). A refusing physician/APRN transfers care or faces discipline (§ 15-18-113). A directive valid where executed is effective unless it violates Colorado law (§ 15-18-108(6)). |
| Connecticut verified 2026-07-31 | Conn. Gen. Stat. chapter 368w, §§ 19a-570–19a-580g. A 'living will' is a written statement of health-care wishes, including life-support withholding/withdrawal. It may stand alone under optional § 19a-575 or appear in the optional combined directive under § 19a-575a; keep it distinct from the representative appointment and MOLST clinician orders |
Any person age 18+ may execute either statutory document (§§ 19a-575, 19a-575a). The forms recite careful reflection and sound mind, but the operative authorization states the age rule and does not add a separate diagnosis or post-diagnosis route |
Living will is written, signed, and dated by the maker with 2+ witnesses (§§ 19a-570(9), 19a-575, 19a-575a). No directed-signer or electronic-specific route appears. Oral health-care communications are not living wills but providers record them, and a court requires clear-and-convincing evidence if their meaning/application is disputed (§§ 19a-578(b), 19a-580c(a)) |
Treatment-only living will: 2+ witnesses; no notary alternative or general relative/heir/provider bar (§ 19a-575). Optional witness affidavits may be sworn before an oath officer for proof (§ 19a-578(a)). Combined representative form: maker signs/dates with 2+ witnesses; because it appoints a representative, that appointee cannot witness and special DMHAS/DDS-facility witness rules apply (§§ 19a-575a, 19a-576) |
Operative when furnished to the attending physician/APRN and that single clinician finds the declarant unable to understand/appreciate consequences and reach/communicate an informed decision (§§ 19a-570(7), 19a-579). For protected life-support removal, attending clinician must find terminal condition, or consult an examining neurologic-diagnosis physician to find permanent unconsciousness (§ 19a-571) |
Instructions may address any health care, including life support (§ 19a-575). Form requests no life support in terminal condition or permanent unconsciousness and lists artificial respiration, CPR, and artificial nutrition/hydration, allowing items to be crossed out/initialed for administration. 'Life support system' includes artificial nutrition/hydration. Comfort care and pain alleviation always continue (§§ 19a-570(8), 19a-573) |
Former pregnancy nonapplicability § 19a-574 was repealed in 2018. Current optional forms instead let signer choose: accept life support if doctor believes it would allow fetus to reach live birth; apply directive without modification; or specify alternative instructions (§§ 19a-575, 19a-575a). Forms state no direct taking of life, only no unreasonable prolonging of dying |
Living will revocable anytime/in any manner, regardless of mental or physical condition; provider records revocation (§ 19a-579a). Provider records a supplied written will and oral health-care communications (§ 19a-578). No advance-directive registry appears in current chapter 368w. Appointment revocation follows a separate witnessed-writing rule and does not control the living will |
Provider considers the will and applies usual/customary medical standards; absent terminal/permanent-unconscious finding, beneficial treatment including nutrition/hydration continues (§ 19a-571). Reasonable pre-removal notice to listed persons and prompt transfer by unwilling provider (§§ 19a-580, 19a-580a). Other-state/country instructions valid if compliant there or in CT and not contrary to CT public policy, with § 19a-580g reliance paths |
| Delaware verified 2026-07-31 | Delaware Uniform Health-Care Decisions Act (2023), 16 Del. C. ch. 25, effective Sept. 30, 2025. 'Advance health-care directive' may be health-care instruction, health-care POA, or both (§ 2502). Section 2511 offers optional combined form; treatment instruction remains distinct from agent appointment and medical orders |
Adult or emancipated minor with capacity may create instruction (§§ 2502(14), (16), 2507). Capacity includes ability to communicate independently or with supports/accommodations and understand nature/consequences, primary risks, and benefits of instruction choices (§ 2503(a)(2)) |
Instruction is a direction 'whether or not in a record' and may be conditional (§ 2502(14)); professional receiving communicated instruction documents it and date (§ 2507(b)). No signature/date requirement for instruction alone. Tangible/electronic records and electronic signatures recognized (§§ 2502(25), (27), 2516(c)–(e)); optional form asks signer/date |
No witness or notary for instruction-only route (§§ 2502(14), 2507). Optional § 2511 form says witness is needed only if naming agent; then separate § 2508 one-adult-witness rules apply. Do not import agent-appointment witness qualifications, presence methods, or any notary requirement into treatment instruction |
Instruction may set specified condition; Act imposes no universal incapacity, terminal, or clinician trigger (§ 2502(14)). Optional form offers treatment/feeding/pain choices for: incurable condition expected to cause death soon even if treated; unconsciousness with no expected recovery; OR unrecoverable condition preventing communication with loved ones, self-care, and recognition (§ 2511) |
Health-care decision includes provide/withhold/withdraw artificial nutrition/hydration, ventilation, and other care (§ 2502(12)). Optional form separately chooses treatment needed to stay alive, lifelong tube food/liquids, and pain care likely to shorten life, with always/never, 3 condition-based, and custom options (§ 2511). Individual may add other goals/preferences (§ 2507) |
Chapter 25 and optional form state no pregnancy-specific suspension, viability, or live-birth test. Act does not authorize mercy killing, assisted suicide, or euthanasia; compliant withdrawal is not suicide/homicide (§ 2527). For long-term disability with routine feeding/hydration/ventilation, surrogate withdrawal is limited unless individual expressly authorized it or another statutory exception applies (§ 2519) |
Revoke instruction wholly/partly while having revocation capacity, by any act clearly indicating intent, including oral statement to professional; later conflicting directive revokes earlier to conflict (§ 2515). Professional documents known creation/revocation and includes furnished record copy (§ 2521(d)). No directive registry provision in chapter 25 |
Professional/institution complies with instruction/reasonable interpretation; conscience/policy, unavailable care, religious/moral, accepted-standard, court-order, or other-law refusal requires notice, reasonable transfer effort, and interim life-sustaining/comfort care under timing rules (§ 2521). Good-faith immunity (§ 2523); physical/electronic copy equals original (§ 2525). Foreign directive valid under named/creation-state law or Delaware Act (§ 2516) |
| District of Columbia verified 2026-07-31 | D.C. Natural Death Act, D.C. Code tit. 7, ch. 6, subch. II (§§ 7-621 to -630). Standalone written 'declaration' for withholding/withdrawal of life-sustaining procedures in terminal condition (§§ 7-621 to -622); statutory form is substantially required but may add consistent directions. Separate from health-care POA under tit. 21 |
Person age 18+ may execute (§ 7-622(a)). Form states sound mind, voluntary intent, and emotional/mental competence; provider may presume sound mind absent actual contrary notice, and execution is not evidence of incompetency (§ 7-626(b)). Directed signer allowed only in declarant's presence and at express direction (§ 7-622(a)(2)) |
Must be writing, signed by declarant or directed signer in declarant's presence/at express direction, dated, and signed in presence of 2+ qualifying adult witnesses (§ 7-622(a)). Statutory declaration form is substantially required, with severable additional consistent directions (§ 7-622(c)). No oral creation, notary alternative, or current electronic-specific route |
At least 2 witnesses age 18+, signing in declarant's presence (§ 7-622(a)(4)); notary cannot substitute. No witness may be directed signer, blood/marriage/domestic-partner relative, intestate/will/codicil taker, person directly financially responsible for care, attending physician, attending physician's employee, or employee of facility where declarant is patient. If signed while patient in intermediate/skilled care facility, 1 of 2 must be patient advocate or ombudsman with same qualifications (§ 7-623) |
Qualified patient has compliant declaration plus terminal condition diagnosed/certified in writing by 2 personally examining physicians, 1 attending (§ 7-621(5)). Terminal condition is incurable and produces death regardless of procedures, which only postpone death (§ 7-621(6)). After certification, attending physician informs patient and documents; if patient cannot comprehend, qualification is immediate (§ 7-625). No separate incapacity certification; qualified patient's current desires always supersede declaration (§ 7-626(a)) |
Declaration directs withholding/withdrawal of 'life-sustaining procedure' that only artificially prolongs dying and does not include medication/procedure necessary for comfort or pain relief (§§ 7-621(3), 7-622(c)). Form directs natural death with comfort/pain care and permits other specific directions consistent with subchapter. Natural Death Act states no separate artificial-nutrition/hydration definition or election; do not infer one from health-care POA form |
Natural Death Act §§ 7-621 to -630 state no pregnancy-specific suspension, viability, or live-birth rule. Subchapter does not condone/authorize/approve mercy killing or permit affirmative/deliberate act or omission to end life beyond natural dying under Act (§ 7-630). Making/using compliant declaration is not suicide or assisting suicide (§ 7-628(a)) |
Only 3 routes, without regard to mental state: destruction/defacement by declarant or directed person in declarant's presence; signed, dated written revocation; OR verbal intent before witness age 18+ who signs/dates confirmation (§ 7-624). Written/verbal revocation effective only when communicated to attending physician, who records specified details; actual knowledge governs liability. Declarant must notify physician of declaration, who files it (§ 7-622(b)). No registry in subchapter |
Attending physician notified of declaration promptly obtains written two-physician certification/confirmation and communicates terminal status as § 7-625 requires. Noncomplying attending physician, with next of kin/responsible person, effects transfer to willing physician (§ 7-627(b)). Good-faith, reasonable-standard immunity for compliant withholding/withdrawal (§ 7-627(a)). Subchapter states no rule validating living will solely because validly executed elsewhere; execution route is § 7-622 |
| Florida verified 2026-07-30 | Florida Health Care Advance Directives Act, Fla. Stat. ch. 765, especially the Life-Prolonging Procedure Act (§§ 765.301-.309): a standalone living will or declaration, which may be written or oral. The § 765.303 form is optional |
Any competent adult may make a living will at any time (§§ 765.101(18), 765.302(1)) |
Written: principal signs in both witnesses' presence; if physically unable, one witness signs the principal's signature in the principal's presence and at the principal's direction (§ 765.302(1)). Oral: a witnessed oral statement is a living will (§ 765.101(13)); chapter 765 states no special electronic or remote-witness route |
Written living will: two subscribing witnesses; at least one may be neither the principal's spouse nor blood relative (§ 765.302(1)). No notary alternative or additional facility witness. An oral statement must be witnessed, but chapter 765 does not specify the witness count or disqualification rule for that route |
Principal must lack a reasonable medical probability of recovering capacity and have a terminal condition, end-stage condition, or persistent vegetative state; oral/written limits must be satisfied (§ 765.304). Primary physician plus at least one consulting physician separately examine, document, and sign findings before withholding or withdrawal (§ 765.306) |
May direct providing, withholding, or withdrawing life-prolonging procedures. Those procedures include artificially provided sustenance and hydration; comfort care and pain-alleviating medication/procedures are excluded (§§ 765.101(12), 765.302). The optional form directs natural dying with comfort and pain relief (§ 765.303) |
No separate pregnancy bar is stated for the principal's own living-will instruction. A surrogate or proxy may not consent to withholding or withdrawal from a pregnant patient 'prior to viability' unless the principal expressly delegated that authority in writing or a court approved it (§ 765.113(2)); the section's cited definition cross-reference is stale. Chapter 765 does not authorize mercy killing or euthanasia (§ 765.309) |
A competent principal may amend or revoke at any time by signed dated writing, directed physical cancellation/destruction, oral expression, or a later materially different directive. Effective when communicated to the surrogate, provider, or facility (§ 765.104). Chapter 765 creates no directive registry or special chart-notation rule for revocation |
An executed living will is rebuttable clear-and-convincing evidence (§ 765.302). A moral/ethical refusal triggers a 7-day transfer-or-comply rule (§ 765.1105). A directive validly executed under another state's or Florida's law is validly executed here (§ 765.112) |
| Georgia verified 2026-07-30 | Georgia Advance Directive for Health Care Act, O.C.G.A. §§ 31-32-1 to -14. Part Two of the combined advance directive states treatment preferences and may operate without Part One's agent appointment; § 31-32-4 form is optional, and another complying form may be used (§ 31-32-5(b)) |
Person of sound mind who is emancipated or age 18+ (§ 31-32-5(a)); another person may sign in the declarant's presence and at the declarant's express direction |
Written and signed by declarant or directed signer (§ 31-32-5(a)). Chapter 32 creates no oral, nonverbal, electronic-signature, or remote-execution route. The optional statutory form requires signing and dating or acknowledgment of both in witness presence; § 31-32-5's alternative-form rule does not separately require a date |
Two witnesses of sound mind and age 18+, attesting/subscribing in declarant's presence; they need not be together or present when declarant signs. Neither may be selected agent, a knowing inheritor/financial beneficiary, or directly involved in care; only one may be facility staff. No notary (§§ 31-32-4, -5(c)) |
Terminal condition or permanent unconsciousness, certified in writing by attending physician plus a second physician after each personally examines declarant (§§ 31-32-2, -9). Statutory Part Two operates only when declarant cannot communicate preferences after reasonable efforts; if an agent is named, the agent decides matters covered by Part Two guided by its preferences (§ 31-32-4) |
May direct withholding/withdrawal of life-sustaining procedures and separately of tube/medical nourishment or hydration (§§ 31-32-2, -5). Optional form offers provide/withhold choices, separate nutrition, fluids, ventilation, and CPR choices. Life-sustaining procedures exclude pain-alleviating medication/procedures; comfort and pain relief remain preserved (§§ 31-32-2(9), -8(2)) |
Before withholding/withdrawal, attending physician must determine declarant is not pregnant or, if pregnant, fetus is not viable and directive specifically says those directions are to be carried out (§ 31-32-9(a)(1)). Chapter does not authorize mercy killing, an affirmative/deliberate life-ending act or omission, or abortion (§ 31-32-14(b)) |
Revocable anytime regardless of mental state/competency by later inconsistent directive, directed destruction, signed dated writing, or clear oral/other expression before adult witness who confirms in signed dated writing within 30 days (§ 31-32-6). In a facility, written/oral revocation is effective on communication to attending physician, who charts specified details. No Chapter 32 registry |
Provider given a copy adds it and known changes/termination to record (§ 31-32-8). Refusing attending physician promptly notifies agent or otherwise next of kin/guardian and, at that person's election, attempts transfer or permits another physician (§ 31-32-9(d)). Foreign document valid where executed is treated as complying (§ 31-32-5(b)) |
| Hawaii verified 2026-07-31 | Hawaii Uniform Health-Care Decisions Act (Modified), Haw. Rev. Stat. ch. 327E. An 'advance health-care directive' may be an oral/written 'individual instruction' or a health-care POA; § 327E-16 offers a modifiable optional combined form. Treatment instruction remains distinct from agent appointment and clinician orders |
Adult or emancipated minor may give an individual instruction (§ 327E-3(a)); emancipated minor means under 18 and totally self-supporting (§ 327E-2). Individual is presumed capable of making/revoking a directive (§ 327E-11); capacity means understanding significant benefits, risks, alternatives, and making/communicating a decision (§ 327E-2) |
Individual instruction may be oral or written and may be conditional (§ 327E-3(a)); no signature, date, witness, notary, or electronic-specific formality is stated for instruction alone. Written health-care POA/combined form separately requires principal's signature/date and witness-or-notary execution (§ 327E-3(b)). Copy of written directive/revocation equals original (§ 327E-12) |
Instruction-only route: none (§ 327E-3(a)). If a combined directive also appoints an agent: 2 witnesses OR Hawaii notary; no witness may be provider, provider/facility employee, or agent, and at least 1 must be unrelated and not an heir (§ 327E-3(b)–(d)) |
Maker may state any condition; absent another method in a written directive, primary physician decides capacity and whether a condition affecting the instruction exists (§ 327E-3(a), (f)). Optional form's no-prolongation choice covers: incurable/irreversible condition causing death relatively soon; unconsciousness with no expected recovery; OR likely burdens/risks outweigh expected benefits (§ 327E-16). No universal two-physician trigger |
May direct any health care, including DNR and providing/withholding/withdrawing artificial nutrition/hydration consistent with generally accepted standards (§ 327E-2). Optional form offers prolong/not prolong; nutrition/hydration follows that choice unless separately required regardless; pain/discomfort treatment may be directed even if it hastens death (§ 327E-16) |
Chapter 327E and its optional form state no pregnancy, viability, or live-birth restriction. Chapter does not authorize mercy killing, assisted suicide, euthanasia, or care prohibited by other Hawaii law, and does not require care contrary to generally accepted standards (§ 327E-13(c)–(d)) |
Revoke all/part of an individual instruction anytime in any manner communicating intent; informed provider, agent, guardian, or surrogate promptly tells supervising provider and treating institution; later conflicting directive revokes earlier only to conflict (§ 327E-4(b)–(c), (e)). No registry filing or registration validity step in chapter 327E |
Provider records known directive/revocation/condition findings and complies with instruction/reasonable interpretation (§ 327E-7). Conscience or medically ineffective/standard-of-care refusal requires notice, continuing care, and reasonable transfer effort. Good-faith compliance/reliance is immune (§ 327E-9). Directive valid if compliant with Hawaii law or execution-state law (§ 327E-3(j)) |
| Idaho verified 2026-07-31 | Idaho Medical Consent and Natural Death Act, Idaho Code §§ 39-4501–39-4515. The treatment instruction is an 'advance care planning document' (ACPD), which may also nominate an agent; the Department of Health and Welfare may publish an optional, nonmandatory form (§§ 39-4502(1), 39-4510). Separate from a clinician POST order |
Any competent person age 18+ (§ 39-4510(1)). Competence means comprehending the need for, nature of, and significant risks ordinarily inherent in the contemplated health-care services (§§ 39-4503, 39-4509(4)) |
A valid ACPD is a document containing the person's name, birth date, telephone number, mailing address, signature of the person or authorized agent, and signing date (§ 39-4510(1)). Other blanks are intentional, not invalidating. Chapter 45 provides no electronic-specific execution rule |
No witness or notary is required. Witness names/contact information and notarization are expressly optional (§ 39-4510(2)(j)–(k)); the ACPD statute therefore states no mandatory-witness disqualification list |
Effective from execution until revoked or replaced; no statutory terminal-condition, vegetative-state, incapacity, or clinician-certification trigger (§ 39-4512). The maker may write treatment objectives and end-of-life conditions, and Idaho recognizes their wishes when they can no longer communicate (§§ 39-4509, 39-4510(2)) |
May include resuscitation, end-of-life, and treatment-objective instructions (§ 39-4510(2)). May direct provision or denial of treatment, assisted feeding, and artificial nutrition/hydration; directed feeding/nutrition/hydration may not be withdrawn, comfort care remains required, and CPR is presumed unless the ACPD says otherwise (§§ 39-4502(8), 39-4514(3)–(5)) |
The ACPD may include pregnancy instructions; the adult-ACPD provisions state no categorical pregnancy, viability, or live-birth override (§ 39-4510(2)(e)). The Act does not authorize euthanasia, mercy killing, assisted suicide, or an affirmative/deliberate life-ending act beyond natural dying, and it does not require nonbeneficial treatment (§ 39-4514(2), (6)) |
Revoke anytime by directed destruction, signed writing, oral expression, or any other clear act; maker must notify providers, who may rely until actual knowledge (§ 39-4511A). Suspend by signed writing, oral expression, or another clear act, with resumption on stated termination terms (§ 39-4511B). Optional DHW registry; nonregistration does not affect validity (§§ 39-4514(10), 39-4515) |
Good-faith reliance on a facially valid ACPD is immune; an ethical/professional objector may withdraw after a good-faith effort to help obtain a willing provider, subject to treatment-direction limits (§§ 39-4513, 39-4514(3)). Registry lookup is optional. No express foreign-execution safe harbor; the Act broadly protects any document authentically expressing a competent person's wishes (§§ 39-4502(1)(c), 39-4509(3), 39-4514(7)) |
| Illinois verified 2026-07-30 | 755 ILCS 35, Illinois Living Will Act. Standalone written declaration directing that death-delaying procedures not prolong life in a terminal condition; § 3(e) supplies an optional form. It is distinct from a health-care agency and from POLST |
Individual of sound mind who has reached majority or is emancipated under the Emancipation of Minors Act (§ 3(a)); another person may sign at the declarant's direction (§ 3(b)) |
Written declaration in hard-copy or electronic format; declarant or directed signer signs (§§ 2(b), 3(b)). The Act does not recognize an oral execution route or require a date outside its optional form. Section 9(i) permits technology-neutral electronic creation and signing that meets its authentication standard |
Two witnesses, each age 18+ (§ 3(b)); no statutory notary route. The mandatory rule states no relationship or financial disqualification. The optional § 3(e) form instead has each witness attest to presence/acknowledgment and that the witness is not an estate taker or directly responsible for care |
Valid and unrevoked declaration; patient unable to direct use of life-sustaining/death-delaying procedures; and qualified-patient status (§ 9.5), subject to agent priority. Qualified status requires attending physician's personal exam and written diagnosis/verification of an incurable, irreversible terminal condition with imminent death and treatment only prolonging dying (§ 2(g)-(h)) |
May direct withholding or withdrawal of death-delaying procedures, including ventilation, dialysis, IV feeding/medication, transfusions, and tube feeding. Comfort care and pain relief remain required. Nutrition/hydration may not be withheld if death would result solely from dehydration/starvation rather than the terminal condition (§ 2(d)) |
A qualified patient's declaration has no force while the attending physician believes continued death-delaying procedures could permit fetal development to live birth (§ 3(c)). The Act does not authorize mercy killing or an affirmative/deliberate act or omission to end life beyond natural dying (§ 9(f)) |
Declarant may revoke anytime regardless of condition by intentional destruction/defacement, signed dated hard-copy or electronic writing, witnessed expression, or qualifying electronic deletion (§ 5). Effective when declarant or revocation witness communicates it to attending physician, who records time/date/place. No living-will registry; 15 ILCS 305/34's registry, due by January 1, 2027, is POLST-only |
Current wishes always supersede the declaration (§ 7). Provider may rely on and, subject to the Act, must comply with an apparent/immediately available operative declaration (§ 9(k)). A refusing physician uses §§ 3(d) and 6 notice/transfer process. Foreign declaration valid if compliant where made or Illinois law, then applied under Illinois Act (§ 9(h)) |
| Indiana verified 2026-07-30 | Ind. Code ch. 16-36-7 modern health care advance directive may state specific decisions/preferences and may include a ch. 16-36-4 living-will declaration. Traditional ch. 16-36-4 living will must substantially follow § 16-36-4-10 and is only presumptive evidence given great weight (§§ 16-36-4-8 to -10) |
Chapter 7 declarant is a competent adult (§ 16-36-7-4). Traditional living will: person age 18+ and of sound mind, acting voluntarily (§§ 16-36-4-8, -10) |
Chapter 7: written, personally signed or signed by another adult at specific direction/presence; electronic record/signature permitted, no date required (§§ 16-36-7-22, -26, -28). Traditional living will: voluntary writing, signed personally or by directed signer, dated, and substantially statutory form (§§ 16-36-4-8 to -10) |
Chapter 7: two adult witnesses OR notary; one witness cannot be spouse/relative; directed signer cannot witness/notarize/serve as representative; remote audiovisual and qualifying telephone witnesses allowed (§§ 16-36-7-19, -28). Traditional living will: two adult competent witnesses OR notary; witness cannot be directed signer, parent/spouse/child, heir, or directly responsible for care (§ 16-36-4-8) |
Chapter 7 directive is immediate unless it delays an instruction to a date/event/incapacity; competent adult's current decision controls (§§ 16-36-7-29, -34 to -35). Traditional living will uses attending physician's written terminal-condition certification: incurable/no recovery and death within short time without life-prolonging procedures (§§ 16-36-4-5, -10, -13) |
Chapter 7 may state specific decisions and preferences about providing, continuing, ending, or refusing life-prolonging procedures, palliative/comfort care, and any health care (§§ 16-36-7-10, -28). Traditional form directs withholding/withdrawal, natural death, comfort/pain care, and a separate receive/refuse/defer choice for artificial nutrition/hydration (§ 16-36-4-10) |
Traditional ch. 16-36-4 living-will declaration has no effect during a physician-diagnosed pregnancy (§ 16-36-4-8(d)); that text does not say every broader ch. 16-36-7 instruction is suspended. Neither chapter authorizes euthanasia; withholding/withdrawal under the statutes is not suicide (§§ 16-36-4-17, -19; 16-36-7-1) |
Chapter 7: new compliant directive, compliant written revocation, or oral present-intent statement in provider's direct physical presence; provider may rely until actual knowledge, and known change/termination is charted (§§ 16-36-7-32, -37). Traditional living will: signed dated writing, directed destruction, or oral expression; effective when communicated to attending physician (§ 16-36-4-12). No state registry |
Traditional living will does not compel use/withholding/withdrawal; it is presumptive evidence given great weight. Refusing physician transfers to willing physician, but may refuse if reasonable search finds none (§§ 16-36-4-8, -13). Chapter 7 protects good-faith reliance and requires record filing; out-of-state writing valid if signer not incapacitated and it meets Indiana law or law of residence/signing place (§§ 16-36-7-28(j), -31, -40) |
| Iowa verified 2026-07-31 | Iowa Life-sustaining Procedures Act, Iowa Code ch. 144A. A standalone 'declaration' governs withholding/withdrawal of life-sustaining procedures; it is separate from ch. 144B's durable health-care POA and from out-of-hospital DNR clinician orders. Optional declaration form at § 144A.3(5) |
A competent adult, age 18+, may execute at any time (§§ 144A.2(1), 144A.3(1)). No post-diagnosis oral declaration route appears. Pre-1992 declarations have a saving rule (§ 144A.12) |
Written document, dated and signed by declarant or by another person acting at declarant's direction (§ 144A.3(2)). Witness path requires signing in declarant's and both witnesses' presence; notary path uses acknowledgment. No electronic-specific execution route appears |
Choose 2+ witnesses OR Iowa notarial acknowledgment (§ 144A.3(2)). Witnesses are together with declarant; 1+ must not be related within third degree. Disqualified: health-care provider attending declarant that day, that provider's employee, and anyone under 18. No heir, agent, or facility-specific witness bar |
Operative only if condition is terminal and declarant cannot make treatment decisions (§ 144A.3(1)). Terminal means incurable/irreversible and, without life-sustaining procedures, death within relatively short time OR permanent unconsciousness with no recovery (§ 144A.2(18)). Attending provider finds condition; second physician, ARNP, or physician assistant confirms; determination recorded (§ 144A.5 as amended by 2026 H.F. 2305) |
Declaration directs withholding/withdrawal of 'life-sustaining procedures': mechanical/artificial support that only prolongs dying in terminal condition. Term excludes nutrition/hydration except parenteral or intubated delivery, and excludes medication/procedures necessary for comfort or pain relief (§ 144A.2(12)). Optional form requests withdrawal of procedures merely prolonging dying and not necessary for comfort/freedom from pain (§ 144A.3(5)) |
Known pregnancy: declaration not in effect while fetus could develop to live birth with continued life-sustaining procedures; subsection preserves existing rights/responsibilities concerning withholding/withdrawal (§ 144A.6(2), current wording under H.F. 2305). Chapter does not authorize mercy killing/euthanasia or deliberate life-ending act/omission beyond natural dying (§ 144A.11(6)) |
Revoke anytime and in any manner communicating intent, regardless of mental/physical condition; effective as to attending provider when declarant or recipient of revocation communicates it, and provider records it (§ 144A.4 as amended by H.F. 2305). Declarant supplies declaration to provider (§ 144A.3(3)). No advance-directive registry appears in current chapter |
Attending provider unwilling to make/comply with condition finding or declaration takes all reasonable transfer steps; provider-policy refusal similarly requires facility transfer (§ 144A.8, current wording under H.F. 2305). Good-faith/statutory compliance immunity and reasonable-medical-standard protection (§ 144A.9). Foreign declaration valid if compliant there and consistent with Iowa; VA-compliant veteran directive also valid (§ 144A.3(4)) |
| Kansas verified 2026-07-31 | Kansas Natural Death Act, K.S.A. 65-28,101–109. Standalone witnessed or notarized written 'declaration' directing physician to withhold/withdraw life-sustaining procedures in terminal condition; § 65-28,103(c) gives substantially required form and allows added directions. Separate from health-care POA (K.S.A. 58-625–632) and clinician DNR/POLST orders |
Any adult may execute (§ 65-28,103(a)); Kansas general majority is 18, though the Act does not separately define adult (§ 38-101). Declaration is voluntarily executed; statutory form recites sound mind and emotional/mental competence (§§ 65-28,102(b), -103(c)) |
Must be written, dated, and signed by declarant or another in declarant's presence and at express direction (§ 65-28,103(a)). Form must be substantially statutory form but may add severable specific directions (§ 65-28,103(c)). No general oral declaration or electronic-specific route |
Either 2+ witnesses age 18+ OR notarial acknowledgment (§ 65-28,103(a)). Every witness must not be directed signer, blood/marriage relative, intestate/will beneficiary, or directly financially responsible for declarant's medical care. No provider/facility witness bar stated |
Terminal condition only: 2 physicians who personally examined patient, including attending physician, diagnose and certify it in writing; procedure would only prolong dying and attending physician judges death will occur whether used or not (§§ 65-28,102(c), (e), -105). No separate permanent-unconsciousness route or incapacity certification; capable qualified patient's present desires always supersede declaration (§ 65-28,106) |
Declaration directs withholding/withdrawal of 'life-sustaining procedures' that only prolong dying (§§ 65-28,102(c), -103(c)). Medication and medical procedures needed for comfort or pain relief are excluded from that definition and retained by form. Act does not separately classify artificial nutrition/hydration or provide a separate feeding election |
Categorical: declaration of qualified patient diagnosed pregnant by attending physician has no effect during entire pregnancy (§ 65-28,103(a)). Act does not authorize mercy killing or an affirmative/deliberate act or omission to end life other than natural dying under Act (§ 65-28,109) |
Revoke by intentional destruction/defacement; signed-and-dated written revocation by declarant or directed person; or verbal intent before adult witness who signs/dates confirmation (§ 65-28,104). Verbal route effective only when attending physician receives writing; physician records time/date/place. No state registry in §§ 65-28,101–109 |
Declarant must notify attending physician, who files declaration/copy and promptly arranges 2-physician written certification (§§ 65-28,103(b), -105). Refusing attending physician must transfer patient; good-faith reasonable-standard immunity and penalties apply (§§ 65-28,106–107). Act states no express foreign-declaration recognition rule |
| Kentucky verified 2026-07-31 | Kentucky Living Will Directive Act, KRS §§ 311.621–311.643: written 'living will directive.' It must substantially follow § 311.625's form, but may add medically accepted directions not otherwise prohibited (§§ 311.625(1), 311.637(6)) |
An adult—age 18+ and of sound mind—with decisional capacity, meaning ability to make and communicate a health-care decision (§§ 311.621(1), (5); 311.623(1)) |
Written, dated, signed by the adult or at the adult's direction (§ 311.625(2)). No general oral creation route. The Act supplies no express electronic-execution procedure |
Either 2+ adult witnesses, all signing in the adult's and each other's presence, OR acknowledgment before a notary/oath officer (§ 311.625(2)). Neither witness nor officer may be a blood relative, intestate beneficiary, attending physician, person directly responsible for care costs, or facility employee except an employee acting as notary |
The statutory form addresses loss of decisional capacity, terminal condition, or permanent unconsciousness (§ 311.625(1)). Terminal condition and permanent unconsciousness each use attending physician + 1 other physician findings (§ 311.621(13), (17)); a capable adult retains ordinary decision rights (§ 311.637(5)) |
May separately direct withholding/withdrawal of life-prolonging treatment and artificial food/fluids, or direct their continuation (§§ 311.623(1), 311.625(1)). Pain-relief medication/procedures are outside 'life-prolonging treatment' (§ 311.621(11)). A surrogate's nutrition/hydration authority has narrower § 311.629(3) limits |
The printed form says the directive has no force during a known pregnancy (§ 311.625(1)); separately, § 311.629(4) requires life-sustaining treatment and artificial nutrition/hydration unless 2 examining physicians certify inability to support development/live birth, physical harm, or severe unrelievable pain. Act does not authorize mercy killing/euthanasia (§ 311.639) |
Revoke immediately by signed dated writing, directed destruction in the adult's presence, or—while decisionally capable—oral statement before 2 adults, 1 a provider (§ 311.627). Providers need notice before changing treatment and must record notice time, date, and place. The Act creates no directive registry |
Directive must be honored, subject to statutory refusal (§ 311.623(2)). Refuser immediately informs patient/representatives, cannot impede an authorized transfer, and supplies records/assistance; written moral, religious, or professional objectors are protected if transfer rules are followed (§ 311.633). Good-faith compliance is protected and execution presumed valid (§ 311.635). No automatic foreign-form rule; other written directives consistent with accepted medical practice may be followed (§ 311.637(6)) |
| Louisiana verified 2026-07-31 | La. R.S. 40:1151.1–1151.9: a 'declaration' authorizing withholding/withdrawal of life-sustaining procedures. It may be written, oral, or nonverbal under separate routes (§§ 40:1151.1–.2). The § 40:1151.2(C) form is illustrative, not mandatory, and may include other specific directions or a narrow treatment decision-maker designation. |
Any adult person; this Subpart defines a minor as under 18 (§§ 40:1151.1, .2). Written declaration may be made at any time. Oral/nonverbal route is available only after diagnosis of a terminal and irreversible condition (§ 40:1151.2). The declarant personally signs the written route. |
Written route: declarant personally signs in 2 witnesses' presence; no mandatory date in the operative rule, though the optional form is dated (§ 40:1151.2(A),(C)). Oral/nonverbal route: any nonwritten communication after diagnosis, in 2 witnesses' presence (§ 40:1151.2(A)(3)). Physician records why a written declaration could not be made (§ 40:1151.2(B)(4)). |
2 witnesses for written and oral/nonverbal routes (§ 40:1151.2). Each is a competent adult, unrelated by blood or marriage, and not entitled to any part of the declarant's estate (§ 40:1151.1(15)). No notary alternative or additional facility-witness rule is stated. |
A 'qualified patient' has a terminal and irreversible condition diagnosed and certified in writing by 2 physicians who personally examined the patient, 1 the attending physician (§ 40:1151.1(11)). Condition means continual profound coma with no reasonable recovery chance, or injury/disease/illness expected to produce death where life-sustaining procedures only postpone death (§ 40:1151.1(14)). No separate incapacity finding is required for the adult's own declaration. |
May authorize withholding/withdrawal of life-sustaining procedures, defined to include invasive nutrition/hydration and CPR but exclude measures necessary for comfort (§ 40:1151.1). Illustrative form separately chooses withdrawal of all procedures including nutrition/hydration or withdrawal except nutrition/hydration, and directs natural dying with comfort medication/procedures (§ 40:1151.2(C)). |
Not blanket suspension. Any ambiguity is interpreted to preserve life, including unborn life, if an obstetrician finds probable postfertilization age 20+ weeks and the pregnant qualified patient's life can reasonably be maintained for continued development/live birth, with the finding communicated to listed family/designees (§ 40:1151.9(E)). Subpart does not authorize assistance to suicide, mercy killing, euthanasia, or another affirmative/deliberate act or omission to end life beyond natural dying (§ 40:1151.9(A)). |
Revoke anytime regardless of mental state/competency by directed destruction, signed dated writing, or oral/nonverbal expression; effective on communication to attending physician, who records notice time/date (§ 40:1151.3(A)). Optional Secretary of State registry accepts originals/multiple originals/certified copies; registered directive needs written revocation notice filed there, with $20 registration and $5 revocation fees (§§ 40:1151.2(D), .3(B)). |
Notified attending physician obtains written two-physician certification; physician refusal requires reasonable transfer effort, and facility policy refusal requires all reasonable transfer steps (§ 40:1151.6). No registry-search duty. Good-faith statutory withholding/withdrawal receives immunity and a compliant declaration is presumed voluntary (§ 40:1151.7). A declaration properly executed under another state's law is deemed validly executed (§ 40:1151.9(D)). |
| Maine verified 2026-07-31 | Maine Uniform Health Care Decisions Act, 18-C M.R.S. §§ 5-801–5-817. An advance directive may be an individual instruction or health-care POA (§ 5-802); § 5-805 offers a modifiable optional combined form whose Part 2 contains treatment instructions. Keep the instruction distinct from the agent appointment and clinician orders |
Adult or emancipated minor with capacity may give instruction; this page covers adults (§ 5-803(1)). Capacity requires basic understanding of diagnosed condition, significant benefits/risks/alternatives and consequences of forgoing treatment, plus ability to make/communicate decision (§ 5-802(3)); capacity is presumed (§ 5-812) |
Instruction may be oral or written and conditional; oral route is valid only if made to provider or person eligible as surrogate (§ 5-803(1)). Instruction-only rule states no signature/date formality. Optional combined form directs signature/date; narrow § 5-803-A remote directed-signature route applies only during infectious-disease isolation in hospital/residential facility |
Instruction-only route states no witness/notary rule (§ 5-803(1)). Optional combined form directs 2 witness signatures (§ 5-805). If document appoints agent, separate POA rule requires principal + 2 witnesses to sign in person, not electronically (§ 5-803(2)); Part 8 states no witness-disqualification list. Section 5-803-A permits real-time audiovisual witnessing only in its facility-isolation setting and does not apply to notarized documents |
Maker may specify any activating condition. Unless written directive says otherwise, primary physician or court determines lack/recovery of capacity or another condition; qualified examiner may determine for mental-health-treatment directive (§ 5-803(4)). Optional form's no-prolongation choice covers near-term-death incurable/irreversible condition, unconsciousness with no expected recovery, OR likely treatment risks/burdens outweighing expected benefits (§ 5-805) |
Health-care decision includes providing/withholding/withdrawing artificial nutrition/hydration and other health care, including life-sustaining treatment (§ 5-802(6)). Optional form chooses no prolongation under 3 tests or maximum prolongation within accepted standards; nutrition/hydration follows that choice unless separately required regardless; pain/discomfort treatment is provided even if it hastens death unless signer states otherwise (§ 5-805) |
Part 8 and optional form state no pregnancy-specific suspension, viability, or live-birth test. Part does not authorize mercy killing, assisted suicide, euthanasia, care prohibited elsewhere, or care contrary to generally accepted standards; compliant withdrawal is not suicide or homicide and does not invalidate insurance/annuity death benefits (§ 5-814) |
Person with capacity may revoke any non-agent part anytime/in any manner communicating intent; informed provider/agent/guardian/surrogate promptly tells supervising provider and treating institution; later conflict revokes earlier directive to extent of conflict (§ 5-804). Provider records known directive/revocation and maintains furnished copy (§ 5-808). Part 8 contains no registry provision |
Provider/institution complies with instruction/reasonable interpretation, subject to Part compliance, conscience, medically ineffective care, and accepted standards; refusal requires prompt notice, continuing care pending transfer/final court order, and reasonable transfer efforts (§ 5-808). Good-faith immunity (§ 5-810); copy equals original (§ 5-813). Directive valid if compliant with Maine Part or execution-state law (§ 5-803(8)) |
| Maryland verified 2026-07-31 | Maryland Health Care Decisions Act, Health-General §§ 5-601–5-618: Part II of the combined 'Maryland Advance Directive' is the treatment-preference 'living will.' The § 5-603 form is optional; Part II may be completed without the agent-appointment Part I. |
Any 'competent individual': age 18+, or with adult medical-consent capacity under § 20-102(a), not determined incapable of an informed decision; the person must be capable of making and communicating an informed decision when making the directive (§§ 5-601(f)–(g), 5-602(a), (d)). |
Written/electronic: dated and signed by or at the adult's express direction (§ 5-602(c)(1)). Recognized unwitnessed video: dated and stored by a recognized electronic-directive service (§ 5-602(c)(3)). Oral: made before the attending physician, physician assistant, or nurse practitioner and one witness, then documented, dated, and signed by both (§ 5-602(d)). |
Written/ordinary electronic route: 2 competent witnesses in the adult's physical or electronic presence; the named agent cannot witness, and at least 1 witness must not knowingly inherit or benefit from the death (§ 5-602(c)). Facility staff and treating clinicians may witness in good faith. No notary required (§ 5-603). Video route has no witnesses if § 5-602(c)(3) is met; oral route uses 1 witness plus the clinician. |
Unless the directive says otherwise, it becomes effective after written incapacity certification (§ 5-602(e)); § 5-606(a) requires the attending physician plus a second physician or nurse practitioner, one examiner within 2 hours, with the second certification excused if the patient is unconscious or cannot communicate. Withholding/withdrawal of life-sustaining procedures under a no-agent directive also requires certified terminal or end-stage condition, or persistent vegetative state (§ 5-606(b)). |
The optional form separately covers terminal condition, persistent vegetative state, and end-stage condition; for each, it offers no life-extending intervention with or without tube nutrition/fluids, or continued intervention (§ 5-603). It separately states pain-relief and exact-versus-flexible preferences. Life-sustaining procedure includes artificial nutrition/hydration and CPR (§ 5-601(p)); providers still make reasonable efforts to offer food and water by mouth (§ 5-611(d)). |
No automatic pregnancy suspension appears in the Act. The optional form instead provides a blank for how the adult's life-sustaining-procedure decision 'shall be modified' during pregnancy and is valid if that blank is left empty (§ 5-603). The Act does not authorize euthanasia or an affirmative or deliberate act or omission to end life beyond permitting natural dying (§ 5-611(c)). |
Revoke by signed dated written/electronic document, physical cancellation or destruction, oral statement to a practitioner, or later directive; the adult may knowingly waive revocation during certified incapacity (§ 5-604(a)). Practitioner plus witness document an oral revocation, and the adult should notify copy-holders (§ 5-604(b)–(c)). Recognized services may store directives and connect to the State exchange, but use is optional (§§ 5-615, 19-144). |
A provider who regards a withdrawal instruction as inconsistent with generally accepted care standards must seek advisory-committee review or court relief (§ 5-612); ethically inappropriate or medically ineffective treatment need not be rendered, subject to § 5-611's certification and notice rules. Good-faith authorized action is protected and a compliant directive is presumed voluntary (§ 5-609). A directive valid under Maryland or the execution state's law is recognized, subject to Maryland limits (§ 5-617). |
| Massachusetts verified 2026-07-30 | No binding standalone living-will statute. The Massachusetts Trial Court Law Libraries says a personal directive or living will is not legally binding but gives providers evidence of wishes. Mass. Gen. Laws ch. 201D instead governs an agent-based health care proxy |
No statutory maker-eligibility rule for a nonbinding personal directive. The separate binding proxy route is available to every competent adult (§ 2) |
No statutory living-will writing, signature, date, oral, directed-signature, or electronic-execution formula. A ch. 201D proxy is written and signed by the adult or at the adult's direction in two witnesses' presence (§ 2) |
No statutory witness or notary rule makes a personal directive binding. The separate proxy requires two adult witnesses, bars the named agent from witnessing, and provides no notary substitute (§ 2) |
No statutory medical-condition or incapacity trigger makes a standalone living will controlling. Proxy authority begins after the attending physician makes and records a written incapacity determination (§ 6) |
A personal directive may give evidence of treatment wishes but does not itself bind doctors. A proxy agent may make any health-care decision the adult could make, including life-sustaining-treatment decisions, subject to express proxy limits (§ 5) |
No standalone living-will statute supplies a document-specific pregnancy, nutrition/hydration, assisted-suicide, or mercy-killing rule. Chapter 201D regulates decisions made through a health care proxy |
No statutory revocation, provider-notice, charting, or registry procedure applies to a personal directive. Section 7's oral, written, intent-act, later-proxy, and spouse-divorce rules revoke a health care proxy, not a standalone living will |
Doctors are not legally bound by a personal directive or living will, though it provides evidence of wishes. Providers must comply with a health care agent's decisions under a valid proxy (§ 5); ch. 201D states no comparable living-will compliance or interstate rule |
| Michigan verified 2026-07-30 | Michigan EPIC Part 5, MCL §§ 700.5506-.5515. Statutory architecture is a patient-advocate designation, not a standalone living-will act; designation may state patient's treatment desires and instructions for advocate (§ 700.5507(1)-(2)). No statutory short form |
Individual age 18+ and of sound mind; named advocate also must be an individual age 18+ (§ 700.5506(1)) |
Designation must be written, signed, dated, voluntary, and added to medical record before implementation (§ 700.5506(3)); no directed-signature route. Section 700.1202's audiovisual/e-signing procedure applies only to documents executed before July 1, 2021. Advocate follows desires given orally or written in designation (§ 700.5509(1)(b)), but oral desires do not replace written designation |
Executed in presence of and signed by two witnesses; no notary alternative. Witness cannot be spouse, parent, child, grandchild, sibling, presumptive heir, known devisee, physician, advocate, or listed insurer/treating-facility/aged-home/mental-health employee, and signs only if patient appears sound and free of duress/fraud/undue influence (§ 700.5506(4)) |
No terminal, unconsciousness, dementia, or other diagnosis is required by EPIC; patient may state chosen conditions. Advocate authority begins only after attending physician plus another physician or licensed psychologist examine patient, determine inability to participate, write/chart finding, and review at least annually (§ 700.5508). Authority suspends if ability returns (§ 700.5509(2)) |
Designation may state desires and instructions about medical treatment broadly (§ 700.5507). EPIC supplies no separate nutrition/hydration or comfort-care checkbox. Advocate may allow death only with clear-and-convincing authorization and acknowledgment of consequence; may choose hospice. Any known current desire for specified life-extending care binds advocate (§§ 700.5509, .5511) |
Designation cannot be used to withhold/withdraw treatment from pregnant patient if that would result in her death (§§ 700.5507(5)(3), 700.5509(1)(d)); this limits advocate decision, not execution validity. SB 33 would replace this current rule |
Patient may revoke anytime, even unable to participate, in any communicative manner; nonwritten revocation witness describes/signs circumstances. Provider with notice charts revocation and notifies advocate; later inconsistent designation also revokes (§ 700.5510). No state advance-directive registry appears in current EPIC Part 5 |
Provider is bound by sound medical practice and compliant advocate's instructions (§ 700.5511(3)); statute gives court dispute/removal route but no express conscience-transfer procedure. Current desire for life-extending care overrides prior desire (§ 700.5511(1)). EPIC Part 5 states no valid-where-executed safe harbor |
| Minnesota verified 2026-07-31 | Minn. Stat. ch. 145C, Health Care Directives Act: one written 'health care directive' may contain health care instructions, a health care power of attorney, or both (§§ 145C.01, 145C.03). § 145C.16 is a nonmandatory suggested form. § 145C.18 separately creates a narrow written nonopioid directive. |
A 'principal': individual age 18+ with capacity to execute (§§ 145C.01 subd. 8, 145C.02–.03). Decision-making capacity means understanding significant benefits, risks, and alternatives and making/communicating a decision (§ 145C.01 subd. 1b). Another person authorized by the adult may sign (§ 145C.03 subd. 1(4)). |
General directive: writing, date, adult's name, and adult's or authorized signer's signature, verified by notary OR witnesses (§ 145C.03). The suggested form permits signature acknowledgment before each verifier. Chapter 145C states no general electronic-execution route. Separate § 145C.18 nonopioid directive is a written instrument executed by a patient with capacity; no witness/notary formality is stated there. |
Notary OR 2 witnesses, not both (§§ 145C.03, 145C.16). Suggested form makes each witness age 18+. If an agent is appointed, that agent/alternate cannot witness or notarize. At least 1 witness must not be a direct-care provider or that provider's employee; the other may be. A direct-care provider employee may notarize. No inheritance or relationship bar. |
No terminal-condition diagnosis is required. By default the directive is effective for a decision when the attending physician, APRN, or physician assistant determines the adult lacks capacity for that decision; effectiveness ends on recovery (§ 145C.06). The adult may state other conditions, and the directive may contain values, preferences, guidelines, or directions about any covered health care (§§ 145C.01, 145C.05). |
May address any physical or mental health care, including consent/refusal/withdrawal and tube/parenteral nutrition or hydration (§ 145C.01). Suggested form covers recovery, dying, permanent unconsciousness, complete dependency, named treatments, and pain relief (§ 145C.16). A separate nonopioid directive bars opioid administration/offers, subject to emergency-record-access and substance-use-disorder-treatment exceptions (§ 145C.18, current through 2026 ch. 127). |
If the adult lacks capacity and there is a real possibility life-sustaining care could allow fetal survival to live birth, provider presumes the adult wanted care sustaining both lives (§ 145C.10(g)). Pregnancy-specific directive terms negate that presumption; absent terms, clear and convincing evidence of contrary competent wishes also negates it. Chapter 145C excludes assisted suicide and does not authorize mercy killing/euthanasia (§§ 145C.01, 145C.14). |
With capacity, revoke all/part anytime by directed destruction, signed dated writing, verbal statement before 2 witnesses (not necessarily together), or later inconsistent directive (§ 145C.09). A patient who personally made a nonopioid directive may revoke anytime in any communicable manner (§ 145C.18). Chapter 145C creates no directive registry; copies equal originals, and the suggested form recommends giving copies for medical records (§§ 145C.10(f), 145C.16). |
Instructions may direct providers and must be followed so long as they address the adult's needs (§§ 145C.02, 145C.16); good-faith, standard-of-care action is protected (§ 145C.11). Directed life-sustaining care must be provided or arranged unless the directive says otherwise (§ 145C.15). Providers must follow a nonopioid directive subject to statutory exceptions (§ 145C.18). A directive valid where executed or under Minnesota formalities is recognized (§ 145C.04). |
| Mississippi verified 2026-07-31 | Mississippi Uniform Health-Care Decisions Act, Miss. Code §§ 41-41-201–229. 'Advance health-care directive' means an individual instruction or health-care POA (§ 41-41-203). Section 41-41-209 publishes an optional combined form; treatment instructions may be used alone, and a different form is allowed. Keep POST/POLST clinician orders under §§ 41-41-301–303 separate |
Adult age 18+ may give an individual instruction; Act also includes emancipated minors, outside this page's adult scope (§§ 41-41-203, -205(1)). Capacity to decide, give, or revoke a directive is presumed (§ 41-41-223) |
Individual instruction may be oral or written and conditioned on a specified event; § 41-41-205(1) states no signature/date/directed-signer requirement for instruction alone. Optional § 41-41-209 form tells user to sign and date. If form includes health-care POA, that power must be written, dated, and signed by principal (§ 41-41-205(2)); no electronic-specific route appears |
Instruction alone: no witness/notary formality stated (§ 41-41-205(1)). Health-care-POA portion: either 2 witnesses who observe signing/acknowledgment OR acknowledgment before Mississippi notary. Witnesses cannot be agent, provider, or provider/facility employee; at least 1 must be unrelated and non-heir, with statutory declarations (§ 41-41-205(2)–(4)) |
Instruction may name its own activating condition. Unless written directive says otherwise, primary physician determines incapacity/recovery or another condition affecting instruction (§ 41-41-205(6)); capable patient retains decision right (§ 41-41-223). Optional form's no-prolongation choice covers incurable/irreversible condition causing death relatively soon, unconsciousness with no expected recovery to reasonable medical certainty, or treatment risks/burdens outweighing expected benefits (§ 41-41-209) |
Health-care decision includes directions to provide, withhold, or withdraw artificial nutrition/hydration and all other health care (§ 41-41-203). Optional form selects no prolongation or prolongation within accepted standards; ANH follows that choice unless signer marks always provide; pain/discomfort treatment is provided at all times even if it hastens death unless signer states otherwise (§ 41-41-209) |
UHCDA §§ 41-41-201–229 state no pregnancy-specific suspension, viability, or live-birth test. Act does not authorize mercy killing, assisted suicide, euthanasia, or care prohibited by other statutes; does not require care contrary to generally accepted standards; and does not apply to the named abortion statutes (§ 41-41-227) |
Any directive part other than agent designation may be revoked anytime/in any manner communicating intent; later conflict revokes earlier directive to extent of conflict (§ 41-41-207). Informed provider/agent/guardian/surrogate must promptly tell supervising provider and treating institution; supervising provider records revocation (§§ 41-41-207, -215). No state directive registry appears in the Act |
Provider/institution must comply or may decline for conscience, timely communicated institutional policy, medically ineffective care, or accepted standards; refusal requires prompt notice, continuing care, and reasonable transfer help (§ 41-41-215). Good-faith immunity (§ 41-41-219). Directive valid regardless when/where made only if it complies with Mississippi Act; copy equals original (§§ 41-41-205(10), -225) |
| Missouri verified 2026-07-30 | Mo. Rev. Stat. ch. 459, §§ 459.010–459.055: written 'declaration'; § 459.015 sample is optional and may include other specific directions. § 459.016 directs DHSS to publish an advance-directive form. Separate from a health-care power of attorney. |
A 'competent person': age 18+, of sound mind, able to receive and evaluate information and communicate a decision (§ 459.010(2)). Another person may sign only in the declarant's presence and at the declarant's expressed direction (§ 459.015.1(2)). |
Must be written, signed by the declarant or directed signer, and dated (§ 459.015.1). No oral declaration route. Chapter 459 states no electronic-execution method; optional electronic registry submission is separate from execution validity (§ 459.250). |
If not wholly in the declarant's handwriting: 2 witnesses age 18+, present for signing; neither may be the directed signer (§ 459.015.1(4)). A wholly handwritten declaration needs no witnesses under that paragraph. No notary alternative or other witness disqualification is stated. |
Operative only when the condition is terminal AND the declarant cannot make treatment decisions; both findings go in the medical record (§ 459.025). 'Terminal' means incurable/irreversible and, in the attending physician's opinion, death will occur within a short time regardless of procedures (§ 459.010(6)). Current capable directions always supersede. |
May direct withholding/withdrawal of 'death-prolonging procedures.' That defined term excludes comfort care, pain-relief medication/procedures, and every procedure providing nutrition or hydration (§§ 459.010(3), 459.015). Other specific directions may be added, but those exclusions limit Chapter 459's defined withdrawal mechanism. |
A withdrawal/withholding declaration has no effect during the declarant's pregnancy, with no viability or prognosis exception stated (§ 459.025). Chapter 459 does not authorize mercy killing, euthanasia, or an affirmative/deliberate act or omission to shorten life (§ 459.055(5)). |
Revoke anytime and in any communicable manner, regardless of mental or physical condition; provider records it, and others are liable for failing to act only with actual knowledge or a charted revocation (§ 459.020). § 459.250 authorizes optional electronic registry filing of directives and revocations; nonregistration does not affect validity. |
Provider may not act contrary without a serious best-interest reason recorded in the chart (§ 459.025). An unwilling physician/facility takes reasonable transfer steps (§ 459.030); good-faith, usual-standard compliance is immune (§ 459.040). Chapter 459 states no separate out-of-state recognition rule. |
| Montana verified 2026-07-31 | Montana Rights of the Terminally Ill Act, MCA tit. 50, ch. 9. Standalone 'declaration' governs withholding/withdrawal of life-sustaining treatment and may also designate another adult for those decisions (§§ 50-9-102, -103). Optional statutory forms; separate from general health-care POA and EMS living-will protocols |
Individual age 18+ and of sound mind may execute anytime (§ 50-9-103(1)). A designee for withholding/withdrawal decisions must also be age 18+ and of sound mind. 'Qualified patient' is age 18+, has compliant declaration, and is determined terminal (§ 50-9-102(13)) |
Written document signed by declarant or another at declarant's direction (§§ 50-9-102(5), -103(1)). Statutory forms are optional and include date/residence lines, but operative execution sentence does not require a date. No oral creation or electronic-specific execution route in chapter 9 |
Exactly 2 witnesses required (§ 50-9-103(1)); Act states no minimum witness age, relationship, inheritance, provider, facility, or designee disqualification. Notarization is not an alternative to the 2 witnesses. Provider may presume validity absent actual contrary notice |
Declaration operates only when communicated to attending physician/APRN and that clinician determines terminal condition plus inability to decide about life-sustaining treatment (§ 50-9-105). Terminal means incurable/irreversible condition expected to cause death relatively soon without treatment; life-sustaining treatment then only prolongs dying (§ 50-9-102). One attending clinician determines; no PVS/end-stage route |
Declaration governs withholding/withdrawal of life-sustaining treatment that only prolongs dying; optional form excludes treatment necessary for comfort or pain relief (§ 50-9-103). Providers remain responsible for comfort/pain treatment, including nutrition and hydration (§ 50-9-202(2)). Act provides no separate artificial-nutrition/hydration election |
No withholding/withdrawal under declaration when attending clinician knows patient is pregnant while continued treatment probably permits fetal development to live birth (§ 50-9-202(3)). Organ-suitability measures continue unless donor's directive expressly says otherwise (§ 72-17-216). Chapter does not authorize mercy killing/euthanasia or require action contrary to reasonable medical standards (§ 50-9-205) |
Revoke anytime/in any manner regardless of mental/physical condition; effective on communication to attending clinician/provider under § 50-9-104's recipient rules, and provider records it. Optional AG registry stores filed declarations; nonfiling and failure to notify registry of revocation do not affect validity, and AG removes declaration on revocation notice (§§ 50-9-501–503) |
Provider given copy records it and promptly advises declarant/designee if unwilling (§ 50-9-103(5)); attending clinician records terminal finding/terms, complies when operative or promptly transfers, and facility transfers if policy bars compliance (§§ 50-9-201, -203). Statutory immunity (§ 50-9-204); no duty to search registry (§ 50-9-502). Substantially similar declaration valid where made is recognized (§ 50-9-111) |
| Nebraska verified 2026-07-31 | Nebraska Rights of the Terminally Ill Act, Neb. Rev. Stat. §§ 20-401–416. Standalone written 'declaration' directs withholding/withdrawal of life-sustaining treatment; § 20-404 supplies optional form. Separate from health-care POA at §§ 30-3401–3432 and clinician orders |
Adult of sound mind may execute anytime (§ 20-404). 'Adult' means age 19+ or a person who is or has been married (§ 20-403(1)); no separate post-diagnosis oral route |
Declaration is writing signed by declarant or another at declarant's direction (§§ 20-403(3), -404(1)). Optional form includes date, signature, and address, but operative execution subsection does not separately require date. No electronic-specific route |
Either 2 adult witnesses OR notary (§ 20-404(1)). No more than 1 witness may be administrator/employee of provider caring for declarant; no witness may be declarant's life/health insurer employee. Notary exempt from witness restrictions. No relative/heir/financial-responsibility bar stated for this declaration |
Operative after communication, attending physician determines terminal condition OR persistent vegetative state and inability to decide about life-sustaining treatment, and physician notifies reasonably available immediate-family member/guardian (§ 20-405). One attending-physician determination; terminal means death relatively soon without treatment, PVS means total irreversible loss of consciousness/cognitive interaction with no reasonable hope of improvement (§ 20-403) |
Declaration/form directs withholding/withdrawal of life-sustaining treatment not needed for comfort/pain (§ 20-404). Definition includes procedures that only prolong dying or maintain PVS (§ 20-403(5)). Act preserves comfort/pain treatment including nutrition and hydration (§ 20-408(2)); no separate artificial-feeding election in statutory form |
Known pregnancy: no withholding/withdrawal under declaration while continued treatment probably would allow fetus to develop to live birth (§ 20-408(3)). Act does not authorize homicide, suicide, or assisted suicide and does not require care contrary to reasonable medical standards (§ 20-412(6)–(7)) |
Revoke anytime/in any manner regardless mental/physical condition; effective when declarant or witness communicates to attending physician/provider, who records it (§ 20-406). No state declaration registry in §§ 20-401–416 |
Receiving provider places copy in medical record and advises declarant if unwilling (§ 20-404(3)); operative declaration requires compliance or prompt reasonable transfer (§§ 20-405, -409). Good-faith/reasonable-standard immunity (§ 20-410). Foreign declaration valid if compliant there or in Nebraska (§ 20-414) |
| Nevada verified 2026-07-31 | Uniform Act on Rights of the Terminally Ill, NRS 449A.400–.481. Standalone written 'declaration' may directly instruct provider (§ 449A.436) or designate another person (§ 449A.439); both optional forms. A Chapter 162A health-care POA addressing withholding/withdrawal also constitutes a declaration (§ 449A.433(3)). Keep POLST/DNR and psychiatric directives separate |
A person of sound mind, age 18+, may execute anytime; may designate another natural person of sound mind and age 18+ for life-support decisions (§ 449A.433). No post-diagnosis oral declaration route |
Declaration is a writing, signed by declarant or another at declarant's direction and attested by 2 witnesses (§§ 449A.415, .433). Operative statute does not mandate a date, though optional forms include one and say declarant voluntarily signed in witness presence. No electronic-specific execution route appears |
Standalone Chapter 449A declaration: 2 attesting witnesses; no notary alternative or express relative/heir/provider/facility disqualification (§ 449A.433). Alternative Chapter 162A POA-as-declaration route: principal signature acknowledged by notary OR witnessed by 2 adults; only current statutory witness bar is nursing-home owner/operator/employee when principal resides there (§§ 449A.433(3), 162A.790) |
Operative when communicated to attending physician/APRN, that clinician determines terminal condition, and declarant no longer can decide about life-sustaining treatment (§ 449A.442). Terminal means incurable/irreversible and, without treatment, death within relatively short time (§ 449A.430). No permanent-unconsciousness alternative or second-clinician confirmation in this Act |
Declaration governs treatment that serves only to prolong dying (§ 449A.418). Optional form withholds such treatment not needed for comfort/pain. GI artificial nutrition/hydration is deemed life-sustaining and must be withheld/withdrawn unless patient expresses different desire in writing; form's initial box selects continued GI nutrition/hydration after other treatment withheld (§§ 449A.436, .451(2)–(3)) |
Known pregnancy: life-sustaining treatment may not be withheld/withdrawn under declaration while it is probable fetus will develop to live birth with continued treatment (§ 449A.451(4)). Act does not require action contrary to reasonable medical standards and does not authorize mercy-killing, assisted suicide, or euthanasia (§ 449A.475) |
Revoke anytime/in any manner regardless mental/physical condition; effective when declarant or witness communicates to attending physician/provider, who records it (§ 449A.445). Optional Secretary of State registry accepts copy/application/possible fee and has replacement/removal procedures (§§ 449A.712, .715). Failure to register or notify registry of revocation affects neither validity nor revocation (§ 449A.724) |
Operative declaration directs compliance or prompt reasonable transfer (§§ 449A.442, .457), with good-faith/reasonable-standards immunity (§ 449A.460). But § 449A.463 says attending clinician gives declaration weight, may consider other factors, and facilities/clinicians have no civil/criminal liability for failure to follow directions. Foreign declaration valid if compliant there or in Nevada (§ 449A.481) |
| New Hampshire verified 2026-07-31 | RSA ch. 137-J. 'Advance directive' combines durable health-care POA and living will; either/both may be completed (§§ 137-J:1(IV), :2(II), :20). Person must receive substantially prescribed disclosure and directive must substantially follow § 137-J:20 form (§ 137-J:13). Living will is written guidance, not a DNR/POLST order |
Principal age 18+ with capacity (§ 137-J:2(VI), (XXIII)). Capacity means understanding/appreciating nature and consequences, significant benefits/harms, and reasonable alternatives. If physically unable, another signs principal's name at express direction in principal's physical presence (§ 137-J:14(II)) |
Written advance directive substantially following § 137-J:20; statutory form is dated and signed (§§ 137-J:2(XVII), :13, :20). Principal signs in physical presence of execution officer/witnesses; no oral creation route and no electronic-specific execution route. Directed signature allowed only for physical inability (§ 137-J:14) |
Choose 2+ subscribing witnesses OR notary OR justice of peace (§ 137-J:14(I)). Witnesses cannot be agent/surrogate, spouse, heir, named property taker, attending practitioner, or person under practitioner's direction/control; no more than 1 may be provider/provider employee. Witnesses affirm sound mind, no duress, awareness, voluntariness |
Two attending physicians, OR physician plus another attending practitioner not supervised by certifying physician, certify in medical record lost capacity plus permanent unconsciousness OR advanced life-limiting incurable progressive condition with treatment excessively burdensome/ineffective (§ 137-J:2(XVII)). Form also lists active dying, permanent unconsciousness, and burdens-over-benefits as burden examples (§ 137-J:20) |
Form chooses all life-sustaining attempts OR only treatment not excessively burdensome and with reasonable hope of benefit; may cross out listed burden situations (§ 137-J:20). Life-sustaining treatment includes tube/IV nutrition/hydration, respiration, dialysis, devices, pressure drugs, transfusions, antibiotics; excludes comfort/pain medication and natural eating/drinking (§ 137-J:2(XVI), (XVIII)) |
No withholding during pregnancy unless attending practitioner + examining obstetrician certify treatment will not permit continuing fetal development/live birth, OR will physically harm principal, OR prolong severe pain not alleviable by medication (§ 137-J:10(II)(a)). Chapter does not authorize suicide, assisted suicide, mercy killing, euthanasia, or deliberate life-ending act beyond natural dying (§ 137-J:10(I)) |
Revoke by signed/dated writing delivered to agent/surrogate/provider; oral revocation before 2 qualified witnesses; directed destruction/other specific-intent act; or later directive (§ 137-J:15(I)). Effective when communicated to attending practitioner; provider immediately records/notifies care team (§ 137-J:15(II)). Divorce/separation/annulment/protective-order filing addresses agent designation, not treatment guidance. No statutory registry filing |
Providers follow directive within responsible practice, add it to record on request, promptly verify incapacity, and arrange transfer for conscience refusal while preserving interim life-saving care (§ 137-J:7); good-faith/reasonable-standard compliance is immune (§ 137-J:12). Foreign living will valid where made is effective subject to NH limits (§ 137-J:17). If living will conflicts with health-care POA component, POA controls (§ 137-J:21(II)) |
| New Jersey verified 2026-07-30 | Advance Directives for Health Care Act, N.J.S.A. §§ 26:2H-53–78: written 'instruction directive.' It may stand alone or accompany a proxy directive; no mandatory statutory form (§§ 26:2H-55, -58). |
An adult who has the mental capacity to execute an advance directive (§ 26:2H-55). The adult may execute it at any time and may direct another person to sign (§ 26:2H-56). |
Must be a writing, signed and dated by the declarant or at the declarant's direction (§§ 26:2H-55 to -56). Audio/video may supplement the writing, but is not a substitute. The Act states no separate electronic-signature path. |
Either two subscribing adult witnesses who attest sound mind and freedom from duress/undue influence, OR acknowledgment before a notary, attorney, or other oath officer (§ 26:2H-56). A designated representative cannot witness; the Act states no additional instruction-only witness disqualification. |
Operative after transmission to the attending physician/institution and a written attending-physician incapacity finding, normally confirmed by another physician (§§ 26:2H-59 to -60). Withholding/withdrawal may rest on experimental, ineffective, futile, or imminently dying treatment; permanent unconsciousness or terminal condition (each confirmed by a second physician); or a serious irreversible condition under the burden-benefit/inhumane-treatment test (§ 26:2H-67). |
May state general treatment philosophy or specific providing, withholding, or withdrawal choices for any health care, including life-sustaining treatment (§ 26:2H-58). Life-sustaining treatment includes artificially provided fluids and nutrition (§ 26:2H-55). Care, comfort, and pain relief remain required (§ 26:2H-67). |
A female declarant may specify what effect the directive has during pregnancy (§ 26:2H-56); the Act states no categorical pregnancy suspension. Good-faith withholding/withdrawal under the Act is not homicide, suicide, assisted suicide, or active euthanasia (§ 26:2H-77). |
Revoke by oral or written notice to the representative, physician, nurse, other health professional, or reliable witness; by conduct showing intent; or by a later directive (§ 26:2H-57). Effective on communication to a person capable of transmitting it. The Act creates no state directive registry or filing requirement. |
A clear instruction is legally operative and must be honored when no representative is available; unclear terms are effectuated through physician consultation and reasonable judgment (§ 26:2H-64). A current request for medically appropriate life-sustaining care overrides a contrary instruction (§ 26:2H-62). Institutions must support timely respectful transfer (§ 26:2H-65). Directives valid under another state or New Jersey law are recognized; foreign-country directives also require no conflict with New Jersey public policy (§ 26:2H-76). |
| New Mexico verified 2026-07-31 | New Mexico Uniform Health-Care Decisions Act, NMSA 1978 §§ 24-7A-1–18. 'Advance health-care directive' is an individual instruction or health-care POA made with capacity (§ 24-7A-1). Section 24-7A-4 supplies an optional combined form whose Part 2 is treatment instructions; any part may be completed or modified and a different form may be used |
Adult or emancipated minor while having capacity may give instruction; this page covers adults (§§ 24-7A-1, -2(A)). Capacity is presumed, and refusing recommended treatment alone does not establish incapacity (§ 24-7A-11) |
Instruction may be oral or written and conditioned on specified event; oral route requires personally informing health-care provider (§ 24-7A-2(A)). Section states no signature/date rule for instruction alone. Optional form tells signer to sign and date; no directed-signature or electronic-specific route appears (§ 24-7A-4) |
No witness or notary required for individual instruction. Optional form says 2 witness signatures are 'recommended but not required' and labels them optional (§ 24-7A-4); Act states no witness-disqualification list. Do not import signed-writing requirement for health-care-POA portion (§ 24-7A-2(B)) |
Instruction may set its own condition. Unless written directive says otherwise, 2 qualified health-care professionals, including primary care practitioner, determine incapacity/recovery or another condition affecting instruction (§ 24-7A-11(C)). Optional form operates when unable to make/communicate plus incurable/irreversible near-term-death condition, unconsciousness with no expected recovery to reasonable medical certainty, or risks/burdens outweigh expected benefits (§ 24-7A-4) |
Health-care decision includes life-support termination and separate provision/withholding/withdrawal of artificial nutrition and hydration (§ 24-7A-1(G)). Optional form chooses no prolongation, prolongation within accepted standards, or agent decision; if no-prolongation chosen, nutrition and hydration each have yes/no selections, with comfort exception for hydration; best comfort/pain care remains even if it hastens death (§ 24-7A-4) |
UHCDA §§ 24-7A-1–18 state no pregnancy-specific suspension, viability, or live-birth test. Act itself does not authorize mercy killing, assisted suicide, euthanasia, or care prohibited elsewhere and does not require care contrary to generally accepted standards (§ 24-7A-13(C)–(D)) |
While having capacity, revoke any non-agent part anytime/in any manner communicating intent; later conflict revokes earlier directive to extent of conflict (§ 24-7A-3(B), (E)). Informed provider/agent/guardian/surrogate promptly tells supervising practitioner and treating institution; practitioner records it (§§ 24-7A-3(C), -7(B)). No state directive registry appears in Act |
Practitioner/institution must comply before and after incapacity, subject to conscience, timely communicated institutional policy, medically ineffective care, or accepted standards; refusal requires notice, continuing care, and reasonable transfer efforts (§ 24-7A-7). Good-faith immunity (§ 24-7A-9). Foreign directive valid if compliant where made; copy equals original (§§ 24-7A-12, -16) |
| North Carolina verified 2026-07-30 | N.C.G.S. Article 23 of Chapter 90, especially § 90-321: Advance Directive for a Natural Death ('Living Will'). The § 90-321(d1) form is optional/nonexclusive; it may be combined with a health-care POA but keeps § 90-321 execution formalities |
Section 90-321 states no numeric minimum age for the declarant; the witnesses must believe declarant is of sound mind. Statutory form permits declarant to sign or direct another to sign on declarant's behalf in witness presence |
Signed, witnessed, dated, and proved document (§ 90-321(a)(1a)); no oral creation route. Statutory form is signed and dated, or directed-signed, with two witnesses and proof before clerk/notary. Article 23 creates no ordinary electronic-signature, counterpart, facsimile, or remote-witness route |
Two witnesses plus proof before clerk/assistant clerk or notary (§ 90-321(c)(3)-(4)). Witnesses cannot be related within third degree to declarant/spouse, expected estate takers, attending physician or listed paid provider/facility employees, or estate claimants. Notary may be such a paid employee |
Declarant selects any/all: terminal condition causing death relatively soon; unconsciousness with high-certainty no recovery; or advanced dementia/other substantial cognitive loss highly certain irreversible (§ 90-321(c)). Attending physician determines selected condition and another physician confirms (§ 90-321(b)); statutory form also requires lack of capacity to make/communicate decisions |
May direct that identified life-prolonging measures 'shall' or 'may' be withheld/discontinued. Those measures include ventilation, dialysis, antibiotics, and artificial nutrition/hydration; comfort and pain care are excluded (§ 32A-16(4)). Form separately lets declarant preserve both nutrition/hydration, hydration only, or nutrition only, and directs comfort/pain care |
Article 23 states no express pregnancy restriction on declarant's own instruction. It does not authorize an affirmative or deliberate act or omission to end life beyond natural dying (§ 90-320(b)) |
Declarant may revoke in writing or any clear/consistent communication regardless of condition; provider liability requires actual notice. Agent only if POA explicitly authorizes; guardian cannot revoke (§ 90-321(e)). Optional registry accepts declaration/revocation; both notarized for filing. Nonfiling does not affect validity; filing revocation with file number/password deletes record (§§ 130A-466 to -468) |
Attending physician follows declaration after § 90-321 findings. Conscience refusal requires noninterference and reasonable cooperation with substitute physician/facility transfer; reasonable authenticity doubt also permits refusal (§ 90-321(k)). Foreign document valid if apparently compliant where made or North Carolina law (§ 90-321(l)) |
| North Dakota verified 2026-07-31 | North Dakota Health Care Directives Act, N.D.C.C. ch. 23-06.5. Combined written 'health care directive' may contain 1+ health-care instructions, health-care POA, or both (§§ 23-06.5-02(5)–(6), -03). Optional statutory form in §§ 23-06.5-16 to -17; instruction remains distinct from agent appointment |
Principal is an adult who executes directive (§ 23-06.5-02(9)); execution requires capacity (§ 23-06.5-05(1)). Capacity to execute or revoke is presumed absent clear-and-convincing contrary evidence (§ 23-06.5-13(3)). Another person may sign as authorized; physically unable principal's name may be written by another in principal's presence and at express direction (§ 23-06.5-05) |
Directive must be written, dated, state principal's name, be signed by principal or authorized signer, verify that signature, and include instruction, POA, or both (§ 23-06.5-05(1)). No oral or electronic-specific creation route in chapter. Optional form requires date/signature and says attached pages are signed/dated with directive, but another compliant form may be used (§§ 23-06.5-16 to -17) |
Signature verified by notary OR at least 2 subscribing witnesses age 18+ (§ 23-06.5-05(2)). At least 1 witness cannot be direct-care provider/employee; notary may be such employee. No notary/witness may be agent, spouse/heir, relative, estate taker/claimant, person financially responsible for medical care, or attending physician. Directed signature uses same verification |
Directive ordinarily effective only when attending physician, psychiatrist, OR psychologist certifies in writing that principal lacks capacity and certification enters medical record; ends when capacity returns (§ 23-06.5-03(3)). No universal terminal, end-stage, PVS, or other diagnosis. Immediate-effect exception in § 23-06.5-03(4) authorizes an AGENT to act while principal retains capacity; it is not a separate instruction-only route |
Instruction may direct any health-care decision, including provide/withhold/withdraw artificial nutrition/hydration and all other care (§ 23-06.5-02(4), (6)). Express feeding/hydration direction controls; if silent, attending physician may withhold/withdraw only when it cannot be assimilated, is physically harmful, or causes unreasonable physical pain (§ 23-06.5-09(6)). Optional form invites instructions for temporary incapacity, dying, permanent unconsciousness, complete dependence, pain relief, and other wishes (§ 23-06.5-17); comfort/pain duty remains (§ 23-06.5-09(4)) |
Contrary instruction does not stop care during pregnancy unless attending physician + examining obstetrician certify, to reasonable medical certainty, care will not permit continuing development/live birth, will physically harm or unreasonably pain principal, OR prolong severe pain not alleviable by medication (§ 23-06.5-09(5)). Withholding directions do not apply to prehospital emergency treatment (§ 23-06.5-13(13)); chapter does not authorize mercy killing (§ 23-06.5-01) |
Revoke by notifying agent or health/long-term-care provider orally, in writing, or by any act showing specific intent, or by executing later directive (§ 23-06.5-07). Informed provider immediately records revocation and notifies agent, attending physician, and care staff. Optional state registry may accept directives/revocations; nonfiling and failure to notify registry do not affect validity, provider need not search, and registry deletes on revocation plus file number (§ 23-06.5-19) |
Provider with knowledge is bound to follow instruction consistent with chapter/directive; conscience/conflict refusal requires all reasonable transfer steps and continuing care until transfer (§ 23-06.5-09). No action contrary to reasonable medical standards; statutory good-faith/ordinary-care immunity (§ 23-06.5-12). Chapter preserves enforceability of directive executed elsewhere in compliance with that jurisdiction's law (§ 23-06.5-11) |
| Ohio verified 2026-08-01 | Modified Uniform Rights of the Terminally Ill Act, R.C. §§ 2133.01–2133.15: a standalone written 'declaration.' Separate from the durable power of attorney for health care (R.C. §§ 1337.11–1337.17) and from DNR identification (§§ 2133.21–2133.26). A declaration supersedes a conflicting health-care power of attorney (§ 2133.03(B)(2)). |
An adult, meaning 18 or older, who is of sound mind, acting voluntarily (§§ 2133.01(A), 2133.02(A)(1)). Another individual may sign at the declarant's direction (§ 2133.02(A)(1)). A declarant who has signed becomes a 'qualified patient' only once found to be in a terminal condition or permanently unconscious state (§ 2133.01(Z)). |
Written only; Ohio has no oral or nonverbal declaration route (§ 2133.01(F)). Signed at the end by the declarant or another at the declarant's direction, dated, and witnessed or acknowledged (§ 2133.02(A)(1)). The declaration must use and define 'terminal condition' and/or 'permanently unconscious state' in capital letters (§ 2133.02(A)(2)). |
Two adult witnesses in whose presence the signature was made, OR notarial acknowledgment as a full alternative (§ 2133.02(B)). Witnesses may not be related by blood, marriage, or adoption, may not be the attending physician, and may not be the administrator of any nursing home where the declarant receives care. Signatures need not appear on the same page (§ 2133.02(B)(1)). |
Attending physician plus one other examining physician must find a terminal condition or a permanently unconscious state, whichever the declaration addresses; for permanent unconsciousness the consulting physician must be qualified by training or experience (§ 2133.03(A)). The attending physician must separately find the declarant can no longer make informed decisions and has no reasonable possibility of regaining that capacity (§ 2133.03(A)(1), (3)). |
May direct use, continuation, withholding, or withdrawal of life-sustaining treatment, and may specifically authorize or decline CPR (§ 2133.02(A)(1)). Withholding nutrition or hydration in a permanently unconscious state requires a separate conspicuous-type statement plus the declarant's initials or signature next to it (§ 2133.02(A)(3)(a)). Comfort care, including nutrition or hydration given to diminish pain, is never withheld (§§ 2133.01(C), 2133.12(E)(1)). |
Life-sustaining treatment 'shall not be withheld or withdrawn from a declarant pursuant to a declaration if she is pregnant and if the withholding or withdrawal of the treatment would terminate the pregnancy, unless' the attending physician and one other examining physician determine to a reasonable degree of medical certainty that 'the fetus would not be born alive' (§ 2133.06(B)). The act does not condone mercy killing, assisted suicide, or euthanasia, and a resulting death is not a suicide or homicide (§ 2133.12(A), (D)). |
Revocable 'at any time and in any manner' (§ 2133.04(A)). Effective when the declarant expresses an intention to revoke, except that if the attending physician was made aware of the declaration it is effective on communication to that physician by the declarant, a witness, or health-care personnel told by that witness. The physician must then make the revocation part of the medical record (§ 2133.04(B)). No state registry. |
On the declaration becoming operative the attending physician and facilities must act on it or comply with § 2133.10 (§ 2133.03(A)(1)). A physician or facility may refuse on conscience or another basis, must promptly advise the declarant, and may not prevent or unreasonably delay transfer; treatment continues pending transfer where the declaration directs continued treatment (§§ 2133.02(D), 2133.10). A declaration executed under another state's law in compliance with that law, or in substantial compliance with Ohio's, is valid here (§ 2133.14). |
| Oklahoma verified 2026-07-31 | Oklahoma Advance Directive Act, 63 O.S. §§ 3101.1–3101.16, plus registry §§ 3102.1–3102.3. A written 'advance directive for health care' may include a living will, proxy appointment, or both (§ 3101.3(1)); § 3101.4(C) supplies an optional form |
An individual of sound mind and age 18+ may execute the directive at any time (§ 3101.4(A)). The Act provides no directed-signer route for the declarant's treatment instruction |
Written and signed by the declarant (§§ 3101.3(1), 3101.4(A)). The statutory form has a signing date line; a nonstatutory Oklahoma form must state nutrition/hydration withdrawal in the declarant's own words or in a separately marked nutrition/hydration-only subdivision (§ 3101.4(B)). No general oral, nonverbal, notarial, or electronic execution route appears |
Exactly 2 witnesses, each age 18+, who are not the declarant's legatees, devisees, or heirs at law (§ 3101.4(A)). No notary alternative, proxy/clinician/facility-employee bar, or special facility witness appears |
Directive is operative when communicated to the attending physician and the declarant can no longer decide about life-sustaining treatment (§ 3101.5). Qualified-patient incapacity is determined after examination by the attending physician and another physician and recorded (§§ 3101.3(10), 3101.7). Form conditions: terminal condition (death within 6 months), persistent unconsciousness, and end-stage condition (§§ 3101.3(4), (7), (12), 3101.4(C)) |
For each form condition, choose: withhold life-sustaining treatment but continue artificial nutrition/hydration; withhold both; provide both; or add specific instructions (§ 3101.4(C)). Nonstatutory nutrition/hydration withdrawal needs the separate specificity rule. Even when treatment or artificial nutrition/hydration is withheld, pain-relieving treatment and oral food/water continue (§ 3101.8(B)) |
Known pregnancy: provide life-sustaining treatment and artificial hydration/nutrition unless the qualified patient specifically authorized withholding/withdrawal during pregnancy 'in her own words'; where appropriate the physician determines pregnancy status (§ 3101.8(C)). The Act does not authorize mercy killing, assisted suicide, or euthanasia (§§ 3101.2(C), 3101.12(F)) |
Revoke whole or part anytime and in any manner, without regard to mental/physical condition; effective when the declarant or a witness communicates it to the attending physician or other provider, who records it (§ 3101.6). A later valid unrevoked directive controls (§ 3101.5(B)). Filing in the Department of Health registry is optional (§§ 3102.1, 3102.3); the statutes add no registry-specific revocation formality |
Providers follow an operative directive or § 3101.9; an unwilling provider promptly arranges other care and, if refusal likely causes death, complies pending transfer unless physically/legally unable (§§ 3101.5, 3101.9). Good-faith/statutory-standard immunity and facial-validity presumption apply (§§ 3101.10, 3101.13). Foreign directive valid if compliant where executed or with Oklahoma law, only within Oklahoma authorizations; nutrition/hydration withdrawal must be specific as § 3101.14 requires |
| Oregon verified 2026-07-31 | Oregon Health Care Decisions Act, ORS 127.505–127.660 and 127.995: combined 'Advance Directive for Health Care.' It must substantially follow § 127.529 and contains an appointment form plus instructions; the instructions still guide care if no representative is chosen or reachable |
A 'capable adult': age 18+, an emancipated minor, or a married minor, who is not incapable (§§ 127.505(1), (7), 127.510(1)). Capable adults retain their own health-care decisions (§ 127.507) |
Written statutory form, signed by the adult; the form includes a date line (§§ 127.510, 127.515, 127.529). No general oral-creation, directed-signer, or electronic-specific execution route appears in the Act |
Signed before 2+ adult witnesses OR notarized (§ 127.515). Witnesses observe signing or acknowledgment and cannot be the attending provider or named representative/alternate. Long-term-care patient: 1 witness must be facility-designated and DHS-qualified. No relative/heir bar |
Directive effective when signed and properly witnessed/notarized, but representative acts only when adult is incapable (§§ 127.510, 127.535). Form offers terminal, advanced progressive illness, and permanent unconsciousness choices (§ 127.529). Statutory 'terminal condition' means death imminent; the form's lay prompt says death within 6 months (§ 127.505(21)) |
For each form condition: all treatments; artificial feeding/IV fluids but not other life support; no sustaining treatment with comfort/natural death; or representative decides (§ 127.529). Artificial nutrition/hydration is presumed accepted unless a § 127.580 exception applies. Oral food/fluids, pain relief, hygiene, privacy, and dignity continue (§ 127.642) |
No pregnancy-specific suspension, viability test, or override appears in current ORS 127.505–127.660. The Act does not authorize mercy killing or an affirmative/deliberate act or omission to end life beyond natural dying (§ 127.570) |
Life-support or artificial-nutrition directions: revoke anytime, in any manner communicating intent; other directions: anytime/in any manner while capable (§ 127.545). Effective on communication to attending provider or representative; provider places it in the medical record. No advance-directive registry; Oregon's separate registry is for POLST clinician orders |
Provider needs a copy and may presume a facially compliant directive valid absent contrary notice (§ 127.575). Unwilling provider promptly notifies the representative; the representative seeks transfer, or without one the provider avoids abandonment and discharges/transfers (§ 127.625). An adult residing out of state may use law of residence, execution location, or Oregon (§ 127.515(6)) |
| Pennsylvania verified 2026-07-30 | 20 Pa.C.S. ch. 54, Subchapter B (§§ 5441-5447), the Living Will Act. Written standalone living will or living-will part of a combined directive; any written form is permitted, and § 5471 is an example |
Individual of sound mind who is age 18+, a high-school graduate, married, or an emancipated minor (§ 5442(a)) |
Written only; date and principal's signature or mark. If unable, another person may sign on the principal's behalf and at specific direction (§ 5442(b)). Chapter 54 does not create an electronic-signature or remote-execution route |
Two witnesses, each age 18+. A directed signer may not witness. A provider or its agent furnishing care may not sign for the principal (§ 5442(b)-(c)). No notary required; the statutory example labels notarization optional (§ 5471) |
Copy delivered to attending physician; that physician determines incompetence plus end-stage medical condition or permanent unconsciousness, then certifies the condition in writing (§ 5443(a), (g)). End-stage means incurable, irreversible, advanced, and death despite treatment; permanent unconsciousness includes irreversible vegetative state or coma (§ 5422) |
May direct initiation, continuation, withholding, or withdrawal of life-sustaining treatment (§§ 5442, 5447). Artificial nutrition/hydration counts only if specifically included in the directive (§ 5422). The § 5471 example separately offers comfort/pain care, listed procedures, and tube-feeding choices |
For an incompetent pregnant woman with an end-stage condition or permanent unconsciousness, provide life-sustaining treatment, nutrition, and hydration unless attending physician plus examining obstetrician certify it will not permit continuing development/live birth, will physically harm her, or will cause unrelievable pain (§ 5429). Chapter does not authorize mercy killing, euthanasia, or aided suicide (§ 5423) |
Principal may revoke at any time, in any manner, regardless of mental or physical condition. Effective when the principal or a witness communicates it to the attending physician/provider, who records it (§ 5444). No directive registry; living will lasts until revoked unless it states a termination time (§ 5443(e)) |
When operative, providers follow it or use § 5424 transfer; a refusing provider informs the proper person and makes every reasonable transfer effort (§§ 5424, 5443). Foreign living will valid if compliant where made, except inconsistent procedures (§ 5446). Copy joins medical record (§ 5443(d)) |
| Rhode Island verified 2026-07-31 | Rhode Island Rights of the Terminally Ill Act, R.I. Gen. Laws ch. 23-4.11. Survey covers § 23-4.11-3 witnessed treatment 'declaration' and optional form; distinct from ch. 23-4.10 durable health-care POA and § 23-4.11-3.1 MOLST clinician order |
Competent individual age 18+ may execute anytime (§ 23-4.11-3(a)). Statutory form recites sound mind, willfulness, and voluntariness. No Rhode Island-residency requirement appears in living-will chapter (contrast health-care-POA form) |
Witnessed written document signed by declarant or another at declarant's direction in presence of 2 subscribing witnesses (§§ 23-4.11-2(4), -3(a)). Optional form includes date/address, but operative execution rule states no date requirement. No oral creation or electronic-specific execution route |
2 subscribing witnesses required; both must be unrelated to declarant by blood or marriage (§ 23-4.11-3(a)). Chapter states no minimum witness age, provider/facility/employee bar, inheritance bar, or notary alternative. Do not import broader witness/notary rules from health-care-POA chapter |
Operative only when communicated to attending physician, physician determines terminal condition, and declarant cannot make treatment decisions (§ 23-4.11-3(c)). Terminal means incurable/irreversible condition that without life-sustaining procedures will result in death; procedure then only prolongs dying (§ 23-4.11-2). One attending physician; no PVS/end-stage route |
Optional form directs withholding/withdrawal of procedures that merely prolong dying and are unnecessary for comfort/pain, with separate include/do-not-include checkbox for artificial feeding (§ 23-4.11-3(d)). Artificial feeding means non-voluntary-oral nutrition/hydration (§ 23-4.11-2(2)); comfort/care/pain actions remain allowed (§ 23-4.11-6(b)) |
Declaration has no force while attending physician knows patient is pregnant and continued life-sustaining procedures probably permit fetal development to live birth (§ 23-4.11-6(c)). Chapter does not authorize mercy killing/euthanasia; compliant withdrawal is not suicide/homicide (§ 23-4.11-10) |
Revoke anytime/in any manner communicating intent regardless of mental/physical condition; effective as to physician/provider/EMS when declarant or revocation witness communicates it, and provider records it (§ 23-4.11-4). Later-executed declaration or health-care POA controls inconsistent terms. No directive registry provision in ch. 23-4.11 |
Provider given copy adds it to medical record (§ 23-4.11-3(b)); attending physician records terminal determination/substance (§ 23-4.11-5). Refusing provider arranges transfer to physician who will effectuate declaration (§ 23-4.11-7); statutory immunity/presumed validity (§§ 23-4.11-8, -11). Out-of-state declaration valid if compliant where executed (§ 23-4.11-12) |
| South Carolina verified 2026-07-31 | South Carolina Death With Dignity Act, S.C. Code Ann. tit. 44, ch. 77 (§§ 44-77-10–44-77-160): 'Declaration of a Desire for a Natural Death.' The declaration must be substantially in the § 44-77-50 statutory form, including emphasized revocation procedures (§§ 44-77-30, -40, -50). Separate from the Title 62 health care power of attorney. |
Person age 18+; statutory form states South Carolina residence/domicile and emotional and mental competence (§§ 44-77-30, -50). The adult must personally sign; Chapter 77 states no directed-signer substitute. A foreign declaration with substantially the same intent is separately recognized (§§ 44-77-20, -30). |
Written mandatory-form declaration, dated and personally signed by the adult in the presence of an officer authorized to administer oaths and 2 witnesses (§ 44-77-40). No oral, directed-signature, or electronic-execution route. Revocation methods printed in boldface or all capitals, at least the size of the rest of the form (§ 44-77-50). |
2 witnesses plus oath officer; 1 witness may be the officer (§ 44-77-40). Witnesses swear the statutory affidavit; at least 1 is sworn with adult, both witnesses, and officer present. Neither witness may be specified relatives, care payer, heir/beneficiary, life-insurance beneficiary, attending physician/employee, estate claimant; no more than 1 facility employee. Hospital/nursing-facility resident: designated ombudsman must be 1 witness. |
Terminal condition or permanent unconsciousness certified after personal exams by 2 physicians, 1 attending (§ 44-77-30). Permanent-unconsciousness certification ordinarily waits 90 consecutive unconscious days, except massive cortical destruction/atrophy or another feature allowing high-certainty diagnosis. At least 6 hours of active treatment follows diagnosis before effect. No separate incapacity certification; form addresses absence of ability to direct. |
Directs withholding/withdrawal of life-sustaining procedures and natural dying with comfort/pain care (§§ 44-77-20, -50). Tube nutrition/hydration is separate: choose provide or not provide for terminal condition and again for permanent unconsciousness. If choices are left blank, nutrition/hydration necessary for comfort or pain relief is provided (§ 44-77-20). |
If pregnancy is diagnosed, the declaration is not effective during the pregnancy, with no viability, prognosis, or live-birth exception stated (§ 44-77-70). Chapter 77 does not authorize mercy killing or an affirmative/deliberate act or omission to end life beyond permitting natural dying (§ 44-77-130). |
Revoke by directed destruction, signed dated writing, qualifying oral expression, authorized designee while adult is incompetent, or later declaration (§ 44-77-80). Except destruction of the only original, revocation becomes effective on communication to the attending physician, who records notice details. Designee may revoke temporarily or permanently. Chapter 77 creates no registry. |
Declaration is self-executing; optional designee or interested person may seek enforcement, but no court order is required (§ 44-77-85). Good-faith compliance and certification receive immunity (§ 44-77-90). Unwilling physician/facility makes reasonable efforts and transfers; failure may be unprofessional conduct (§ 44-77-100). A domicile-state declaration with substantially the same intent is recognized (§§ 44-77-20, -30). |
| South Dakota verified 2026-07-31 | South Dakota Living Wills chapter, SDCL ch. 34-12D. Standalone written 'declaration' governs withholding/withdrawal of life-sustaining treatment (§§ 34-12D-1 to -3); optional statutory form. Separate from a durable power of attorney, although the later document controls a conflict (§ 34-12D-4) |
Competent adult may execute at any time (§ 34-12D-2); adulthood begins at 18 because minority is under 18 (§ 26-1-1). Another person may sign at the declarant's direction; chapter states no separate post-diagnosis creation route |
Declaration is a writing, signed by declarant or directed signer (§§ 34-12D-1(2), -2). Operative rule states no date, presence, delivery, or acknowledgment requirement beyond chosen witness/notary route. Optional § 34-12D-3 form includes date/address lines; chapter states no oral or electronic-specific creation route |
Either 2 adult witnesses OR notarization by a notary public (§ 34-12D-2). Chapter states no relationship, inheritance, provider, facility, or other witness disqualification. Optional older form displays both witness and notary blocks, but is nonmandatory and § 34-12D-2 makes the routes alternatives |
Operative only when attending physician determines terminal condition, death imminent, and inability to communicate medical-care decisions (§ 34-12D-5). Terminal condition includes imminently fatal incurable/irreversible condition OR indefinite coma/permanent unconsciousness meeting detailed communication, movement, and interaction tests (§ 34-12D-1(7)); § 34-12D-5 still expressly requires imminent death |
May govern withholding/withdrawal of life-sustaining treatment; declaration MUST state artificial-nutrition/hydration preferences, or ordinary no-declaration law governs that issue (§ 34-12D-2). Optional form separately offers prolong/do-not-prolong/custom treatment and provide/withhold feeding/hydration choices (§ 34-12D-3). Comfort, hygiene, dignity, oral food/water, and pain relief are outside 'life-sustaining treatment' and remain provider duties (§§ 34-12D-1(4), -9) |
Despite declaration, provide life-sustaining treatment and artificial nutrition/hydration during pregnancy unless attending physician plus 1 other examining physician certify either no continuing-development/live-birth benefit, physical harm to woman, OR prolongation of severe pain unrelieved by medication (§ 34-12D-10). Chapter does not authorize mercy killing, euthanasia, suicide, or assisted suicide (§ 34-12D-20) |
Declarant may revoke anytime and in any manner regardless of mental/physical condition; effective when communicated to health-care provider, who places revocation in medical record (§ 34-12D-8). Attending physician records known declaration after terminal finding (§ 34-12D-7). Chapter 34-12D establishes no directive registry |
Provider may decline withholding/withdrawal but must reasonably seek willing physician/provider transfer (§ 34-12D-11). Directed treatment or feeding/hydration must continue when technically feasible until objecting provider transfers (§ 34-12D-12); accepted medical standards remain controlling (§ 34-12D-19). Statutory immunity (§ 34-12D-13). Declaration valid if execution met law of residence, place signed, or South Dakota (§ 34-12D-22) |
| Tennessee verified 2026-07-30 | Tennessee Health Care Decisions Act, Tenn. Code §§ 68-11-1801 to -1815. An 'advance directive' includes an individual instruction, living will, or health-care power of attorney; the instruction may stand alone or appear in the optional combined state form (§§ 68-11-1802 to -1805) |
Adult or emancipated minor (§ 68-11-1803(a)); capacity to give/revoke a directive is presumed, and means understanding significant benefits, risks, alternatives, and communicating a decision (§§ 68-11-1802, -1812) |
Individual instruction alone may be oral or written and may name its own condition; no signature/date rule (§ 68-11-1803(a)). A formal advance directive must be written and signed by the principal; statute states no directed-signature or electronic-specific route (§ 68-11-1803(b)) |
No witness/notary for an individual instruction alone. Formal advance directive: notary OR two competent adult witnesses; agent cannot witness, at least one witness must be unrelated by blood/marriage/adoption and unable to inherit, and written directive needs attestation clause (§ 68-11-1803(b)) |
No mandatory terminal diagnosis or incapacity trigger for the adult's own instruction; adult may specify any condition. Designated physician determines and charts a condition affecting the instruction (§§ 68-11-1803(a), (d), -1808(a)). Incapacity is the default trigger for agent authority, not every instruction |
Instruction may consent to, refuse, or withdraw any health care (§ 68-11-1802). Optional state form separately addresses CPR, life support/artificial support, treatment of new conditions, tube feeding/IV nutrition and hydration, comfort and pain management, and other instructions |
No pregnancy-specific limit appears in Part 18 or the state form. Withholding/withdrawal under the Act is not suicide, euthanasia, homicide, mercy killing, or assisted suicide; surrogate authority does not extend to Title 33 matters (§ 68-11-1814) |
While having capacity, revoke treatment instructions at any time in any manner communicating intent; later conflicting directive revokes to the conflict's extent (§ 68-11-1804). Copy of written revocation equals original (§ 68-11-1813). No mandatory provider-receipt trigger, chart notation, or state registry in Part 18 |
Provider generally complies with instruction/reasonable interpretation. Conscience, timely communicated institutional policy, or medically inappropriate-care objection triggers prompt notice, continuing care, and reasonable transfer effort; no compulsion if transfer fails (§ 68-11-1808). Good-faith reliance protected. Nonresident's out-of-state directive valid if compliant with Tennessee or residence-state law (§§ 68-11-1803(h), -1810) |
| Texas verified 2026-07-30 | Texas Advance Directives Act, Health & Safety Code ch. 166, Subchapter B (§§ 166.031–166.054): 'Directive to Physicians.' The § 166.033 statutory form is optional; providers may not require their own form (§ 166.036). Separate from a medical power of attorney and out-of-hospital DNR order. |
Written route: any competent adult, at any time (§ 166.032(a)). Nonwritten route: a competent adult who is already a 'qualified patient' with an attending-physician-certified terminal or irreversible condition (§§ 166.031(2), 166.034). |
Written directive signed by the adult; no specific form is mandatory (§§ 166.032, 166.036). A qualified patient may use a nonwritten means before the attending physician and two witnesses (§ 166.034). Digital/electronic signatures are allowed only if they meet § 166.011's verification, control, data-link, and persistence requirements. |
Written: two competent-adult witnesses, at least one disinterested, OR notarial acknowledgment instead (§§ 166.003, 166.032(b)–(b-1)). Nonwritten: attending physician plus two qualified witnesses; no notary substitute (§ 166.034). The disinterested witness cannot be the decision-maker, relative, heir/estate claimant, attending physician or employee, or specified facility employee (§ 166.003(2)). |
The attending physician must diagnose and certify in writing a terminal or irreversible condition (§§ 166.031(2), 166.040(a)). Before withholding or withdrawing treatment, the physician must confirm compliance with the statute and the patient's existing desires; the qualified patient's current desire supersedes the directive (§§ 166.037, 166.040(b)). |
May direct administering, withholding, or withdrawing life-sustaining treatment for a terminal or irreversible condition (§ 166.031(1)). The optional form offers discontinue/withhold except comfort OR continue treatment, and permits added instructions about artificial nutrition and hydration (§ 166.033). Nutrition/hydration is included in life-sustaining treatment; pain management and comfort care are excluded (§ 166.002(10)). |
A person may not withdraw or withhold life-sustaining treatment under Subchapter B from a pregnant patient (§ 166.049). The subchapter does not authorize mercy killing or an affirmative act or omission to end life beyond permitting the natural process of dying (§ 166.050). |
Revoke at any time regardless of mental state or competency by directed physical destruction, signed dated writing, or oral statement (§ 166.042(a)). Written and oral revocations take effect on notice or, for the writing, mailing to the attending physician, who records the event and marks the chart copy VOID (§ 166.042(b)–(c)). No patient filing is a validity step; § 166.053 is a provider-transfer registry, not a directive registry. |
A notified attending physician provides for qualified-patient certification and checks the proposed action against the statute and current wishes (§ 166.040). Failure to effectuate can trigger discipline; a refusing physician who does not use § 166.046 must continue life-sustaining treatment until a reasonable transfer opportunity exists (§ 166.045). A directive validly executed elsewhere has the same effect, subject to Texas prohibitions (§ 166.005). |
| Utah verified 2026-07-31 | Uniform Health Care Decisions Act, Utah Code §§ 75A-9-101–129, effective 2026-01-01. An advance directive may be a health-care instruction, health-care POA, or both; instruction means a direction, whether or not in a record, about providing/withholding/withdrawing health care (§ 75A-9-101). Instruction may share a record with POA; optional combined form at § 75A-9-110 |
An 'individual'—adult or emancipated minor—with decision-specific capacity: able to communicate with assistance/accommodation and understand the instruction's nature, consequences, primary risks, and benefits (§§ 75A-9-101(14), 75A-9-102). Capacity is presumed unless rebutted or found lacking (§ 75A-9-103) |
Instruction may be oral or in a physical/electronic record; provider documents a communicated/provided instruction and date (§§ 75A-9-101(12), 75A-9-106, 75A-9-115). Instruction-only route has no mandatory signature, directed-signer, date-on-document, witness, or notary. Optional form includes signature/date. If same record creates POA, § 75A-9-107's signature/witness formalities apply to that power |
No witness/notary for instruction alone. Combined POA: individual signs plus 1 adult witness who believes act voluntary/knowing; no notary alternative. Witness cannot be agent, agent's spouse/cohabitant, or—if individual resides/receives care in nursing home/assisted living—facility owner/operator/employee/contractor. Presence may be physical, live audio-video, or authenticated live audio (§ 75A-9-107) |
Instruction may state a future condition and is followed according to its terms; no mandatory diagnosis/incapacity trigger or fixed condition list (§§ 75A-9-101(12), 75A-9-106, 75A-9-120). Optional form offers incurable/soon-fatal condition, irreversible unconsciousness, and nonrecoverable loss of communication/self-care/recognition. Surrogate authority separately begins after a documented capacity finding, subject to objection/confirmation rules (§§ 75A-9-103–104, 75A-9-117) |
Instruction may direct any health care, including artificial nutrition/hydration and mechanical ventilation (§ 75A-9-101(10), (12)). Optional form separately asks about sustaining treatment, lifelong tube food/liquids, and pain relief under each condition, plus other instructions/priorities (§ 75A-9-110). Long-term-disability protection limits surrogate withdrawal of routinely accepted nutrition/hydration/ventilation unless express instruction or § 75A-9-118 alternative applies |
Current chapter 9 contains no pregnancy suspension, viability/live-birth test, or pregnancy-specific limit. It does not authorize mercy killing, assisted suicide, or euthanasia; no-directive status creates no presumption (§ 75A-9-126). Preserve separate mental-health, nursing-home-placement, and long-term-treatment protections without turning them into pregnancy or diagnosis rules |
Individual may revoke whole/part if capacity is not judicially or professionally found lacking; if objecting to professional finding, confirmation rules apply (§ 75A-9-114). Any clear act works, including oral statement to professional; later conflicting directive/instruction revokes earlier to conflict (§§ 75A-9-106(3), 75A-9-114). Provider documents instruction/revocation and record copy (§ 75A-9-120). No advance-directive registry appears in current chapter |
Provider/institution complies with instruction or reasonable surrogate interpretation, but may refuse for timely disclosed institutional conscience policy, unavailable care, permitted professional conviction, accepted standards, court order, or law; must notify, immediately seek transfer, and continue specified life-sustaining/comfort care pending transfer or statutory period (§ 75A-9-120). Foreign directive valid under named/creation state or Utah law; electronic form cannot alone defeat effect, and copies equal originals (§§ 75A-9-115, 75A-9-124) |
| Vermont verified 2026-07-31 | 18 V.S.A. ch. 231. A single written 'advance directive' may appoint an agent and include the adult's own health-care desires or treatment goals; it is distinct from a clinician's DNR/COLST order (§§ 9701(1), (6), (8), 9702) |
Adult with capacity (§§ 9701(4), (23), 9703(a)). Capacity to decide health care means a basic understanding of the condition and the benefits, risks, and alternatives to the proposed care |
Written, dated directive signed by principal, or by another in principal's presence and at express direction if physically unable (§§ 9701(1), 9703(b)). Digital signature permitted. No oral-creation route; no mandatory statutory form (§ 9703(g)) |
2+ witnesses age 18+; no notary alternative (§ 9703(b)). Physical presence OR remote witness known to principal using live audio-video or telephone, with witness contact/relationship recorded. Agent and principal's spouse, parent, adult sibling, adult child, adult grandchild cannot witness. Facility patient/resident also needs authorized explainer (§ 9703(b)-(e)) |
No universal terminal diagnosis. Directive may take effect on execution, on a maker-selected circumstance even unrelated to capacity, or by default after principal's clinician determines incapacity, records cause/nature/projected duration, and makes reasonable notice efforts (§§ 9702(a)(3)-(4), 9706) |
May direct desired or rejected health care, hospitalization/transfer, specific treatment, and any emergency/short- or long-term life-sustaining treatment, including medically administered nutrition/hydration (§ 9702(a)(5), (7), (12)). Natural eating/drinking includes spoon feeding and is outside that defined medical-means category (§ 9701(19)-(20)) |
No default pregnancy override. Adult may direct which life-sustaining treatment is desired or not desired if pregnant when directive becomes effective (§ 9702(a)(8)). Withholding/withdrawal under directive is not suicide; chapter preserves existing law on intentionally hastened death and permits professionally appropriate suffering-relief medication (§ 9715) |
With or without capacity, may revoke non-agent treatment instructions orally, in writing, or by any act showing specific intent; signed statement, clinician notice entered in record, or burning/tearing/obliterating also revoke all/part (§ 9704). Deliver applicable directive to provider (§ 9705). Registry submission is optional; providers record/flag revocation and notify registry when applicable (§§ 9701(28), 9704(c), 9709(c)(3)) |
Provider must check for effective directive and follow it unless inconsistent with directive/chapter, unlawful/professionally impermissible, or subject to moral/ethical conflict; conflict route requires prompt notice, transfer help, ongoing care, and record documentation (§ 9707). Good-faith statutory compliance is immune (§ 9713); valid out-of-state directive remains enforceable, compliant Vermont directive is presumed valid, and copies count (§§ 9716-9717) |
| Virginia verified 2026-07-30 | Virginia Health Care Decisions Act, Va. Code §§ 54.1-2981–2995. A single 'advance directive' may give treatment instructions, appoint an agent, or both (§ 54.1-2983). The § 54.1-2984 combined form is suggested, not mandatory. |
Any adult capable of making an informed decision (§§ 54.1-2982 to -2983). A written directive may be made at any time; the oral route is limited to a capable adult already diagnosed by the attending physician with a terminal condition (§ 54.1-2983). |
Written: declarant signs in the presence of two subscribing witnesses (§ 54.1-2983). Oral: after terminal-condition diagnosis, made before the attending physician and two witnesses. The Act states no directed-signature or electronic-specific execution path. |
Two witnesses for either route; no notary alternative (§ 54.1-2983). A witness may be any person over 18, expressly including a spouse or blood relative; good-faith facility and physician-office employees may witness (§ 54.1-2982). |
A written directive may address any or all health care once the adult is incapable of the particular informed decision (§§ 54.1-2982 to -2983). The attending physician certifies incapacity in writing after personal examination and normally obtains an independent capacity reviewer's written certification, repeated at least every 180 days; reviewer confirmation is waived for unconsciousness or profound consciousness impairment (§ 54.1-2983.2). Terminal condition includes imminent death or persistent vegetative state (§ 54.1-2982). |
May authorize or refuse any health care (§ 54.1-2983). 'Life-prolonging procedure' includes artificially administered hydration and nutrition; comfort and pain relief remain permitted (§ 54.1-2982). The optional form separately addresses general care, terminal-condition procedures, respiration, CPR, nutrition, hydration, comfort, and pain (§ 54.1-2984). |
The optional form lets a declarant modify terminal-condition life-prolonging-procedure instructions for pregnancy (§ 54.1-2984); the Act states no categorical pregnancy suspension. The Act does not authorize mercy killing, euthanasia, or an affirmative or deliberate act or omission to end life beyond permitting natural dying (§ 54.1-2990). |
While capable of understanding the act's nature and consequences, revoke all or part by signed dated writing, directed destruction in the declarant's presence, or oral expression; effective when communicated to the attending physician (§ 54.1-2985). Optional Advance Health Care Planning Registry filing (§§ 54.1-2983, -2995); removal of a registered revocation requires notarization, but failure to remove it does not defeat an otherwise valid revocation. |
A notified attending physician promptly records the written directive/copy or fact of an oral directive (§ 54.1-2983). A refusing physician makes reasonable transfer efforts (§ 54.1-2987); medically/ethically inappropriate-care disputes use written reasons, hospital review, at least 14 days for transfer while requested life-sustaining treatment continues, court review, nutrition/hydration limits, and continuing comfort care (§ 54.1-2990). Another-state directive is valid if executed under Virginia or execution-state law and is construed under Virginia law (§ 54.1-2993). |
| Washington verified 2026-07-30 | Natural Death Act, RCW ch. 70.122: written 'directive' or 'health care directive' to withhold/withdraw life-sustaining treatment (§§ 70.122.020, .030). The § .030 form is optional and may include added directions; separate from a durable power of attorney and POLST. |
Any 'adult person': a person who has reached majority and has capacity to make health-care decisions (§§ 70.122.020(1), .030(1)). |
Written directive signed by the declarer (§§ 70.122.020(3), .030(1)). Chapter 70.122 provides no oral or directed-signature execution route and states no electronic-specific signing method. |
Either acknowledgment before a notary/other acknowledgment officer OR two witnesses (§ 70.122.030(1)). Witnesses cannot be related by blood/marriage, inherit under the current will or intestacy, be the attending physician, the physician's or patient's facility's employee, or hold an estate claim. |
Terminal condition: attending physician's written diagnosis after personal exam. Permanent unconscious condition: written diagnosis by two physicians, one attending, both after personal exam (§§ 70.122.020(6), (8), .030(2)). The directive governs when life-sustaining treatment would only prolong dying; if the patient remains capable, proposed steps must match current desires (§ 70.122.060(1)). |
Directs withholding/withdrawal of life-sustaining treatment for a terminal or permanent unconscious condition (§ 70.122.030). Life-sustaining treatment includes artificially provided nutrition and hydration, but the model form makes provide/do-not-provide a separate election. Pain-alleviating medication/procedures are excluded from life-sustaining treatment (§ 70.122.020(5)). |
No pregnancy-specific restriction appears in current ch. 70.122; the 2025 amendment removed pregnancy references from the model form. The chapter does not authorize mercy killing, lethal injection, or active euthanasia (§ 70.122.100). |
Revoke at any time regardless of mental state/competency by directed destruction, signed dated writing, verbal expression, or registry online method (§ 70.122.040). Written/verbal revocation takes effect on communication to the attending physician, who records it. Optional state registry; nonfiling does not affect validity, and failure to update a valid revocation does not defeat it (§ 70.122.130). |
Attending physician verifies compliance and current desires (§ 70.122.060). A physician/facility policy may decline to honor the directive if disclosed and a written plan is filed; individual practitioners may refuse participation. The unrevoked directive is conclusively presumed to state the patient's directions, with good-faith immunity. An out-of-jurisdiction directive is valid only to the extent Washington and federal constitutional law permit (§ 70.122.030(3)). |
| West Virginia verified 2026-07-31 | West Virginia Health Care Decisions Act, W. Va. Code §§ 16-30-1–16-30-25. A 'living will' is a written, witnessed directive for withholding/withdrawing life-prolonging intervention; it may stand alone or be combined with a medical power of attorney. Section 16-30-4(g), (i) forms are optional and may include consistent added directions |
Any competent adult may execute at any time (§ 16-30-4(a)). 'Adult' includes age 18+, an emancipated minor, or a mature minor with clinician-determined decision capacity (§ 16-30-3). Execution competence is presumed absent actual contrary notice when the person later is incapacitated (§ 16-30-6(g)) |
Must be in writing, dated, and executed by the principal; if physically unable, another may sign in the principal's presence at express direction (§ 16-30-4(a)). No oral or nonverbal creation route and no electronic-specific execution route in Article 30 |
At least 2 witnesses age 18+; they sign and attest, and their signatures/attestations must be acknowledged before a notary (§ 16-30-4(a)). Witness cannot be directed signer, blood/marriage relative, known heir, person financially responsible for care, attending physician, representative, or successor (§ 16-30-4(b)) |
Statutory form applies when the person is very sick and unable to communicate and one personally examining physician certifies a terminal condition (§§ 16-30-3, 16-30-4(g)). Attending physician then confirms, certifies, and documents terminal condition; incapacity is personally examined and contemporaneously recorded by an authorized physician, psychologist, physician assistant, or APRN (§§ 16-30-7, 16-30-19). No persistent-vegetative-state trigger |
Living will/form directs withholding/withdrawal of life-prolonging intervention, including CPR, ventilator, dialysis, and IV/tube food and fluids (§§ 16-30-3, 16-30-4(g)). Comfort and pain procedures are excluded from life-prolonging intervention; form requests pain relief and offers oral food/fluids as desired and tolerated |
Article 30 and its statutory living-will form state no pregnancy, viability, or live-birth restriction. The Act does not legalize, condone, authorize, or approve mercy killing or assisted suicide (§§ 16-30-2, 16-30-15) |
Principal may revoke anytime by directed destruction, signed dated writing delivered to attending physician, or oral expression before an adult witness who signs/dates confirmation; oral route is effective on communication to attending physician, who records notice (§ 16-30-18). Article 30 states no registry filing or registration validity requirement; principal/representative must notify providers and presented documents/revocations enter the medical record (§ 16-30-4(d)) |
Good-faith/reasonable-medical-standard compliance is immune; noncomplying attending physician must effect transfer, while conscience objector promptly informs and cooperates in transfer (§§ 16-30-10, 16-30-12). Actual-knowledge noncompliance can draw licensing review (§ 16-30-22). Another-state directive is valid if compliant there or in WV (§ 16-30-21) |
| Wisconsin verified 2026-07-31 | Wis. Stat. ch. 154, subch. II (§§ 154.02–154.15): written 'Declaration to Health Care Professionals' (Wisconsin Living Will). The § 154.03(2) statutory form is optional in form and substance. Separate from ch. 155 health-care-agent appointment and DNR orders. |
Any person of sound mind who is age 18+ may execute (§ 154.03(1)). Chapter 154 does not create a separate post-diagnosis oral route; a directed signer may sign only for a physically unable adult at the adult's express direction and in the adult's presence. |
Written and signed by the adult before 2 witnesses; if physically unable, a witness or other person signs the adult's name at express direction and in the adult's presence, with signing or acknowledgment before both witnesses (§ 154.03(1)). No oral declaration or general e-signature route. Lawyer-supervised, real-time audiovisual presence is permitted under § 154.03(3)'s Wisconsin-location, identity, delivery/counterpart, and affidavit conditions. |
2 witnesses, each age 18+; neither may be related by blood/marriage/adoption, know of an estate entitlement or claim, be directly financially responsible for care, or be a serving provider or disallowed provider/facility employee (§ 154.03(1)). Chaplains and social workers are excepted from the employee bar. The form says all 3 sign at the same time. No notary alternative. |
Terminal condition or persistent vegetative state, diagnosed and certified in writing by 2 health care professionals who personally examine the adult; one must be the attending professional and one a physician (§§ 154.01, 154.02). No separate incapacity certification: the declaration takes effect on execution, but a competent qualified patient's current desires always supersede (§§ 154.03(1), 154.07(2)). |
May authorize withholding/withdrawal of life-sustaining procedures or feeding tubes (§ 154.03). Life-sustaining procedure excludes pain relief and all nutrition/hydration; feeding tube is separately defined. Withdrawal cannot be authorized if it causes pain or reduced comfort that pain relief cannot alleviate; non-tube nutrition/hydration may be withdrawn only if medically contraindicated. The statutory form defaults unchecked feeding-tube and persistent-vegetative-state treatment boxes to use. |
A qualified patient's declaration has no effect during pregnancy once the attending professional diagnoses pregnancy, with no viability or prognosis exception stated (§ 154.07(2)). The subchapter does not authorize an affirmative or deliberate act to end life beyond permitting natural dying (§ 154.11(6)). |
Revoke anytime by directed physical destruction, signed dated writing, verbal expression, or later declaration (§ 154.05). Verbal revocation becomes effective only when the attending professional is notified; that professional records revocation and notice details. The adult notifies the attending professional of the declaration, which enters the chart (§ 154.03). Optional fee-based safekeeping with the county register in probate creates no presumption if omitted (§ 154.13). |
A refusing professional must make a good-faith transfer attempt or commits unprofessional conduct; providers receive the stated immunity, including for unknown revocations (§ 154.07). Current competent wishes control. Original, legible photocopy, or electronic facsimile is presumed valid and goes in the medical record; an out-of-state document is enforceable to the extent consistent with Wisconsin law (§ 154.11(5m), (8)–(9)). |
| Wyoming verified 2026-07-31 | Wyoming Health Care Decisions Act, Wyo. Stat. §§ 35-22-401 to -416. 'Advance health care directive' means individual instruction, health-care POA, or both; 'individual instruction' is direction about individual's own health-care decision (§ 35-22-402). No codified fill-in form. Treatment instruction remains distinct from agent appointment, psychiatric directive, CPR directive, and POLST |
Adult OR emancipated minor may give instruction (§ 35-22-403(a)). Capacity means ability to understand significant benefits, risks, alternatives and make/communicate decision (§ 35-22-402(a)(iv)); presumed unless primary physician certifies lack in writing (§ 35-22-412(b)). No directed-signer rule is needed for oral instruction; chapter states none for written instruction alone |
Instruction may be oral or written and limited to take effect on specified condition (§ 35-22-403(a)). No signature, date, delivery, acknowledgment, witness, notary, or electronic-specific requirement for instruction alone. Writing/signature and notary-or-witness rules in § 35-22-403(b) apply to health-care POA, not standalone instruction |
No witness or notary for standalone individual instruction (§ 35-22-403(a)). Notary OR 2-witness verification and provider/agent/care-facility witness bars in § 35-22-403(b)–(c) govern health-care POA only. Do not import those execution blocks—or any unrelated/non-heir witness rule, which Wyoming does not have—into instruction-only validity |
No universal incapacity, terminal, permanent-unconsciousness, or clinician trigger; maker may state instruction now or condition it (§ 35-22-403(a)). Unless written directive specifies otherwise, primary physician determines capacity/recovery or other condition affecting instruction; treating primary health-care provider may decide if physician unavailable (§ 35-22-403(e)). Capable individual's current decision remains controlling (§ 35-22-412(a)) |
Instruction may direct any health-care decision, including provide/withhold/withdraw artificial nutrition/hydration and all other care (§ 35-22-402(a)(ix), (xi)). Artificial nutrition/hydration includes tube/IV food or water but excludes assisted spoon/bottle feeding (§ 35-22-402(a)(iii)). Act prints no preset terminal/PVS/pain choices. Provider may refuse medically ineffective or generally accepted-standard-conflicting care (§ 35-22-408(f)) |
Health Care Decisions Act §§ 35-22-401 to -416 state no pregnancy-specific suspension, viability, or live-birth test. Act does not authorize mercy killing, assisted suicide, euthanasia, or care prohibited by other Wyoming statutes (§ 35-22-414(c)); involuntary mental-health treatment and psychiatric directives remain under separate law (§ 35-22-414(e)). Existing CPR directive stays effective unless advance directive specifically revokes it (§ 35-22-414(f)) |
Individual WITH capacity may revoke instruction anytime/in any manner communicating intent; oral revocation must ASAP be documented in signed, dated writing by individual or witness (§ 35-22-404(b)). Later conflicting directive revokes earlier to conflict. Informed provider/agent/guardian/surrogate promptly relays revocation to primary health-care provider and institution (§ 35-22-404(c)); primary provider records known directive/revocation and maintains furnished copy (§ 35-22-408(b)). No registry in Act |
Provider/institution complies with instruction/reasonable interpretation; conscience/policy or medically ineffective/accepted-standard refusal requires prompt notice, continuing care including life-sustaining care, and immediate reasonable transfer efforts unless assistance refused (§ 35-22-408). Good-faith, accepted-standard immunity (§ 35-22-410). Directive valid if it complied with applicable law at time of execution or communication (§ 35-22-403(j)); copy equals original (§ 35-22-413) |
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