Virginia Living Will Requirements

Virginia does not have a legally separate living-will statute. The Health Care Decisions Act creates one combined instrument, the advance directive (suggested form: Advance Medical Directive), which may specify treatment wishes, appoint a health care agent, and address an anatomical gift, all in one document with one signature and witness block.

Any adult capable of making an informed decision may make an advance directive under Section 54.1-2983. Section 54.1-2983.2 presumes every adult capable unless determined otherwise, and requires an attending physician's written certification, plus a capacity reviewer's certification in most cases, before treating the person as incapable.

A written directive requires two subscribing witnesses over the age of 18. Virginia's statute explicitly permits your spouse or a blood relative to serve as a witness, and it permits employees of health care facilities and physician's offices acting in good faith to witness as well. There is no requirement that a witness be unrelated to you, disinterested in your estate, or unaffiliated with your health care provider.

Section 54.1-2982 defines terminal condition as a condition from which the patient cannot recover to a reasonable degree of medical probability, where either death is imminent or the patient is in a persistent vegetative state. Life-prolonging procedure is defined to include artificially administered nutrition and hydration.

Sections 54.1-2983 and 54.1-2984 let you appoint a health care agent inside the same advance directive as your treatment instructions. Section 54.1-2986.1 governs the agent's actual authority and decision-making priority once appointed. Naming an agent is a separate function from the living-will treatment-wishes instruction covered on this page. For full agent-designation guidance, see Virginia Healthcare Power of Attorney.

You may revoke all or part of your advance directive at any time, but only while you are capable of understanding the nature and consequences of your actions, by a signed dated writing, by physically destroying it yourself or directing someone else to destroy it in your presence, or by an oral expression of intent to revoke. Filing for divorce or annulment from your named agent, or filing for custody or visitation of a child you share with that agent, automatically revokes the agent's authority.

Virginia's Revised Uniform Anatomical Gift Act provisions let you authorize organ, tissue, or eye donation, and the state's own suggested advance directive form includes a dedicated anatomical-gift option alongside its treatment-wishes and agent-designation sections.

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

An advance directive validly executed in another state, under that state's law or under Virginia's, is deemed validly executed for purposes of Virginia's Health Care Decisions Act, and Virginia law governs how it is interpreted here. The separate federal Patient Self-Determination Act (42 U.S.C. Section 1395cc(f)) requires Medicare- and Medicaid-participating facilities to inform patients of their right to make an advance directive, but it does not itself govern interstate recognition of the document.

Artificially administered nutrition and hydration is included within the statutory definition of life-prolonging procedure, so your general end-of-life instruction covers it automatically. Virginia's suggested form does not require or provide a separate, specifically-initialed line for ANH alone, though you may add your own custom ANH-specific instruction in the form's open-ended directions section if you want to address it separately.

The suggested form authorizes pain-relieving medication in excess of recommended dosages, sufficient to relieve pain, even if it carries a risk of addiction or of hastening death, and states that withholding life-prolonging procedures does not mean withholding comfort care or pain relief.

An attending physician who refuses to comply with a patient's advance directive or an agent's health care decision must make a reasonable effort to transfer the patient to another physician, and this duty applies even if the physician considers the requested care medically or ethically inappropriate.

If stored or transmitted electronically, the directive should comply with Virginia's Uniform Electronic Transactions Act and the federal E-SIGN Act. These laws provide a general framework for electronic signatures and records; they are not part of the Health Care Decisions Act itself.

If you have not made an advance directive, or your directive does not address the health care at issue and does not name an agent, Virginia authorizes a ranked list of decision-makers on your behalf: a guardian, then spouse, then adult child, then parent, then adult sibling, then other blood relatives, then in limited circumstances another adult familiar with your values.

Federal Medicare and Medicaid conditions of participation require covered hospitals, nursing facilities, and other providers to give patients written information about their rights under Virginia law to make an advance directive, including stating their own treatment wishes.

The suggested form directs your agent not to make a health care decision the agent knows, or upon reasonable inquiry ought to know, is contrary to your religious beliefs or basic values, and Section 54.1-2986.1 requires any agent or authorized decision-maker to make a good faith effort to ascertain and follow those beliefs and values.

Unlike states that let you choose between notarization and witnesses, Virginia's only path for executing a written advance directive is signing it in the presence of two subscribing witnesses. There is no notary-instead-of-witnesses option for the directive itself. Notarization only becomes relevant if you later revoke a directive that was submitted to the state registry.

An adult already diagnosed by his attending physician as having a terminal condition may make an oral advance directive instead of a written one, stating treatment wishes and optionally naming an agent, as long as it is spoken in the presence of the attending physician and two witnesses.

The suggested form includes a dedicated blank letting you write your own modification to your end-of-life instructions in case you are pregnant when your attending physician determines you have a terminal condition. Virginia's statute supplies no default rule of its own; if the blank is left empty, your general instructions apply as written.

If any provision of your advance directive conflicts with an emergency custody order, temporary detention order, involuntary admission order, or mandatory outpatient treatment order issued under Title 37.2, the conflicting provision of your directive has no effect, though the rest of your directive is otherwise given full effect.

A Durable Do Not Resuscitate Order is a physician's order, issued only with the patient's or authorized decision-maker's consent, and Virginia's statute expressly states it is not and shall not be construed as an advance directive. It is typically used alongside a directive for patients with serious illness, to translate treatment wishes into an actionable medical order, but it does not replace, and is not required by, your living-will instructions.