Living Will and Advance Health-Care Instruction Requirements in Alabama

At a glance

Alabama's Natural Death Act uses a written Advance Directive for Health Care. The document can contain a living will, a health care proxy designation, or both. This page addresses the adult's own living-will instructions, not the separate proxy appointment or the chapter's clinician-order and minor-care provisions.

Requirements one by one

The adult must use a written, witnessed directive

Under § 22-8A-3, a competent adult is at least 19, alert, able to understand a lay description of the procedures, and able to appreciate the consequences of providing, withholding, or withdrawing them. Section 22-8A-4(c) requires the directive to be written, dated, and signed by the adult or by another person in the adult's presence and at the adult's expressed direction.

Two witnesses age 19 or older must be present for signing. A witness cannot be the directed signer, a named health care proxy, a relative by blood, adoption, or marriage, someone entitled to inherit under intestacy or a will, or someone directly financially responsible for the adult's medical care. The Natural Death Act does not offer notarization in place of those witnesses.

Under § 22-8A-4(h), the directive must be substantially in the statutory form but may add other specific directions. The form puts the living will and optional proxy designation in one instrument; a proxy is not required for the adult's treatment instructions to be followed.

Incapacity and a two-physician diagnosis activate it

Execution and operation are separate. Under § 22-8A-4(d), the attending physician must determine that the adult can no longer understand, appreciate, and direct medical treatment. Two physicians who personally examined the adult must also diagnose and document either terminal illness or injury or permanent unconsciousness. One must be the attending physician, and one must be qualified and experienced in making the diagnosis.

The chapter defines permanent unconsciousness as a condition that, to a reasonable degree of medical certainty, will last permanently without improvement and lacks cognitive thought, sensation, purposeful action, social interaction, and awareness after enough time under professional standards to make the diagnosis. The statutory form translates the terminal route as an incurable condition likely to cause death in the near future.

Treatment and tube feeding are separate choices

Under § 22-8A-4(a), the living will may direct providing, withholding, or withdrawing life-sustaining treatment and artificially provided nutrition and hydration. The statutory form asks separately about life-sustaining treatment and food and water through a tube or IV, once for terminal illness or injury and again for permanent unconsciousness.

Artificial nutrition and hydration may not be withheld or withdrawn through the living will unless the document specifically authorizes it. Medication or treatment that the attending physician considers necessary for comfort or pain relief is excluded from the chapter's definition of life-sustaining treatment.

Pregnancy suspends the directive

Under § 22-8A-4(e), an advance directive has no effect during the pregnancy when the attending physician knows the adult is pregnant. The provision states no viability, gestational-age, prognosis, or live-birth exception.

Section 22-8A-10 separately says the chapter does not authorize mercy killing, physician-assisted suicide, or another affirmative or deliberate act or omission to end life beyond allowing the natural dying process provided by the chapter.

Revocation includes a witnessed verbal route

Section 22-8A-5 permits revocation at any time through intentional destruction or defacement; a signed, dated writing by the adult or a person acting at the adult's direction; or a verbal expression before one witness age 19 or older who signs and dates a written confirmation. A verbal revocation becomes effective when the attending physician or provider receives that confirmation. The provider records the time, date, and place of notice in the medical record.

Section 22-8A-14 separately permits optional recording with the probate judge in the adult's county of residence for $5 plus any other fee required by law. The filing is not open for general public inspection, does not affect the living will's validity, and does not require a provider to search probate records. It is county recording, not a central directive registry.

A refusing provider must assist transfer

The adult is responsible for giving the attending physician and other treating providers a copy, and the provider places it in the medical record under § 22-8A-4(f). While the adult can still decide, the adult's current desires always supersede the directive under § 22-8A-7.

A provider refusing to comply must promptly advise the adult and any designated decision-maker, permit transfer, and reasonably cooperate in a timely transfer to a provider that will follow the living will. During transfer, § 22-8A-8 requires continued life-sustaining treatment, including resuscitation and artificial nutrition and hydration. Good-faith statutory compliance under reasonable medical standards receives the immunity stated in § 22-8A-7.

An advance directive executed in another state in compliance with that state's law or Alabama law is valid for this chapter under § 22-8A-12, but it cannot authorize care otherwise prohibited by Alabama law.

What trips people up

• Alabama's adult age is 19. The maker and both witnesses must meet that age threshold.
• The two medical conditions are alternatives, but incapacity is also required. Terminal illness or injury and permanent unconsciousness are the condition routes; the attending physician's inability-to-direct-treatment finding is a separate part of the trigger.
• Tube feeding must be addressed specifically. A general direction about life-sustaining treatment does not itself authorize withholding or withdrawal of artificial nutrition and hydration.
• Probate recording is optional. It neither creates validity nor replaces giving the document to treating providers.
• Treatment continues during a refusal transfer. Alabama requires all life-sustaining measures, resuscitation, and artificial nutrition and hydration to be maintained until transfer.

Common questions

Does an Alabama living will need a notary?

No notary substitute appears in the Natural Death Act. The directive must be signed in the presence of two qualified witnesses age 19 or older.

May I make the living will orally?

No. The directive itself must be written, signed, dated, and witnessed. A verbal statement is available for revocation, but only with the witness and written-confirmation steps in § 22-8A-5.

Does my current decision still control after I sign?

Yes. Section 22-8A-7 says the individual's desires always supersede the advance directive. The document is for the later period after the statutory findings are made.

Will Alabama recognize a directive signed elsewhere?

Yes, if it complied with the execution law of that state or Alabama. Alabama's own prohibitions on administering, withholding, or withdrawing care still apply.

Statutes and sources

• Ala. Code §§ 22-8A-1 and 22-8A-3 — Natural Death Act name and definitions of adult, competent adult, advance directive, living will, life-sustaining treatment, terminal illness or injury, and permanent unconsciousness. Official code (accessed 2026-07-31).
• Ala. Code § 22-8A-4 — permitted treatment directions, writing, directed signature, date, witness rules, medical trigger, pregnancy, delivery to providers, and substantially statutory form. Official code (accessed 2026-07-31).
• Ala. Code § 22-8A-5 — destruction, signed-writing, and witnessed-verbal revocation routes; receipt and medical-record notation. Official code (accessed 2026-07-31).
• Ala. Code §§ 22-8A-7 and 22-8A-8 — current wishes, good-faith immunity, provider refusal, timely transfer, and maintenance of treatment during transfer. § 22-8A-7 and § 22-8A-8 (accessed 2026-07-31).
• Ala. Code §§ 22-8A-10 and 22-8A-12 — natural-dying boundary and out-of-state validity subject to Alabama prohibitions. § 22-8A-10 and § 22-8A-12 (accessed 2026-07-31).
• Ala. Code § 22-8A-14 — optional county-probate recording, fees, limited inspection, no validity effect, and no provider search duty. Official code (accessed 2026-07-31).