State-Specific Requirements for Advance Directives
Advance directives are legal documents that help you plan and communicate your wishes regarding your medical care should you ever be in a situation where you are unable to do so. The actual documents may have different titles in different states. In general, however, advance directives are usually comprised of two documents. One, commonly called a living will, describes your wishes regarding medical treatment. The second, usually called a medical health care power of attorney or health care proxy, appoints a person to make medical decisions on your behalf. Again, both of these documents are only used when you are unable to make decisions yourself.
There's a common misconception that only people who are elderly need advance directives. Unfortunately, however, there are many misfortunes that can cause one to be unable to dictate one's own health care. All adults should consider having advance directives in place so that they are able to indicate their health care wishes and spare their loved ones unnecessary anxiety in times of medical crisis.
The table below provides a general overview of advance directive information by state. It is not all-encompassing and should not be used in place of legal advice or without a more thorough review of your state's guidelines. While some state statutes do not require witnesses, it is considered a good idea to have witnesses in order to ensure that your wishes are carried out.
| State | Statute |
|---|---|
| Alabama | Advance directive for health care (encompasses living will, health care proxy, and durable power of attorney) requires an individual to be at least 19 years of age and requires two qualified witnesses. Advance directives are not valid if pregnant. |
| Alaska | A living will (called "Individual Instruction for Health Care") does not require witnesses or notarization. A health care proxy requires either two qualified witnesses or must be acknowledged before a notary public in the state of Alaska. Individual instructions may not be honored if pregnant. |
| Arizona | A living will (Individual Instruction for Health Care) does not require a witness or notary. A health care power of attorney (proxy) requires either two qualified witnesses or must be acknowledged before a notary public. Directives may not be valid if the individual is pregnant. |
| Arkansas | A declaration (both living will and health care proxy) requires the signatures of two qualified witnesses. The declaration may not be valid if pregnant. |
| California | Instructions for health care (living will) and the health care power of attorney requires two qualified witnesses or a notary public. |
| Colorado | A declaration (living will) requires two qualified witnesses. A power of attorney for health care does not require witnesses or notarization. The declaration is invalid if physician determines that a pregnant person's fetus is viable. |
| Connecticut | Health care instructions (both living will and health care proxy) require two qualified witnesses (witnesses are encouraged to have a Witness Affidavit notarized). Instructions are invalid if pregnant. |
| Delaware | Instructions for health care (living will) and health care power of attorney require one or more qualified witnesses. Notarized declarations are recommended. A living will may be invalid if pregnant. |
| District of Columbia | A declaration and a health care power of attorney require two qualified witnesses. |
| Florida | Two qualified witnesses are needed for both a living will and a designation of health care surrogate. Women wishing to refuse life-sustaining treatment while pregnant must put in writing on the health care surrogate form that they authorize the surrogate to follow their instructions regarding treatment while pregnant. Two people can be designated as a health care surrogate: one main representative and an alternate surrogate. |
| Georgia | An advance directive (treatment preferences and health care agent) requires two qualified witnesses. Women wishing to refuse life-sustaining treatment while pregnant must indicate this on the form. However, if a physician determines that the fetus is viable, this preference becomes invalid. |
| Hawaii | Instructions for health care and health care power of attorney require two qualified witnesses or the signature of a notary public. You can revoke or change your Advance Directive at any time in writing or orally. An attorney is not required to complete the form. |
| Idaho | No witnesses or notarization are required for a living will or a health care power of attorney. A living will is invalid if pregnant. |
| Illinois | A power of attorney for health care requires one qualified witness. A living will declaration requires the signature of two qualified witnesses and may be invalid if pregnant. |
| Indiana | The power of attorney for health care decisions must be signed by notary public. The Health Care Representative directive must be witnessed by one adult. The Living Will Declaration and the Life-Prolonging Procedures Declaration each require two witnesses. A living will is invalid if pregnant. |
| Iowa | The power of attorney for health care and the declaration (living will) must be signed by a notary public or two qualified witnesses. |
| Kansas | The living will and health care proxy forms require the signature of two qualified witnesses or a notary public. Both may be invalid if pregnant. |
| Kentucky | A living will and an appointment of health care surrogate require two qualified witnesses or a notary public. Both may be invalid if pregnant. |
| Louisiana | The declaration and the health care power of attorney instructions require two qualified witnesses who are of no relation and not entitled to the estate. Documents may be written or electronic. Individuals may register the form with the Secretary of State's office. |
| Maine | The living will and the power of attorney for health care instructions require two qualified witnesses who are of no relation and not entitled to the estate. Documents may be written or electronic. The form also allows an individual to designate a physician to have primary responsibility for health care. |
| Maryland | The advance medical directive and the appointment of a health care agent instructions require two qualified witnesses where neither of whom can be the health care agent, and at least one must not be entitled to the estate. Documents may be written or electronic. There is a section to include special instructions in the event of pregnancy. |
| Massachusetts | The health care proxy instructions require the signature of two qualified witnesses who cannot be the health care agent or alternate agent. Documents may be written or electronic. There is no state statute regarding a living will. |
| Michigan | The instructions for a patient advocate for health care requires two qualified witnesses who are of no relation, not the doctor or proposed patient advocate, not an employee of a health facility or program where individual receives care, and not entitled to the estate. A patient advocate does not have the right to make decisions regarding a pregnant patient that could result in the pregnant patient's death. There is no state statute regarding living wills. |
| Minnesota | The appointment of a health care agent and health care instructions requires two qualified witnesses or the signature of a notary public. Women must explicitly state if they would like the instructions honored if they are pregnant. |
| Mississippi | Advance directive for health care encompasses durable power of attorney and a living will. The power of attorney for health care and living will require two qualified witnesses and a notary public. |
| Missouri | Advance directive for health care encompasses durable power of attorney and health care instructions. The power of attorney for health care requires a notary public; health care instructions require two witnesses. An advance directive, including a living will, is invalid during pregnancy, and any directions to withhold or withdraw treatment will not be followed. |
| Montana | Advance directive for health care encompasses a living will and power of attorney. An individual must be 18 years of age or older in order to file. Health care directives must be signed by two qualified witnesses. Invalid if a woman is pregnant and the fetus is determined to be viable with continued life-sustaining treatment. |
| Nebraska | The power of attorney for health care requires two qualified witnesses or a notary public. Both of the witnesses must sign an additional declaration. Invalid if a woman is pregnant and the fetus is determined to be viable with continued life-sustaining treatment. |
| Nevada | The power of attorney for health care requires two qualified witnesses or a notary public. At least one of the witnesses must sign an additional declaration. Invalid if a woman is pregnant and the fetus is determined to be viable with continued life-sustaining treatment. |
| New Hampshire | Advance directive for health care encompasses a living will and durable power of attorney. An advance directive must be signed by either a notary public or two qualified witnesses or a justice of the peace. A health care agent cannot consent to withdrawal of treatment if the patient is pregnant and if the withdrawal of that treatment is deemed likely to terminate the pregnancy unless the treatment will be physically harmful to the patient or prolong severe pain which cannot be alleviated by medication. |
| New Jersey | The appointment of a health care representative and the living will each require two qualified witnesses, a notary public, an attorney at law, or another person authorized to administer oaths. An option to provide specific instructions for treatment if pregnant is included. |
| New Mexico | The power of attorney for health care and the instructions for health care require no witnesses. |
| New York | The health care proxy requires two qualified witnesses. The living will has no specific requirements. |
| North Carolina | The health care power of attorney and the advance directive for a natural death (living will) require two qualified witnesses and a notary public. The Secretary of State maintains a registry where both documents can be filed. |
| North Dakota | The statutory health care directive (encompassing both the health care agent and the living will) requires two witnesses or a notary public. |
| Ohio | The durable power of attorney for health care and the living will require two qualified witnesses or a notary public. Both may be invalid if pregnant. The living will declaration supersedes the power of attorney for health care if there is any conflict. |
| Oklahoma | The advance directive for health care (includes a living will and health care proxy) requires two qualified witnesses. The directive is invalid if pregnant unless a woman has specifically authorized the withholding of treatment if she is pregnant. Individuals must specifically state if artificial nutrition or hydration is not authorized. |
| Oregon | The appointment of a health care representative and the health care instructions (living will) each require two qualified witnesses. Individuals must specifically indicate if the health care representative is authorized to withhold artificial nutrition and hydration. The directive is invalid if the person is pregnant unless the directive specifically states that life-sustaining treatment can be withheld or withdrawn even if the person is pregnant. |
| Pennsylvania | The directive includes both the living will and the appointment of a health care agent, and it requires two qualified witnesses. The directive may be invalid if pregnant. |
| Rhode Island | The durable power of attorney for health care requires two qualified witnesses or a notary public. The declaration (living will) requires two qualified witnesses. Both may be invalid if pregnant. |
| South Carolina | The health care power of attorney requires two witnesses. The declaration of desire for a natural death (living will) requires two qualified witnesses and a notary public (notary may be one of the witnesses). Both may be invalid if pregnant. |
| South Dakota | The power of attorney for health care requires two adult witnesses or a notary public. The directive may be invalid if pregnant and must specifically express in the document if artificial nutrition and hydration are not authorized. The living will declaration requires two adult witnesses and may be invalid if pregnant. If an individual has executed both a declaration and a durable power of attorney, the later executed document will supersede to the extent that there are conflicting provisions. |
| Tennessee | The appointment of a medical power of attorney and the advance care plan (living will) each require two qualified witnesses or a notary public. These documents are not valid for pregnant patients. |
| Texas | The appointment of a medical power of attorney and living will each require two qualified witnesses or a notary public. These documents are not valid for pregnant patients. |
| Utah | The advance health care directive encompasses both the medical power of attorney and living will. The advance health care directive can be written or oral with one qualified witness. This document is not valid for pregnant patients. |
| Vermont | The advance health care directive encompasses both the medical power of attorney and the living will. The advance health care directive requires two qualified witnesses. The advance health care directive also includes documents designated under prior law as durable power of attorney for health care or terminal care document. Vermont does not have specific statutes invalidating for pregnant patients therefore individuals have the option to provide specific instructions for treatment if pregnant. |
| Virginia | The advance health care directive encompasses both the medical power of attorney and the living will. The advance health care directive can be written or oral and requires two qualified witnesses. This directive provides the option to file with the Virginia Advance Health Care Directive Registry. This document is not valid for pregnant patients. |
| Washington | The advance health care directive encompasses both the durable power of attorney and the living will. The advance health care directive requires two qualified witnesses or a notary public. This document is not valid for pregnant patients. |
| West Virginia | The advance health care directive encompasses both the living will with an option to include appointment of a medical power of attorney. Each document requires two qualified witnesses and a notary public. These documents are not valid for pregnant patients. |
| Wisconsin | The advance health care directive encompasses both the living will with an option to include appointment of a medical power of attorney. Each document requires two qualified witnesses. These documents are not valid for pregnant patients. |
| Wyoming | The advance health care directive encompasses both the living will with an option to include appointment of a medical power of attorney. Each document requires two qualified witnesses or a notary public. These documents are not valid for pregnant patients. |
McLamb, K. & A. Elliot (Ed.). (Revised 2025 [Ed.]). State-specific requirements for advance directives or living wills. Raleigh, NC: Workplace Options.