Pennsylvania: Living Will and Advance Health-Care Instruction Requirements
The short answer
Pennsylvania uses a written living will dated and signed or marked by an eligible person before two adult witnesses; notarization is optional, not a substitute. It becomes operative after a copy reaches the attending physician and that physician determines the person is incompetent and has an end-stage medical condition or is permanently unconscious. A pregnancy rule generally requires life-sustaining treatment, nutrition, and hydration unless one of three physician-and-obstetrician-certified exceptions applies.
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This is the general rule in Pennsylvania. Ezel applies current Pennsylvania law to your specific facts and answers with citations to the statutes.
| Governing law and document | 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 |
|---|---|
| Who may make an instruction | Individual of sound mind who is age 18+, a high-school graduate, married, or an emancipated minor (§ 5442(a)) |
| Oral, written, and signature form | 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 |
| Witness, notary, and disqualifications | 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) |
| Covered conditions and trigger | 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) |
| Treatment, nutrition, hydration, and comfort | 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 |
| Pregnancy and other statutory limits | 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) |
| Revocation, notice, and registry | 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)) |
| Provider duties, recognition, and effect | 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)) |
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Pennsylvania's Living Will Act is Subchapter B of Title 20, Chapter 54. A
living will is the adult's written treatment instruction; it may stand alone or
appear inside the combined directive form that also appoints an agent.
Requirements one by one
Execution uses a dated writing and two adult witnesses
Under § 5442, a person of sound mind may make a living will if age 18 or
older, a high-school graduate, married, or an emancipated minor. The instrument
must be dated and signed or marked by the principal. If the principal cannot
sign, another individual may sign on the principal's behalf and at the
principal's specific direction.
Two witnesses age 18 or older are required. The directed signer cannot also be
a witness. A provider or its agent furnishing care to the principal cannot sign
for the principal. The statute does not require a notary; the § 5471 example
expressly labels notarization optional.
The living will becomes operative only after delivery and findings
§ 5443 requires a copy to be provided to the attending physician. That
physician must determine that the principal is incompetent and has an end-stage
medical condition or is permanently unconscious, then promptly certify the
condition in writing.
An end-stage medical condition is incurable, irreversible, advanced, and will
result in death despite treatment. Permanent unconsciousness is total and
irreversible loss of consciousness and environmental interaction, including an
irreversible vegetative state or coma. The living will remains valid until
revoked unless it states a termination time.
Treatment directions may address nutrition, hydration, and comfort
Sections 5442 and 5447 permit written directions to initiate, continue,
withhold, or withdraw life-sustaining treatment. Artificial nutrition and
hydration are included only when the advance directive specifically provides
for them under § 5422.
The statutory § 5471 example separately offers tube-feeding choices and directs
treatment to relieve pain or provide comfort even if it might shorten life,
suppress appetite or breathing, or be habit forming. The example is not the
only permitted form; § 5447 allows any written form expressing the principal's
wishes.
Pregnancy has three certified exceptions
Under § 5429, life-sustaining treatment, nutrition, and hydration generally
continue for an incompetent pregnant woman with an end-stage condition or
permanent unconsciousness despite a contrary living will. The rule yields only
when the attending physician and an examining obstetrician certify in the
medical record that the measures will not permit continuing development and
live birth, will physically harm the woman, or will cause pain that medication
cannot alleviate.
Chapter 54 also states that it does not authorize mercy killing, euthanasia,
aided suicide, or an affirmative or deliberate act or omission to end life
beyond the chapter's terms (§ 5423).
Revocation may occur at any time and in any manner
§ 5444 lets the principal revoke regardless of mental or physical condition.
Revocation takes effect when the principal or a witness communicates it to the
attending physician or another provider, which must add the revocation to the
medical record. Chapter 54 creates no directive registry.
Providers must comply or pursue transfer
Once operative, providers follow the living will or use the § 5424 process. A
provider that cannot comply in good conscience, or whose policy bars compliance,
must notify the proper person and make every reasonable effort to assist a
transfer to a willing provider. A copy supplied to a provider becomes part of
the principal's medical record.
Pennsylvania recognizes a living will made in another jurisdiction under that
jurisdiction's law, except to the extent it directs procedures inconsistent
with Pennsylvania law (§ 5446).
What trips people up
- Signing does not make the instruction immediately operative. Delivery,
incompetence, and one of the two statutory medical conditions are required. - Notarization is optional. It does not replace the two adult witnesses.
- Nutrition and hydration must be addressed specifically to fall within the
directive's life-sustaining-treatment definition. - HB 2701 would rewrite this architecture. It was introduced July 14, 2026
and remains in the House Health Committee; it is not current law.
Common questions
Must I use the long combined statutory example?
No. Section 5447 permits any written form that expresses the required wishes.
May someone sign for me?
Yes, if you are unable to sign and specifically direct that person to sign on
your behalf. That directed signer cannot serve as a witness.
Can I revoke after losing capacity?
Yes. Section 5444 says revocation may occur at any time and in any manner,
regardless of the principal's mental or physical condition.
Will an out-of-state living will be recognized?
Yes if it complied with the law where made, except for procedures inconsistent
with Pennsylvania law.
Statutes and sources
- 20 Pa.C.S. §§ 5422-5424 and 5429 — definitions, provider transfer, and
pregnancy. Official Title 20 PDF
(accessed 2026-07-30). - 20 Pa.C.S. §§ 5441-5447 — Living Will Act execution, operation,
revocation, validity, and form. Official Title 20 PDF
(accessed 2026-07-30). - 20 Pa.C.S. § 5471 — optional combined example, comfort care, tube
feeding, witnesses, and optional notarization. Official Title 20 PDF
(accessed 2026-07-30). - PA HB 2701, PN 3772 — pending proposed replacement framework. Official
bill text
(checked 2026-07-30).
Source links
Every statute quoted above, linked, with the date we checked it.
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