Living Will and Advance Health-Care Instruction Requirements in South Carolina

At a glance

South Carolina's living will is a Declaration of a Desire for a Natural Death under the Death With Dignity Act. It is a narrow instruction about life- sustaining procedures in a terminal condition or permanent unconsciousness. It is not the separate Title 62 health care power of attorney.

Requirements one by one

The statutory form and oath process are mandatory

Under § 44-77-40 and § 44-77-50, the declaration must substantially follow the statutory form. The adult dates and personally signs it before an officer authorized to administer oaths and two witnesses. One witness may also be the oath officer. Chapter 77 supplies no route for another person to sign the adult's name and no oral or electronic execution method.

The two witnesses subscribe the statutory affidavit, and at least one is sworn while the adult, both witnesses, and oath officer are present. The form's revocation procedures must appear in boldface or all capital letters using characters at least as large as the rest of the declaration.

Witness eligibility depends on relationship, finances, and care setting

Neither witness may fall within the listed family relationships, pay directly for the adult's medical care, inherit under a will or intestacy, be a life- insurance beneficiary, be the attending physician or that physician's employee, or hold an estate claim. No more than one may be an employee of the facility where the adult is a patient.

A hospital patient or nursing-care-facility resident needs an additional safeguard: § 44-77-40(3) requires a State Ombudsman-designated ombudsman to serve as one of the two witnesses.

Two physician certifications and active treatment precede effect

Under § 44-77-30, the attending physician and another physician must personally examine the adult and certify a terminal condition or permanent unconsciousness. A permanent-unconsciousness certification ordinarily cannot be made until 90 consecutive days of unconsciousness. Earlier certification is allowed for massive cortical destruction or atrophy, or another condition feature permitting the diagnosis with a high degree of medical certainty.

Every patient diagnosed with the life-threatening terminal or permanent- unconscious condition receives at least six hours of active treatment before the physician gives effect to the declaration. The statutory form addresses the adult's absence of ability to give directions; the chapter does not add a separate incapacity-certificate procedure.

Tube nutrition and hydration require separate choices

The declaration directs withholding or withdrawal of defined life-sustaining procedures and continued medication or procedures necessary for comfort care. Under § 44-77-20 and § 44-77-50, tube nutrition and hydration are addressed separately for a terminal condition and again for permanent unconsciousness.

For each condition, the adult initials provide or do-not-provide. If the adult does not initial the nutrition and hydration statements, the statute preserves nutrition and hydration necessary for comfort care or pain relief.

Pregnancy makes the declaration ineffective

Under § 44-77-70, after pregnancy is diagnosed, the declaration is not effective during the pregnancy. It gives no viability, gestational-age, live-birth, or prognosis exception.

Under § 44-77-130, Chapter 77 does not authorize mercy killing or an affirmative or deliberate act or omission to end life beyond permitting natural dying.

Most revocations wait for communication to the attending physician

Under § 44-77-80, the adult may revoke by destruction, a signed dated writing, a qualifying oral expression, an authorized designee's temporary or permanent revocation while the adult is incompetent, or a later declaration. The designee is the limited person named in the form to revoke; this is not a general health care agent appointment.

Except when the only original is destroyed, effectiveness turns on communication to the attending physician. The physician records the required time, date, place, and notice details. An oral revocation conveyed by another person has added presence, prompt-communication, and inability-to-confirm conditions. Chapter 77 has no directive registry.

Refusal triggers transfer, while court enforcement is optional

The declaration is self-executing under § 44-77-85. A named enforcement agent or another interested person may petition the common pleas court, but the declaration does not need a court order to be valid or implemented.

Good-faith certification and compliance receive the immunity in § 44-77-90. Under § 44-77-100, an unwilling physician or facility must make reasonable efforts to find a willing provider and transfer the patient; a physician's failure to comply without reasonable transfer efforts may be unprofessional conduct. South Carolina also recognizes a domicile-state declaration that expresses substantially the same intent as its own statute.

What trips people up

• A notary-style oath officer is part of execution. It is not merely an optional acknowledgment added after two witness signatures.
• Facility residents need an ombudsman witness. An ordinary second witness does not replace that statutory safeguard.
• Permanent unconsciousness usually has a 90-day clock. The statute states narrow earlier-certification routes, not a general physician waiver.
• Pregnancy is categorical. The declaration has no effect during the pregnancy; the chapter has no viability exception.

Common questions

May someone else sign the declaration for me?

Chapter 77 does not provide a directed-signer route. Section 44-77-40 requires the declarant's dated signature in the required presence.

Do I need both witnesses and a notary?

You need two witnesses and an officer authorized to administer oaths. One person may serve in both roles (§ 44-77-40).

What happens if I leave the tube-feeding choices blank?

Nutrition and hydration necessary for comfort care or pain relief will be provided (§ 44-77-20).

Will South Carolina recognize a declaration signed elsewhere?

Yes, if it complied with the law of the adult's domicile when adopted and expresses substantially the same intent as South Carolina's declaration (§§ 44-77-20, 44-77-30).

Statutes and sources

• S.C. Code Ann. §§ 44-77-10 through 44-77-50 — Act, definitions, conditions, timing, execution, witnesses, ombudsman, and mandatory form. Official Chapter 77 (accessed 2026-07-31).
• S.C. Code Ann. §§ 44-77-65 through 44-77-85 — supplemental nutrition instructions, pregnancy, revocation, and optional enforcement agent. Official Chapter 77 (accessed 2026-07-31).
• S.C. Code Ann. §§ 44-77-90 through 44-77-160 — immunity, transfer, natural-dying boundary, absence-of-declaration rule, and penalties. Official Chapter 77 (accessed 2026-07-31).