Alabama Living Will Requirements

Alabama does not have a legally separate living will statute. Code of Alabama Sections 22-8A-1 through 22-8A-17, known as the Natural Death Act, create one combined instrument, the Advance Directive for Health Care, defined as a writing that may include a living will, a health care proxy designation, or both together in one document with one execution block.

Section 22-8A-3 defines a terminally ill or injured patient as one whose death is imminent, or whose condition is hopeless to a reasonable degree of medical certainty unless artificially supported through life sustaining procedures, as confirmed by a physician qualified and experienced in making such a diagnosis. Separately, Section 22-8A-4(d) requires two physicians, your attending physician and this qualified physician, to personally examine you and jointly document this diagnosis before your directive takes effect.

Section 22-8A-3 defines permanent unconsciousness as a condition that will last permanently without improvement, in which cognitive thought, sensation, purposeful action, social interaction, and awareness of self and environment are absent, existing long enough to be diagnosed and confirmed by a physician qualified and experienced in making such a diagnosis. As with a terminal illness or injury diagnosis, Section 22-8A-4(d) requires two physicians to personally examine you and jointly document this diagnosis before your directive takes effect.

Alabama requires two or more adult witnesses at least 19 years old. A witness cannot be the person who signed on your behalf, your named health care proxy, related to you by blood, adoption, or marriage, entitled to any part of your estate, or directly financially responsible for your medical care. Unlike some states, Alabama's witness disqualification list does not separately bar your health care provider or a care facility employee from serving as a witness, unless that person is also your named proxy.

Alabama law states that an advance directive for health care has no effect during the course of a pregnancy the attending physician knows the declarant to be experiencing. The statutory form restates this in plain language for the signer.

Alabama applies one uniform revocation rule to the entire advance directive, both the living will and proxy designation together. You may revoke at any time by destroying or defacing the document with intent to cancel, by a signed and dated written revocation, or by telling a witness at least 19 years old who signs and dates a writing confirming your verbal intent to revoke. No one faces liability for failing to act on a revocation unless they had actual knowledge of it.

Section 22-8A-4(b) also lets you name a health care proxy inside the same Advance Directive for Health Care. That is a separate function from the living will treatment wishes covered on this page. If you execute both and they conflict, Alabama law gives your proxy's decisions precedence over your living will unless your documents say otherwise. For full agent designation guidance, see Alabama Healthcare Power of Attorney.

A health care provider who refuses to comply with your living will, proxy, or surrogate must promptly tell you and permit your transfer to another provider who will follow your wishes, while continuing life sustaining treatment during the transfer. Separately, no nurse, physician, or other provider can be required by law or contract to participate in withholding or withdrawing treatment if they object, and no one may be discriminated against for participating or refusing to participate.

A physician, licensed health care professional, medical facility, or other health care provider who in good faith follows a living will, proxy designation, or surrogate decision made under this chapter is not subject to criminal or civil liability, or a finding of unprofessional conduct, absent actual knowledge of a revocation.

Withholding or withdrawing life sustaining treatment or artificial nutrition and hydration under this chapter does not, for any purpose, constitute suicide and does not constitute assisting suicide.

Executing an advance directive for health care does not affect the sale, procurement, or issuance of any life or health insurance policy, and does not modify the terms of an existing policy. No policy can be impaired or invalidated because life sustaining treatment or artificial nutrition and hydration was withheld or withdrawn under a valid directive.

Federal HIPAA regulations govern how your health care proxy can be authorized to access your protected health information once the proxy designation portion of your combined directive is in effect. This authorization supports the proxy decision maker half of your directive. It does not change or expand your own treatment wishes.

Federal law requires Medicare and Medicaid participating hospitals, nursing homes, and other facilities to inform patients in writing of their right under Alabama law to make an advance directive, including stating their own treatment wishes.

Alabama's anatomical gift laws let you authorize organ and tissue donation separately from your Advance Directive for Health Care. Unlike some states, Alabama's own statutory living will and proxy form does not include a built in organ donation section, so this remains a separate legal topic rather than part of the form itself.

An advance health care directive validly executed in another state, under that state's law or Alabama's, is valid in Alabama, though this does not authorize care that Alabama law otherwise prohibits.

Life sustaining treatment under Alabama law includes assisted ventilation, cardiopulmonary resuscitation, renal dialysis, surgical procedures, blood transfusions, and drugs and antibiotics, but excludes medication or treatment the attending physician considers necessary for comfort or pain relief. Artificial nutrition and hydration is treated separately: it can only be withheld under your living will if you specifically authorized that in writing, and Alabama's statutory form requires its own initialed choice, distinct from your general treatment answer, for each of the two trigger conditions.

Alabama law excludes comfort and pain relief from the definition of life sustaining treatment, so choosing not to receive life sustaining treatment under your living will does not stop you from receiving medication or care the attending physician considers necessary to ease pain or provide comfort.

Alabama's Advance Directive for Health Care must be dated, signed by you or by another adult in your presence and at your direction, and signed in the presence of two or more witnesses at least 19 years old. Unlike some states, Alabama's statute provides no notary acknowledgment alternative to witnessing for this document.

You may file and record your living will with the judge of probate in the Alabama county where you reside, for a five dollar fee. Recording is optional and does not affect the validity of your directive. A recorded directive is not open to general public inspection, only to emergency medical personnel, hospital personnel, treating physicians, immediate family, or a person you authorize in writing.