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Virginia Advance Medical Directive
Support GuideVirginia11 min read

Virginia Advance Medical Directive

How a Virginia advance medical directive works: one witnessed document for living-will wishes plus a health care agent, the surrogate list, and VDH registry.

By Settled Editorial

In Virginia you do not need separate paperwork for a living will and a medical power of attorney. One document, called an advance directive, 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 before two witnesses, and it takes effect only after a doctor finds you are unable to make an informed decision. This sits under the Virginia Health Care Decisions Act (Code of Virginia Title 54.1, Chapter 29, Article 8, starting at § 54.1-2981). (Source: Va. Code § 54.1-2983.)

Use this Virginia advance medical 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 Virginia estate-planning attorney can help you sign a directive that says what you mean. This page connects to the Virginia probate and estate directory and to the Virginia power of attorney guide for the money side of planning.

What a Virginia Advance Directive Does

A Virginia advance directive is one written, witnessed document that can carry two kinds of choices. The Health Care Decisions Act lets you combine them or use just one. (Source: Va. Code § 54.1-2983.)

  • Living-will instructions. You can write down the care you do and do not want, including end-of-life care if you reach a terminal condition. This is the "living will" part. Virginia does not use a stand-alone living will statute. Those instructions live inside the advance directive.
  • A health care agent. You can name an adult you trust to make medical decisions for you, consent to or refuse treatment, and see your medical records when you cannot decide for yourself. This is Virginia's version of a health care power of attorney. You can also name a successor agent as a backup. (Source: Va. Code § 54.1-2984.)

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. Virginia also lets the directive authorize an anatomical gift.

One naming note that confuses people: Virginia does not have a separate "health care surrogate" document you fill out in advance. The agent you name is your chosen decision-maker. A "surrogate" in Virginia law is the person who steps in by default when there is no agent, which the next sections explain.

How to Sign It in Virginia

A written Virginia advance directive must be signed by you in the presence of two subscribing witnesses. That is the core rule. (Source: Va. Code § 54.1-2983.)

A few practical points sit on top of that rule:

  • Notarization is not required by statute, but it is recommended. A notarized signature helps prevent later disputes and can help other states recognize your directive if you travel or move. (Source: Va. Code § 54.1-2983.)
  • Pick clean witnesses. Virginia's statute requires two witnesses. Confirm witness eligibility against the current statutory suggested form in Va. Code § 54.1-2984, and do not rely only on the general tips below. Best practice is to avoid using your named agent or anyone who would inherit from you as a witness, so no one can question their role later. A Virginia attorney can confirm that your witnesses are compliant before you sign.
  • You can use the suggested form, or not. Va. Code § 54.1-2984 gives an optional suggested advance directive form. You may use it, adapt it, or write your own, as long as it meets the signing rule.

There is one narrow exception for people already facing the end of life. A patient who has been diagnosed with a terminal condition may make an oral advance directive in front of the attending physician and two witnesses. That oral option is only for that situation. For everyone planning ahead, the written, two-witness route is the path. (Source: Va. Code § 54.1-2983.)

When the Directive Takes Effect

A Virginia advance directive does not switch on the moment you sign it. It takes effect after a finding that you cannot make an informed decision about your care. While you can still decide for yourself, you stay in charge, and your own contemporaneous choices control. (Source: Va. Code § 54.1-2983.2.)

The Health Care Decisions Act sets out how that finding works:

  • Your attending physician must certify in writing, after a personal exam, that you are incapable of making an informed decision.
  • A capacity reviewer (a licensed physician, clinical psychologist, or professional counselor, as defined in Va. Code § 54.1-2983.2) also provides written certification, except when you are unconscious or have a profound impairment of consciousness from trauma, stroke, or another acute condition.
  • The finding is re-checked at least every 180 days while you still need care, so your capacity is not treated as a permanent label.

For the living-will, end-of-life instructions to apply, Virginia adds a second layer. You must be incapable of deciding and have a terminal condition, which the statute defines as a condition you cannot recover from where death is imminent, or a persistent vegetative state. Persistent vegetative state means a loss of consciousness with no behavioral evidence of self-awareness or awareness of your surroundings. (Source: Va. Code § 54.1-2982 and § 54.1-2983.2.)

Who Decides If You Have No Directive

If you never signed a directive and never named an agent, Virginia does not leave the decision open. State law sets a default surrogate priority list. Once a doctor finds you cannot make an informed decision and there is no agent to act, the right to decide passes down this order. (Source: Va. Code § 54.1-2986.)

PriorityWho can decide
1A court-appointed guardian with health care authority
2Your spouse, unless a divorce action has been filed and is not yet final
3An adult child
4A parent
5An adult brother or sister
6Any other relative, in descending order of blood relationship
7An adult who has shown special care and concern, knows your values, and is willing to be involved (with limits on end-of-life choices)

A few rules shape how this list works:

  • It applies only when you cannot decide and either have no directive or have one that does not cover the issue and names no agent, and the physician knows of no available, willing person in a higher class.
  • If people in the same class disagree, the attending physician may rely on the decision of a majority of the reasonably available members of that class.
  • A surrogate is supposed to decide based on your known wishes, or, if those are unknown, on your best interests.

The takeaway for planning: the surrogate list works, but it may put the decision with someone you would not have picked, or split it among several people. Naming your own agent in an advance directive keeps that choice in your hands.

Changing or Revoking Your Directive

A Virginia advance directive does not expire. It stays in force until you revoke it or replace it. (Source: Va. Code § 54.1-2985.)

You can change course in several ways:

  • Sign a new, dated writing that revokes the old directive. A later directive controls over an earlier one.
  • Destroy or cancel the directive, yourself or by someone acting in your presence and at your direction.
  • Say you revoke it. An oral revocation takes effect when you communicate it to your attending physician.
  • Revoke only part of it and leave the rest in place.

One automatic rule is worth knowing for spouses. If you named your spouse as agent and a divorce, annulment, or related petition is filed, your spouse's authority as agent is automatically revoked. 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, and the registry if you stored a copy there.

The Free Virginia Advance Directive Registry

The Virginia Department of Health runs a free, secure online Advance Health Care Directive Registry (ConnectVirginia) under the Health Care Decisions Act. You can store your advance directive, a durable do-not-resuscitate order, and an anatomical gift declaration so providers can find them when needed. (Source: VDH Advance Health Care Directive Registry and Va. Code §§ 54.1-2994 to 54.1-2996.)

Registration is optional. Storing your directive in the registry does not make it more or less valid. A directive that meets the signing rule is valid whether or not you register it. The registry is about access. It gives hospitals and your agent a reliable place to find the document in an emergency. Keep your own signed copies too, and give one to your agent and your doctor.

Virginia also recognizes a separate Durable Do Not Resuscitate Order (DDNR), a portable physician's order to withhold CPR. A DDNR is a medical order signed by a physician, not part of your advance directive, so do not treat the two as the same document. (Source: Va. Code § 54.1-2987.1.)

A Simple Planning Sequence

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

  1. Decide whether you want living-will instructions, a named agent, or both in one document.
  2. Choose your health care agent and a successor agent, and ask them first.
  3. Write your care instructions, including end-of-life wishes for a terminal condition or persistent vegetative state.
  4. Sign the directive in front of two witnesses. Consider notarizing it.
  5. Give signed copies to your agent and your doctor, and consider the free VDH registry.
  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 Virginia power of attorney guide covers who manages your money and property if you cannot, and the how to avoid probate in Virginia guide covers passing assets without a court file. For the full set of Virginia estate and probate pages, start at the Virginia estate directory.

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

This guide is general information about Virginia estates. It is not legal advice. Confirm anything that affects your situation with the Clerk of the Circuit Court, the Commissioner of Accounts, or a licensed Virginia attorney.

Sources

Information current as of June 9, 2026

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

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