Living Will and Advance Health-Care Instruction Requirements in District of Columbia
At a glance
| Governing law and document | 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 |
|---|---|
| Who may make an instruction | 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)) |
| Oral, written, and signature form | 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 |
| Witness, notary, and disqualifications | 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) |
| Covered conditions and trigger | 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)) |
| Treatment, nutrition, hydration, and comfort | 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 |
| Pregnancy and other statutory limits | 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)) |
| Revocation, notice, and registry | 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 |
| Provider duties, recognition, and effect | 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 |
The District's living will is a standalone declaration under the Natural Death Act, D.C. Code §§ 7-621 to 7-630. It is separate from the durable power of attorney for health care in Title 21 and from a clinician's DNR order.
Requirements one by one
The declaration needs a writing, date, signature, and qualified witnesses
Under § 7-622(a), the declarant must be at least 18. The declaration is in writing, dated, and signed personally or by another person in the declarant's presence and at the declarant's express direction. At least two witnesses age 18 or older must sign in the declarant's presence. A notary is not an alternative.
Every witness must be independent under the statute. A witness cannot be the directed signer; a blood, marriage, or domestic-partner relative; an intestate, will, or codicil beneficiary; a person directly financially responsible for the declarant's care; the attending physician; that physician's employee; or an employee of the facility where the declarant is a patient.
If the declarant is in an intermediate-care or skilled-care facility when the declaration is signed, one of the two witnesses must be a patient advocate or ombudsman who also satisfies the ordinary witness qualifications (§ 7-623).
Two physicians certify the terminal condition
A qualified patient has both a properly executed declaration and a terminal condition diagnosed and certified in writing by two physicians who personally examined the patient, one of them the attending physician (§ 7-621(5)). The condition must be incurable and produce death regardless of life-sustaining procedures, which would only postpone death.
After certification, the attending physician informs the patient verbally or in writing and documents that communication. If the patient cannot comprehend the communication, qualification occurs immediately upon written certification and confirmation (§ 7-625). The statute does not require a separate incapacity certificate, and a qualified patient's present desires always supersede the declaration (§ 7-626(a)).
The declaration preserves comfort and pain care
The statutory form directs withholding or withdrawal of procedures that would only artificially prolong dying and directs that the declarant be allowed to die naturally with medication and procedures necessary for comfort care or pain relief. The definition of life-sustaining procedure likewise excludes that comfort and pain care (§ 7-621(3)).
The form may contain additional specific directions consistent with the subchapter. But the Natural Death Act states no separate artificial-nutrition- or-hydration definition or election. Treatment choices printed in the separate health-care power-of-attorney form should not be imported into this declaration.
What trips people up
- The facility witness is validity-critical. A declaration signed while the patient is in an intermediate-care or skilled-care facility has no effect unless one witness is a qualified patient advocate or ombudsman (§ 7-623).
- Revocation uses only the listed routes. The declarant may destroy or deface the declaration, sign and date a written revocation, or verbally revoke before an adult witness who signs and dates a confirmation. Written and verbal revocations become effective only when communicated to the attending physician under § 7-624.
- There is no pregnancy-specific provision. Sections 7-621 through 7-630 state no pregnancy suspension, viability test, or live-birth rule. The Act's express boundary instead is § 7-630's prohibition on mercy killing and deliberate life-ending acts outside the natural-dying process it authorizes.
Common questions
May a notary replace the witnesses? No. § 7-622(a)(4) requires at least two qualified adult witnesses and provides no notarial alternative.
Can I change my mind after losing capacity? The revocation rule applies without regard to mental state and reserves the act to the declarant or someone acting at the declarant's express direction. The method and, for written or verbal revocation, communication requirements in § 7-624 still must be followed.
What if the attending physician will not comply? The physician must work with the patient's next of kin or another responsible individual to transfer the qualified patient to a physician who will honor the declaration (§ 7-627(b)). Good-faith conduct under reasonable medical standards receives the immunity stated in § 7-627(a).
Does D.C. maintain a living-will registry? The Natural Death Act establishes no registry. The declarant is responsible for notifying the attending physician, who places the declaration or a copy in the medical record (§ 7-622(b)).
Statutes and sources
- D.C. Code §§ 7-621 to 7-623 — definitions, execution, form, witness qualifications, and facility advocate or ombudsman. D.C. Law Library (accessed 2026-07-31).
- D.C. Code §§ 7-624 to 7-626 — revocation, two-physician certification, communication, present wishes, and validity presumption. Same official source (accessed 2026-07-31).
- D.C. Code §§ 7-627 to 7-630 — immunity, transfer, suicide and insurance effects, preserved rights, and statutory limits. Same official source (accessed 2026-07-31).
Source links
Every statute quoted above, linked, with the date we checked it.
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