DISCLAIMER (READ FIRST)
This template is provided for informational purposes only and does not constitute legal advice or create an attorney-client relationship. Use of this form should be reviewed by a licensed Alabama attorney to ensure compliance with current law and the signer’s particular circumstances. Statutory references herein are to the Alabama Natural Death Act, Ala. Code §§ 22-8A-1 et seq. (the “ANDA”).
ALABAMA ADVANCE DIRECTIVE FOR HEALTH CARE
(Living Will & Durable Power of Attorney for Health Care)
Effective Date: [DATE]
Governing Law: Alabama Natural Death Act (Ala. Code §§ 22-8A-1 et seq.)
TABLE OF CONTENTS
- Document Header
- Definitions
- Advance Directive – Operative Provisions
3.1 Statement of Intent
3.2 Treatment Instructions (Living Will)
3.3 Designation of Health-Care Proxy (Durable POA) - Representations & Warranties
- Covenants & Restrictions of Proxy
- Default, Reliance & Remedies
- Risk Allocation
- General Provisions
- Revocation Procedures
- Execution Block
1. DOCUMENT HEADER
1.1 Parties
(a) “Principal”: [PRINCIPAL FULL LEGAL NAME], a resident of [COUNTY], Alabama, date of birth [DOB].
(b) “Proxy”: [PROXY FULL LEGAL NAME], relationship: [RELATIONSHIP], address: [ADDRESS].
[// GUIDANCE: Insert alternate/ successor proxy names if desired.]
1.2 Recitals
(a) Principal is of sound mind and acting voluntarily.
(b) Principal desires to execute a legally binding advance directive pursuant to ANDA to provide health-care instructions and appoint a proxy empowered to make decisions during periods of incapacity.
1.3 Consideration
The mutual promises contained herein constitute sufficient consideration.
2. DEFINITIONS
For purposes of this Directive:
“Adult” means an individual 19 years of age or older.
“Artificial Nutrition and Hydration” means medically assisted feeding or fluids, including via IV or feeding tube.
“Health-Care Provider” means any individual licensed or authorized to provide medical care in Alabama.
“Life-Sustaining Treatment” means any medical procedure that extends life by artificial means and is not expected to cure the underlying medical condition.
“Proxy” means the individual designated in Section 3.3 as the Principal’s health-care agent.
“Terminal Condition” has the meaning set forth in Ala. Code § 22-8A-3(13).
[// GUIDANCE: Add or delete terms as clinically or legally relevant.]
3. ADVANCE DIRECTIVE – OPERATIVE PROVISIONS
3.1 Statement of Intent
The Principal directs that this instrument be honored by all Health-Care Providers pursuant to Ala. Code §§ 22-8A-4 and -11 and that good-faith reliance upon its provisions shall immunize Providers under Ala. Code § 22-8A-7.
3.2 Treatment Instructions (Living Will)
(a) End-Stage/Terminal Condition
☐ I do / ☐ I do not consent to Life-Sustaining Treatment when my attending physician determines I am in a Terminal Condition.
(b) Persistent Vegetative State
☐ I do / ☐ I do not consent to Life-Sustaining Treatment if I am diagnosed in a Persistent Vegetative State with no reasonable expectation of recovery.
(c) Artificial Nutrition and Hydration
☐ Provide / ☐ Withhold / ☐ Proxy to Decide
(d) Pain Management
I direct that medication be administered as necessary for comfort, even if it may hasten death.
(e) Additional Instructions
[FREE-FORM TEXT]
3.3 Designation of Health-Care Proxy (Durable Power of Attorney)
(a) Appointment
Principal hereby appoints the Proxy to make all health-care decisions on Principal’s behalf when Principal lacks capacity, with authority coextensive with Ala. Code § 22-8A-4(b).
(b) Successor Proxy(ies)
1st Successor: [NAME, CONTACT]
2nd Successor: [NAME, CONTACT]
(c) Scope of Authority
The Proxy may:
(i) consent to, refuse, or withdraw treatment;
(ii) employ and discharge Health-Care Providers;
(iii) access medical records;
(iv) authorize admission to or discharge from health-care facilities;
(v) execute documents required by insurance or governmental programs.
(d) Limitations
[INSERT ANY EXPRESS LIMITATIONS]
4. REPRESENTATIONS & WARRANTIES
4.1 Principal represents that:
(a) Principal is an Adult and competent;
(b) No undue influence or duress has been exerted;
(c) Any prior advance directive is hereby revoked (see Section 9).
4.2 Proxy represents acceptance of the appointment and a commitment to act in good faith and in accordance with Principal’s known wishes or best interests.
5. COVENANTS & RESTRICTIONS
5.1 Proxy covenants to consult with medical professionals and family where feasible to determine Principal’s expressed wishes.
5.2 Proxy shall not transfer authority unless and until unwilling or unable to serve.
5.3 No Proxy may authorize voluntary sterilization or psychosurgery absent specific written authority.
6. DEFAULT, RELIANCE & REMEDIES
6.1 Good-Faith Compliance
Any Health-Care Provider acting in good-faith reliance on this Directive or Proxy instructions shall be protected from civil, criminal, and disciplinary liability per Ala. Code § 22-8A-7.
6.2 Conflicts
If disagreement arises among family, Proxy’s decision controls unless revoked or overruled by court order.
6.3 Judicial Relief
Interested persons may petition the probate court of the county where the Principal resides for review pursuant to Ala. Code § 22-8A-11.
7. RISK ALLOCATION
7.1 Indemnification of Providers
Principal agrees that Providers acting in good faith in accordance with this Directive shall be indemnified and held harmless to the fullest extent permitted by law.
7.2 Limitation of Liability
No party shall be liable for acts or omissions performed in good-faith compliance with this Directive, subject to gross negligence or willful misconduct.
8. GENERAL PROVISIONS
8.1 Governing Law
This Directive is governed exclusively by the laws of the State of Alabama.
8.2 Severability
If any provision is held invalid, remaining provisions shall remain in full force.
8.3 Amendments
Amendments must: (i) be in writing, (ii) signed by Principal while competent, and (iii) witnessed in conformity with Section 10.
8.4 Copies
Photostatic, electronic, and certified copies of this Directive shall be as valid as the original.
8.5 Integration
This instrument constitutes the entire advance directive of Principal and supersedes all prior inconsistent directives.
9. REVOCATION PROCEDURES
9.1 Methods of Revocation (Ala. Code § 22-8A-4(c))
(a) Signed, dated written revocation;
(b) Physical destruction of the Directive or directing another to destroy it;
(c) Oral or other expression of intent to revoke in the presence of two Adults, one of whom promptly documents the statement in writing.
9.2 Effectiveness
Revocation is effective upon communication to the attending physician or Health-Care Provider.
10. EXECUTION BLOCK
I declare under penalty of perjury that I am an Adult of sound mind, and that this Advance Directive expresses my wishes.
Principal Signature: ______ Date: __
Print Name: _________
Witness Attestation
We are Adults, not related to the Principal by blood, marriage, or adoption, not entitled to any portion of the Principal’s estate, not directly financially responsible for Principal’s medical care, and not an employee of any health-care facility in which the Principal is a patient. We witnessed the signing of this Directive by the Principal (or the Principal’s acknowledgment of the signature) and state that the Principal appeared to be of sound mind and free from duress.
-
Witness #1
Signature: ______ Date: ___
Print Name: _____
Address: __________ -
Witness #2
Signature: ______ Date: ___
Print Name: _____
Address: __________
[OPTIONAL NOTARIZATION – not required under ANDA but recommended for evidentiary purposes]
State of Alabama )
County of _____ )
Subscribed and sworn before me on ___, 20, by ________, who is personally known to me or produced identification.
Notary Public Signature: ____
My Commission Expires: _____
[// GUIDANCE:
1. Provide copies to Proxy, attending physician, and primary hospital.
2. Encourage clients to review and update periodically, especially after major life events.
3. Advise clients to carry a wallet card noting existence of this Directive. ]