Virginia: Living Will and Advance Health-Care Instruction Requirements
The short answer
Virginia uses an 'advance directive' that may contain treatment instructions, appoint an agent, or do both. A capable adult may sign a written directive before two witnesses; after an attending physician diagnoses a terminal condition, a capable adult may instead make a witnessed oral directive before that physician and two witnesses. Instructions ordinarily operate after a written incapacity determination by the attending physician and an independent capacity reviewer, subject to the statute's exceptions and provider-transfer procedure.
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This is the general rule in Virginia. Ezel applies current Virginia law to your specific facts and answers with citations to the statutes.
| Governing law and document | 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. |
|---|---|
| Who may make an instruction | 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). |
| Oral, written, and signature form | 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. |
| Witness, notary, and disqualifications | 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). |
| Covered conditions and trigger | 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). |
| Treatment, nutrition, hydration, and comfort | 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). |
| Pregnancy and other statutory limits | 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). |
| Revocation, notice, and registry | 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. |
| Provider duties, recognition, and effect | 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). |
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Requirements one by one
Virginia provides written and post-diagnosis oral routes
Under § 54.1-2983, any adult capable of an informed decision may sign a written
directive before two subscribing witnesses. A capable adult already diagnosed
by the attending physician with a terminal condition may instead make an oral
directive in the presence of that physician and two witnesses. The oral route is
not a general substitute available before diagnosis.
Virginia's witness definition is broad
Section 54.1-2982 permits any person over 18 to witness and expressly includes a
spouse or blood relative. Good-faith employees of health care facilities and
physician offices may also witness. Section 54.1-2983 requires two witnesses and
does not offer notarization as an execution alternative.
Incapacity is decision-specific and normally independently reviewed
Under § 54.1-2983.2, capacity is presumed and cannot be rejected based only on a clinical
diagnosis. Before care is provided, continued, withheld, or withdrawn under the
Act, the attending physician certifies incapacity in writing after personal
examination and normally obtains a second written certification from an
independent physician or clinical psychologist. The finding is revisited at
least every 180 days while the need continues. Reviewer certification is not
required for unconsciousness or a profound impairment of consciousness from an
acute physiological condition.
Treatment instructions may be broad or condition-specific
Section 54.1-2983 permits a written directive to address any or all forms of
health care. The optional § 54.1-2984 form supplies separate spaces for care the
declarant wants, care the declarant refuses, and end-of-life instructions when
life-prolonging procedures would only artificially prolong dying. It separately
names artificial respiration, CPR, nutrition, hydration, comfort, and pain
relief.
Revocation and registry removal are different acts
Under § 54.1-2985, a declarant who understands the nature and consequences may
revoke all or part by signed dated writing, directed destruction in the
declarant's presence, or oral expression. It takes effect when communicated to
the attending physician. If the directive was filed in the optional registry,
the revocation must be notarized before submission for removal, but failure to
remove it does not invalidate an otherwise effective revocation.
The registry's filing authority appears in § 54.1-2995.
Provider refusal follows a timed process
Section 54.1-2987 requires a refusing attending physician to make reasonable
transfer efforts. Under § 54.1-2990, a medical- or ethical-inappropriateness
determination must be documented and explained in writing, followed by hospital
review and at least 14 days to seek transfer. Requested life-sustaining treatment
continues during that period if reasonably available. Court review remains
available; artificial nutrition and hydration have additional limits; pain and
comfort care continue in all cases.
What trips people up
- The oral path starts only after a terminal-condition diagnosis. A general
earlier oral statement is not the witnessed oral advance directive defined by
§§ 54.1-2982 and 54.1-2983. - Registry filing is optional and does not replace notice. Section
54.1-2983 still makes the declarant responsible for giving the attending
physician the information needed to find a filed directive. - Pregnancy instructions are customizable. The optional form in
§ 54.1-2984 gives space to modify terminal-condition instructions during
pregnancy; the Act does not impose a categorical suspension.
Common questions
Can my spouse or adult child witness my directive?
Yes. Section 54.1-2982 expressly includes a spouse or blood relative in the
definition of a permitted witness.
Must the written directive be notarized?
No. Section 54.1-2983 requires the declarant's signature before two witnesses.
Notarization appears only when a revocation is submitted to remove a filed
directive from the optional registry.
Will an advance directive signed elsewhere be recognized?
Section 54.1-2993 treats an out-of-state directive as validly executed if it
complied with Virginia law or the law of the state where it was executed. Its
meaning is construed under Virginia law.
Statutes and sources
- Va. Code §§ 54.1-2982 to -2985 — document forms, capacity, witnesses,
treatment choices, pregnancy option, revocation, notice, record notation, and
optional registry filing. Official Virginia
Code
(accessed 2026-07-30). - Va. Code §§ 54.1-2987 and 54.1-2990 — provider refusal, written review,
transfer period, treatment continuation, nutrition and hydration, comfort,
and natural-dying boundary. Official §
54.1-2990
(accessed 2026-07-30). - Va. Code §§ 54.1-2993 and 54.1-2995 — reciprocity and registry filing.
Official §
54.1-2993
and §
54.1-2995
(accessed 2026-07-30). - VA HB 548 (2026) — pending proposal to replace most of the current Act
with a Uniform Health Care Decisions Act. Official bill
page (checked
2026-07-30).
Source links
Every statute quoted above, linked, with the date we checked it.
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