Alabama Healthcare Power of Attorney Requirements

The Health Care Proxy is created as part of the Advance Directive for Health Care, governed specifically by Code of Alabama Section 22-8A-4, within Chapter 8A (the Natural Death Act, Sections 22-8A-1 through 22-8A-13).

The declarant must be a competent adult, defined as alert, capable of understanding a lay description of medical procedures, and able to appreciate the consequences of providing, withholding, or withdrawing them, and at least 19 years old.

The health care proxy must be a competent adult (19 or older). The proxy can never be the declarant's health care provider, with no relative exception for the provider itself; a proxy who is instead merely an employee of the health care provider is barred only if not the declarant's relative.

The declarant signs, or directs another to sign in the declarant's presence, in front of two witnesses at least 19 years old, who then sign the document. Both witnesses, not just one, must also clear a full disqualification list: neither may be the person who signed for the declarant, the named health care proxy, related to the declarant by blood, adoption, or marriage, entitled to any part of the declarant's estate, or directly financially responsible for the declarant's medical care.

Alabama's health care proxy authority is limited by statute to deciding whether to provide, withhold, or withdraw life-sustaining treatment and artificially provided nutrition and hydration; it is not automatically a general grant of authority over all medical treatments and procedures. Broader, everyday health care decision authority requires a separate durable power of attorney health care rider under Code of Alabama Section 26-1-2(g), which itself excludes psychosurgery, sterilization, abortion except to preserve the declarant's life, and involuntary hospitalization or treatment.

The proxy's authority activates only when the attending physician determines the declarant can no longer understand, appreciate, and direct medical treatment, AND two physicians, one being the attending physician and one qualified and experienced in making the diagnosis, personally examine the declarant and document either a terminal illness or injury or a state of permanent unconsciousness.

The statutory form provides fields for a first and second choice of health care proxy, so the declarant may name an alternate who serves if the first choice is unable, unwilling, or unavailable.

The declarant may revoke at any time by destroying or defacing the document with intent to cancel, by a signed and dated written revocation, or by a verbal expression of intent to revoke made in the presence of a witness at least 19 years old who signs and dates a writing confirming the statement (effective once the health care provider receives that writing).

Alabama law automatically suspends the entire advance directive for health care, including any proxy designation, during the course of a pregnancy the attending physician knows about, regardless of what the document itself says.

Alabama has adopted the Revised Uniform Anatomical Gift Act, which defines an 'agent' to include a person authorized to make health care decisions for the principal under a power of attorney for health care, and permits that agent to make an anatomical gift on the principal's behalf unless the health care directive expressly prohibits it.

Alabama's Health Care Proxy under Chapter 22-8A does not extend to general mental health treatment decisions at all; its authority is limited to life-sustaining treatment and artificial nutrition and hydration decisions Broader authority, if desired, requires a separate durable power of attorney health care rider under Code of Alabama Section 26-1-2(g), which itself explicitly excludes 'involuntary hospitalization or treatment covered by Subtitle 2 of Title 22' and psychosurgery.

A physician, licensed health care professional, medical care facility, or other health care provider who in good faith and pursuant to reasonable medical standards follows a living will, a designated proxy's directions, or a duly appointed surrogate's directions, without actual knowledge of a revocation, is not subject to criminal or civil liability and is not found to have committed unprofessional conduct.

Where a declarant has executed both a living will and a proxy designation, the health care proxy's decisions regarding life-sustaining treatment and artificially provided nutrition and hydration take precedence over the living will, unless the declarant's living will or proxy designation states otherwise. In Alabama, the living will and the health care proxy designation are typically executed as sections of the same combined statutory form, not as two separate documents.

Alabama law requires only two qualifying witnesses under Code of Alabama Section 22-8A-4(c); it does not require or offer notarization as an alternative. The official ADPH form has a two-witness signature block and no notary block.

Federal HIPAA regulations govern how the health care proxy can be authorized to access the declarant's protected health information once the document is in effect.

An advance health care directive executed in another state in compliance with that state's law, or with Alabama's law, is valid for purposes of Chapter 22-8A, though this does not authorize administering, withholding, or withdrawing health care otherwise prohibited under Alabama law.

Facilities that participate in Medicare and Medicaid must inform patients of their rights under state law to make advance directives, including an Advance Directive for Health Care with a health care proxy designation.

Where the declarant has not given specific instructions, the health care proxy must make decisions that conform as closely as possible to what the declarant would have wanted, taking into account the declarant's personal, philosophical, religious, and moral beliefs and ethical values.