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Alabama Advance Directive for Health Care
Support GuideAlabama12 min read

Alabama Advance Directive for Health Care

Alabama advance directive rules: one document for the living will and health care proxy, two witnesses age 19 or older, when it takes effect, and revocation.

By Settled Editorial

Alabama puts the living will and the medical decision-maker appointment in one document. The Advance Directive for Health Care can state the end-of-life treatment you want, name a health care proxy to decide for you, or do both. Any competent adult age 19 or older can sign one, and it must be signed in front of two witnesses who are also at least 19. The rules sit in Alabama's Natural Death Act, Code of Alabama 1975, Title 22, Chapter 8A, starting at Section 22-8A-1. (Source: Ala. Code 22-8A-3 and 22-8A-4.)

Use this Alabama advance directive guide as a plain-language map, not as legal advice or a finished form. Your health, your family, and your wishes shape the wording you need, and an Alabama estate-planning attorney can confirm the document says what you mean. This page connects to the Alabama probate and estate directory and to the Alabama power of attorney guide for the financial side of incapacity planning.

What an Alabama Advance Directive Does

An Alabama advance directive is one written, witnessed document that can carry two kinds of choices. (Source: Ala. Code 22-8A-4(a) and (b).)

  • Living-will instructions. You can direct the providing, withholding, or withdrawal of life-sustaining treatment and artificially provided nutrition and hydration if you ever have a terminal illness or injury or become permanently unconscious. This is the living-will part.
  • A health care proxy. You can appoint another competent adult to make those same decisions for you. The proxy designation can sit inside the living will or stand as a separate document. Your proxy must accept the appointment in writing, and that written acceptance must be attached to the designation.

Two Alabama-specific rules deserve bold print. First, tube feeding needs its own authorization: artificially provided nutrition and hydration cannot be withheld or withdrawn under your living will or by your proxy unless the document specifically authorizes it. Second, your health care provider, or a nonrelative employee of your provider, can never act as your health care proxy. (Source: Ala. Code 22-8A-4(a), (b), and (b)(4).)

Know the limits of this document. The Natural Death Act covers end-of-life decisions about life-sustaining treatment and artificial nutrition and hydration. Any general health care powers you give your proxy beyond that scope are limited to the powers allowed under Alabama's durable power of attorney law. So most Alabamians pair the advance directive with a durable power of attorney for broader decision authority. An attorney-in-fact under a durable power of attorney who holds specific end-of-life powers counts as a proxy under the act. (Source: Ala. Code 22-8A-4(b)(1) and (b)(2).)

How to Sign It in Alabama

Section 22-8A-4(c) sets four execution requirements. The advance directive must be:

  1. In writing. Alabama does not recognize an oral advance directive.
  2. Signed by you, or by another person in your presence and at your expressed direction.
  3. Dated.
  4. Signed in the presence of two or more witnesses who are at least 19 years old.

Watch the witness disqualifications. A witness cannot be the person who signed the directive on your behalf, the person you appoint as health care proxy, anyone related to you by blood, adoption, or marriage, anyone entitled to a share of your estate under Alabama intestate law or under your will or a codicil, or anyone directly financially responsible for your medical care. Two coworkers or neighbors usually work well. (Source: Ala. Code 22-8A-4(c).)

Three practical notes:

  • Age 19, not 18. Alabama defines an adult as a person 19 or older, so both you and your witnesses must be at least 19, and you must be a competent adult, meaning alert, able to understand a lay description of medical procedures, and able to appreciate the consequences. (Source: Ala. Code 22-8A-3(1), (6).)
  • No notary required. The statute does not require notarization. Notarizing anyway is a sensible extra step if you travel or might move, since some states expect it.
  • Use the statutory form as your base. Section 22-8A-4(h) sets out the official Advance Directive for Health Care form, and your directive must be substantially in that form. You may add other specific directions, and any invalid direction is severable from the rest. (Source: Ala. Code 22-8A-4(h).)

When the Directive Takes Effect

Signing the directive does not switch it on. It becomes effective only when both of these happen. (Source: Ala. Code 22-8A-4(d).)

  1. Your attending physician determines that you can no longer understand, appreciate, and direct your medical treatment.
  2. Two physicians, one of them your attending physician and one qualified and experienced in making the diagnosis, personally examine you and document in your medical record that you have a terminal illness or injury or are in a state of permanent unconsciousness.

Permanent unconsciousness has a strict statutory definition: a condition that to a reasonable degree of medical certainty will last permanently without improvement, with no cognitive thought, sensation, purposeful action, social interaction, or awareness of self and environment, that has lasted long enough to support the diagnosis, confirmed by a qualified physician. (Source: Ala. Code 22-8A-3(13).)

Two more effect rules matter:

  • Pregnancy pauses the directive. If your attending physician knows you are pregnant, the advance directive has no effect during the pregnancy. (Source: Ala. Code 22-8A-4(e).)
  • Your proxy outranks your living will. If you signed both parts, the duly designated proxy's decisions about life-sustaining treatment or artificial nutrition and hydration take precedence over the living will, unless either document says otherwise. The proxy must still follow your specific instructions and, where you gave none, decide as you would have, weighing your personal, philosophical, religious, and moral beliefs. (Source: Ala. Code 22-8A-4(g) and 22-8A-6.)

It is also your job to deliver the document. The statute makes the declarant responsible for giving a copy to the attending physician and other treating providers, who then make it part of your medical record. (Source: Ala. Code 22-8A-4(f).)

Who Decides If You Have No Directive

If you never signed a directive, no appointed proxy is reasonably available, or your directive does not address the situation, Alabama law lets a surrogate decide about life-sustaining treatment and artificial nutrition and hydration. Before a surrogate can act, the attending physician must determine you can no longer understand, appreciate, and direct your treatment with no hope of regaining that ability, two physicians must certify a terminal illness or injury or permanent unconsciousness in the medical record, and the treating physician must determine that withholding or withdrawing treatment will not cause you undue pain or discomfort. (Source: Ala. Code 22-8A-11(a).)

The statute ranks who may serve as surrogate, in this order. (Source: Ala. Code 22-8A-11(d).)

PriorityWho can decide
1A judicially appointed guardian whose appointment specifically covers these decisions
2Your spouse, unless legally separated or a party to a divorce proceeding
3An adult child
4A parent
5An adult sibling
6Any surviving adult relative of the next closest degree of kinship
7If no relatives can be found after reasonable inquiry, a facility committee that includes the primary treating physician, with notice to the Alabama Department of Human Resources

Guardrails apply to every surrogate. The surrogate must be a competent adult, must decide as you would have decided in light of your religious, spiritual, personal, philosophical, and moral beliefs, and must certify on a State Board of Health form, signed before two witnesses at least 19 years old, that everyone in an equal or higher class consented or did not object. Your health care provider, or a nonrelative employee of the provider, cannot witness that certification. Withdrawing artificial nutrition and hydration from a permanently unconscious patient requires clear and convincing evidence of the patient's wishes. Knowingly certifying false material information is a Class C felony, and disputes go to the circuit court where the patient is being treated. (Source: Ala. Code 22-8A-11(b), (c), (e), (i), (j), (k).)

The planning takeaway: the surrogate ladder works, but it can hand the hardest decision of your life to a person you would not have chosen, under a felony-backed certification process. Signing your own directive keeps the choice yours, and it spares your family a possible guardianship proceeding over medical authority.

Changing or Revoking Your Directive

An Alabama advance directive has no expiration date: nothing in the Natural Death Act sets one, so the document stays effective until you revoke it. Ala. Code 22-8A-5 lets you revoke at any time by any of these methods.

  • Destroy it. Obliterate, burn, tear, or otherwise destroy or deface the document in a way that shows you intend to cancel it.
  • Revoke it in writing. Sign and date a written revocation, yourself or through a person acting at your direction.
  • Say it in front of a witness. Verbally express your intent to revoke in the presence of a witness 19 or older who signs and dates a writing confirming what you said. The verbal revocation takes effect when your attending physician or health care provider receives that writing.

One automatic rule protects people after a split: unless your proxy designation or a court order says otherwise, divorce, dissolution, or annulment of your marriage revokes the designation of your former spouse as health care proxy. If that happens, sign a new directive so you are not left without a decision-maker. No one faces liability for failing to act on a revocation they did not actually know about, so tell your providers and your proxy whenever you change course. (Source: Ala. Code 22-8A-4(b)(3) and 22-8A-5(b).)

Storing Your Directive, and Related Orders

Alabama has no statewide electronic registry for advance directives. Instead, you may optionally file and record your directive with the judge of probate in the county where you live for a five dollar statutory recording fee, plus any other recording fees that general or local law requires. The recorded document is not open to general public inspection, but emergency medical personnel, hospital staff, treating physicians, immediate family, an agent under a power of attorney, and anyone you authorize in writing can inspect and copy it. Recording has no bearing on validity, and providers are not required to search probate records, so you still need to hand copies to your doctor, your proxy, and your hospital. (Source: Ala. Code 22-8A-14.)

Two related documents are easy to confuse with the advance directive:

  • Portable physician DNAR order. A do-not-attempt-resuscitation order is a physician's order, entered in your medical record on the State Board of Health form, that resuscitative measures not be provided after cardiopulmonary cessation. It is a medical order signed through your physician, not part of your advance directive. (Source: Ala. Code 22-8A-3(7), (16) and 22-8A-4.1.)
  • Out-of-state directives. An advance directive executed in another state is valid in Alabama if it complied with that state's law or Alabama's, though it cannot authorize anything Alabama law prohibits. (Source: Ala. Code 22-8A-12.)

A Simple Planning Sequence

Use this order as a checklist, then confirm the details with an Alabama attorney or your provider:

  1. Decide whether you want living-will instructions, a health care proxy, or both in one document.
  2. Choose a proxy you trust, ask first, and collect the written acceptance the statute requires.
  3. Decide explicitly whether your document authorizes withholding or withdrawing artificially provided nutrition and hydration.
  4. Start from the statutory form in Section 22-8A-4(h) and add any specific directions you want.
  5. Sign and date it before two qualified witnesses age 19 or older. Consider a notary for portability.
  6. Give copies to your proxy and your doctor, and consider recording it with your county probate judge.
  7. Review it after any major life change, especially divorce, and replace it when your wishes change.

Pair the directive with the rest of your planning documents. The Alabama power of attorney guide covers who manages money and property if you cannot, the Alabama guardianship planning guide shows what happens when no documents exist, and the Alabama will requirements guide covers what happens to property at death. For every Alabama probate and estate page, start at the Alabama directory.

This guide is general information about Alabama planning documents. It is not legal advice. Confirm anything that affects your situation against the current Code of Alabama or with a licensed Alabama attorney before you sign.

Sources

Information current as of June 11, 2026

This content is for informational purposes only and does not constitute legal advice. Probate laws and procedures in Alabama can change. Consult with a qualified attorney for advice specific to your situation. Full disclaimer.

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