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Tennessee Advance Directive for Health Care
Support GuideTennessee12 min read

Tennessee Advance Directive for Health Care

How a Tennessee advance directive works: one written document for care wishes plus a health care agent, the surrogate rules, and notary-or-two-witness signing.

By Settled Editorial

In Tennessee you do not need two separate papers for a living will and a medical power of attorney. One written document, called an advance directive for health care, can do both. It can write down the care you want, and it can name a health care agent to speak for you when you cannot speak for yourself. You sign it, and you make it valid by either notarizing it or having two witnesses sign it. This sits under the Tennessee Health Care Decisions Act (Tennessee Code Annotated Title 68, Chapter 11, Part 18, starting at T.C.A. § 68-11-1801). (Source: T.C.A. § 68-11-1803.)

Use this Tennessee advance directive guide as a planning map, not as legal advice or a finished form. The exact wording you need depends on your health, your family, and your wishes. A Tennessee estate-planning attorney can help you sign a directive that says what you mean. This page connects to the Tennessee probate and estate directory and to the Tennessee power of attorney guide for the money side of planning.

What a Tennessee Advance Directive Does

A Tennessee advance directive is one written, signed document that can carry two kinds of choices. The Health Care Decisions Act lets you combine them or use just one. (Source: T.C.A. § 68-11-1803.)

  • Individual instructions. You can write down the care you do and do not want. These instructions can be oral or written, and you can set one to take effect only if a specific condition arises. Many people put end-of-life wishes here.
  • A health care agent. You can name an adult you trust to make any health care decision you could have made yourself, including consent to or refusal of treatment, once you lack the capacity to decide. This is Tennessee's durable power of attorney for health care. You can also name a backup agent.

You do not have to use both parts. Some people only name an agent. Some only write instructions. Many do both in one signed document. The directive can also nominate a guardian of the person, so a court has your pick on file if a guardianship ever comes up.

Here is a naming note that trips people up. Tennessee uses three related words. An agent is the person you appoint yourself in the directive. A surrogate is a person who steps in by default when there is no agent, which a later section covers. A living will, sometimes called an advance care plan, is the instruction part about end-of-life care. Tennessee also keeps an older, separate living will statute, the Right to Natural Death Act, which still works on its own. (Source: T.C.A. § 32-11-104.)

How to Sign It in Tennessee

A written Tennessee advance directive must be signed by you (the principal), and it is valid only if it is either notarized or witnessed by two witnesses. Notarizing and witnessing are alternatives. You do not need both. (Source: T.C.A. § 68-11-1803.)

A few practical points sit on top of that rule:

  • Pick clean witnesses if you go the witness route. Each witness must be a competent adult, and none of them may be your named agent. At least one of the two witnesses must be a person who is not related to you by blood, marriage, or adoption and who would not inherit any part of your estate under a will, a codicil, or state law. The written directive must include an attestation clause where the witnesses confirm they meet these rules. (Source: T.C.A. § 68-11-1803.)
  • A notary can stand in for witnesses. If you have the document notarized, you do not need the two witnesses. A notarized directive also helps if you move or travel, since other states tend to recognize a notarized signature.
  • You can use a state model form, or your own. The Tennessee Health Facilities Commission publishes model Advance Care Plan, Appointment of Health Care Agent, and Appointment of Surrogate forms in English and Spanish. You may use a model form, adapt it, or write your own, as long as it meets the signing rule. (Source: Tennessee Health Facilities Commission, Advance Directives and POST.)

One more point on the older living will. Under the Right to Natural Death Act, a written living will declaration follows the same either/or pattern: it is valid if your signature is attested by a notary with no witnesses, or witnessed by two witnesses with no notary. The same witness restrictions and attestation clause apply, and the statute gives a suggested form. (Source: T.C.A. § 32-11-104 and § 32-11-105.)

When the Directive Takes Effect

A Tennessee advance directive does not switch on the moment you sign it. Unless your directive says otherwise, your agent's authority becomes effective only after a determination that you lack capacity, and it ends once you are found to have recovered capacity. While you can still decide for yourself, you stay in charge, and your own contemporaneous choices control. (Source: T.C.A. § 68-11-1803.)

Here is how that finding works:

  • Capacity means your ability to understand the benefits, risks, and alternatives to a proposed treatment and to make and communicate a health care decision.
  • A determination that you lack or have recovered capacity, or that another condition affects an instruction or your agent's authority, must be made by the designated physician. That physician may consult others as appropriate.
  • Your agent must follow your written instructions and known wishes first. If your wishes are unknown, the agent decides based on your best interest, weighing your personal values to the extent the agent knows them.

A decision your agent makes is effective without judicial approval, so your family does not need a court order to follow it. (Source: T.C.A. § 68-11-1803.)

Who Decides If You Have No Directive

If you never signed a directive and never named an agent, Tennessee does not leave the decision open. A surrogate can step in once the designated physician finds you lack capacity and there is no agent or guardian available to act. You can also name your own surrogate at any point, orally or in writing, just by telling your supervising health care provider. (Source: T.C.A. § 68-11-1806.)

When no one has been appointed, the supervising health care provider identifies the surrogate and documents the choice in your clinical record. Tennessee is unusual here. It does not use a rigid, mandatory ranking. The provider looks for the person best qualified to decide for you, and the statute lists categories in order of descending preference as a guide.

Order of preferenceWho may serve
1Your spouse, unless you are legally separated
2Your adult child
3Your parent
4Your adult sibling
5Any other adult relative
6Any other qualifying adult who has shown special care and concern and knows your values

A few rules shape how this works:

  • The surrogate must be an adult who has shown special care and concern for you, knows your personal values, is reasonably available, and is willing to serve. A person under a protective order or no-contact order regarding you cannot serve.
  • When picking among candidates, the provider weighs best-qualified criteria: who can best decide per your wishes or best interest, regular contact with you, demonstrated care, and availability to meet face to face with your care team.
  • A surrogate decides based on your known wishes, or, if those are unknown, on your best interest and personal values.

The takeaway for planning: the surrogate rules work, but they may put the decision with someone you would not have picked. Naming your own agent in an advance directive keeps that choice in your hands. A directive and a health care agent also reduce the need for a court-appointed guardian, which the Tennessee guardianship and conservatorship planning guide covers.

Changing or Revoking Your Directive

A Tennessee advance directive stays in force until you revoke it or replace it. You can change course in a few ways, and the rule splits depending on whether you are revoking your agent or the rest of the document. (Source: T.C.A. § 68-11-1804.)

  • Revoke the agent. While you have capacity, you can revoke the designation of an agent only by a signed writing or by personally informing your supervising health care provider.
  • Revoke the rest. While you have capacity, you can revoke all or part of the directive, other than the agent designation, at any time and in any manner that shows you intend to revoke.
  • Sign a later directive. A new advance directive that conflicts with an earlier one revokes the older directive to the extent they conflict.

One automatic rule helps spouses. A decree of divorce, annulment, dissolution of marriage, or legal separation revokes a prior designation of your spouse as agent, unless the decree or the directive says otherwise. If that happens, sign a new directive naming someone else so you are not left without an agent. After any change, tell your providers, your agent or surrogate, and your family.

POST: Tennessee's Universal DNR Order

Tennessee also uses a Physician Order for Scope of Treatment (POST), sometimes called the Universal Do Not Resuscitate order. A POST is a portable medical order on a form approved by the state. It states whether CPR should be attempted and which other treatments are provided or withheld, and it travels with you across care settings. (Source: T.C.A. § 68-11-224.)

Two points keep the POST in its lane:

  • A POST is a medical order, not an advance directive. A physician issues it with your informed consent, or with your agent's or surrogate's consent if you cannot decide. It stays in effect until revoked.
  • Your advance directive and your POST should agree. If a later living will conflicts with a POST, the living will revokes the conflicting parts of the POST. Keep both consistent and give copies to your care team.

Tennessee does not run a statewide advance directive registry. So the practical step is to make copies. Keep your own signed copy, and give one to your agent or surrogate, your doctor, and a family member who would be involved. (Source: Tennessee Health Facilities Commission, Advance Directives and POST.)

A Simple Planning Sequence

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

  1. Decide whether you want individual instructions, a named agent, or both in one document.
  2. Choose your health care agent and a backup, and ask them first.
  3. Write your care instructions, including end-of-life wishes.
  4. Make it valid by either notarizing it or signing in front of two witnesses, with the attestation clause the witnesses sign.
  5. Give signed copies to your agent or surrogate, your doctor, and a family member.
  6. Review it after any major life change, especially marriage or divorce, and replace it if your wishes change.

Pair this directive with the rest of your plan. The Tennessee power of attorney guide covers who manages your money and property if you cannot, and the how to avoid probate in Tennessee guide covers passing assets without a court file. A directive stops working at death, so the Tennessee probate guide picks up the estate work from there. For the full set of Tennessee estate and probate pages, start at the Tennessee estate directory.

This Tennessee advance directive guide is a planning map, not legal advice. The Tennessee Health Care Decisions Act and the official Tennessee Code Annotated control. Verify the current statute text and any state model form before you sign, and talk with a Tennessee attorney for a directive built around your wishes.

This guide is general information about Tennessee estates. It is not legal advice. Confirm anything that affects your situation with your local Chancery Court Clerk and Master, your health care provider, or a licensed Tennessee attorney.

Sources

Information current as of June 14, 2026

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

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