Two documents, doing two different jobs

  • A health care proxy — also called a health care power of attorney, or a health care surrogate designation depending on the state — names a person to make medical decisions when the patient cannot.
  • A living will, or advance directive in the narrower sense, records what the patient wants: which treatments they would accept, and which they would refuse.

The names differ by state, which is a real source of confusion. What does not differ is why both matter: the proxy answers who decides, and the directive tells that person what to decide. A proxy with no instructions puts an impossible weight on a family member; instructions with nobody authorized to act on them get argued about.

A financial power of attorney does not cover medical decisions. Families discover this at the hospital, and it is a frequent gap in an otherwise well-prepared set of documents.

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Sahvelo gives information drawn from statutes, agency guidance and official forms. It is not legal advice for your particular situation. Terms & disclaimer.

The failure is retrieval, not signing

The document that decides what happens is the one the hospital has in front of it. A correctly executed directive in a safe-deposit box at 2am on a Sunday is, for practical purposes, no directive at all.

What actually works

  1. Give a copy to the named agent, and confirm they know they have been named. Being appointed by surprise is a bad way to find out.
  2. Give a copy to the primary care physician's office and ask for it to be scanned into the chart.
  3. Take a copy to any hospital admission, including planned ones. Hospitals do not share records with each other by default.
  4. Keep a photograph of it on the agent's phone. Not a substitute for the original, but it settles arguments at 2am.
  5. Register it with your state's registry if one exists.

Do not put the only copy in a safe-deposit box. In several states the box is sealed on death, and in every state it is closed at night.

The third document, which is easy to overlook

Being named as a health care agent lets someone make decisions. It does not, on its own, guarantee access to medical records — and a family member trying to understand a diagnosis before any decision is needed is often doing exactly that.

A HIPAA authorization is a separate written document under federal regulation with its own required contents: what information may be disclosed, who may disclose it, who may receive it, the purpose, an expiry, and the individual's signature and date.

6

What it takes to sign one, by state

The purpose of these documents is identical everywhere. What makes one valid is not, and the differences are sharper here than for financial powers of attorney — some of the states read here require no notary at all.

Witnesses and notary

The answer in 43 states

  • Alabama

    Two or more witnesses at least NINETEEN years of age, and nothing in its place. Alabama's age of majority is 19 and every other state read here sets the witness age at 18, so a document witnessed by two eighteen-year-olds does not satisfy the section. The directive must also be in writing, signed by the declarant or by another in the declarant's presence at their expressed direction, and dated. There is a further step families miss: if the directive names a health care proxy, that person must ACCEPT IN WRITING and the acceptance must be attached to the designation. Naming somebody is not enough in Alabama.•

  • Alaska

    Two witnesses or a notary, and three details in the same sentence can each invalidate the document. A DATE is required on the face: Sahvelo has read no other state that makes a date a condition of validity for a health care directive. The witnesses must be PERSONALLY KNOWN to the principal, which rules out the two strangers a hospital or a bank can usually supply. And the notary alternative works only at a place in Alaska, so a document notarized while the principal was out of state does not take that route. The other half of the scheme is far looser: an individual instruction, which is Alaska's living will, may be ORAL.•

  • Arizona

    Either. Notarized, or witnessed in writing by at least one adult who affirms they were present and that the principal appeared of sound mind and free from duress.1

  • California

    Either. Acknowledged before a notary public, or signed by at least two qualified witnesses. If the directive is executed electronically, a notary is required and the witness alternative is not available.3

  • Colorado

    Either: two witnesses, or a notary. And then a clause worth reading before you choose, because Sahvelo has found it in no other state. The notary route carries an exception on its face, that a court may determine it should not apply to a particular declaration in the interest of justice. So the two-witness route is the one that cannot be reopened, and a family with any reason to expect a dispute should use witnesses, or use both. This alternative arrived with a 2021 amendment effective 7 May 2021, so a Colorado declaration signed before that date was made under a different rule.•

  • Delaware

    ONE adult witness on the appointing document, and none at all on a statement of wishes. A power of attorney for health care must be in a record, signed by the individual, and signed by one adult witness. Delaware then defines presence three ways: physically in the same location, on a real-time audio AND video connection, or on an audio connection alone where the witness personally knows the individual or can authenticate their identity from accurate answers. A telephone call is enough. Of the states Sahvelo has read for this topic Delaware is the one that does not need a picture. And a health-care instruction, as opposed to the appointment, needs no writing, no signature and no witness: it may be spoken to a clinician, who must then record it and its date in the chart.••

  • Florida

    Two subscribing adult witnesses. No notary is required.4

  • Hawaii

    Either, and the date on the face is a condition of validity. The power must be in writing, contain the date of its execution, be signed by the principal, and be witnessed either by at least two individuals who witnessed the signing or the principal's acknowledgment of the signature, or acknowledged before a notary public at any place within Hawaii. Notarization has to happen in the State, so a document notarized on the mainland does not satisfy that branch. A separate individual instruction about treatment may be oral, with no condition attached about who it is said to.•

  • Idaho

    Neither is required. Idaho rewrote this in 2023 and put witnesses and notarization in the list of things an advance care planning document MAY include rather than must. What it must include is the person's name, date of birth, telephone number and mailing address, the signature of the person or their authorized agent, and the date it was signed. A document signed alone at a kitchen table meets the statute. Two more things travel with that: blanks left unfilled are deemed intentional and do not invalidate the document, and any form the Department of Health and Welfare publishes is expressly optional. A reader arriving from a state where an unwitnessed signature is fatal should not carry that expectation into Idaho.•

  • Illinois

    It depends which document, because Illinois puts them in two different acts with two different rules. A health care power of attorney needs one witness aged 18 or over and no notary — the statutory form says in terms that there is no need to have it notarized. A living will needs two witnesses aged 18 or over, and no notary either. Neither needs a notary; only the property power does, and that one also needs its witness to be a different person from the notary.••

  • Indiana

    It depends which document, and the gap between them is the widest in this comparison. A DECLARATION must be voluntary, in writing, signed, DATED, and signed before at least two competent adult witnesses OR a notary public. An APPOINTMENT of a health care representative needs one adult witness who is not the representative, and no notary at all. The document that hands another person the decision is the one Indiana asks least for. One date to watch: the route that let a designee sign for the appointor closed on 1 January 2023, so an appointment made after that must be signed by the appointor personally.••

  • Iowa

    Either, on both documents, and both must carry the date of execution. The witness route is stricter than most: two individuals who witnessed the signing in the presence of each other AND of the declarant, so the two of them being in the room at different times does not work. The alternative is acknowledgment before a notarial officer within Iowa. Both the living will in chapter 144A and the durable power of attorney for health care in chapter 144B use the same pair of methods, and chapter 144B conditions the agent's authority on the document explicitly authorizing health care decisions as well as being properly witnessed.••

  • Kansas

    Either, and which branch you pick decides who can help. A Kansas declaration must be in writing, signed, dated, and then either signed in the presence of two or more witnesses at least 18 years old, or acknowledged before a notary public. Every restriction Kansas imposes on who may witness sits inside the witness branch; the notary branch is four words long and carries none of them. Kansas also suspends a declaration during a pregnancy known to the attending physician, and makes the specific directions in a declaration severable so one invalid direction does not take the rest down with it.•

  • Kentucky

    Either, and Kentucky applies the same disqualification list to both. An advance directive must be in writing, dated, and signed by the grantor or at their direction, and either witnessed by two or more adults IN THE PRESENCE OF THE GRANTOR AND OF EACH OTHER, or acknowledged before a notary public or other person authorized to administer oaths. Witnesses signing in turn does not satisfy the first branch. And switching to the notary does not escape the restrictions on who may help, because the statute names the notary in the same sentence as the witnesses, which is not how the states that offer a choice usually draw it.•

  • Maine

    Two witnesses, and Maine puts no notarized route in their place. The document must be in writing and signed by the principal and two witnesses. Then the sentence that decides a question most statutes are silent about: notwithstanding any law validating electronic or digital signatures, the signatures of the principal and the witnesses must be made IN PERSON and not by electronic means. A Maine power of attorney for health care cannot be signed over a video call. Vermont, next door, expressly permits remote witnessing and digital signatures, so a family with relatives in both states should not assume the paperwork travels.•

  • Maryland

    Two witnesses, and Maryland is the state read here that has gone furthest in making that practical rather than physical. The directive may be written OR electronic, must be dated and signed by or at the express direction of the declarant, and must be subscribed by two witnesses in the physical presence OR THE ELECTRONIC PRESENCE of the declarant. Electronic presence is in the statute rather than borrowed from an emergency order, and documents signed under the 2020 executive order on remote witnessing are separately preserved. There is also a video route with no witness at all, and a separate oral route, both under the next questions.•

  • Massachusetts

    Two other adults, and no notary option. The proxy must be in writing, signed by the adult or at their direction, in the presence of two other adults who subscribe their names as witnesses. Those two do more than sign: they must affirm in writing that the principal appeared to be at least eighteen, of sound mind, and under no constraint or undue influence. That is why a Massachusetts proxy form has sentences in the witness block rather than two blank lines.•

  • Minnesota

    Either. A Minnesota health care directive must be in writing, dated, state the principal's name, be executed by a principal with capacity, and carry verification of the signature by a notary public OR by witnesses. The section that lists those requirements does not say how many witnesses, and the state's own suggested form does: two. That form is expressly not required, so it is evidence of the count rather than a template anybody has to use.••

  • Missouri

    It depends on the handwriting, which is a distinction Sahvelo has read in no other state here. A Missouri declaration must be in writing, signed, and dated. Witnesses are required only IF NOT WHOLLY IN THE DECLARANT'S HANDWRITING, in which case two or more witnesses at least eighteen years of age are needed. Read the other way round: a declaration written out by hand from beginning to end satisfies the section with no witness at all. A typed one, or a filled-in form, needs two. No notary is offered either way, and the statutory form is expressly optional.•

  • Montana

    Two witnesses, and that is the whole of it. No notary route is offered and none is needed, no age is stated for the witnesses, and nobody is disqualified from being one. The declaration must be signed by the declarant or by another at the declarant's direction and witnessed by two individuals. One sentence in the same subsection matters at an admissions desk: a health care provider may presume, in the absence of actual notice to the contrary, that the declaration complies with the chapter and is valid, so a Montana provider does not have to satisfy themselves about the execution before acting on it.•

  • Nebraska

    Either: two adults, or a notary public. An adult of sound mind may execute the declaration at any time, signed by them or by another at their direction. The optional statutory form prints a witness block and a notary block as alternatives, joined by the word Or, so the choice is visible on the page the family is filling in.•

  • Nevada

    Two witnesses attesting, and the section names no notarized route instead. A person of sound mind aged eighteen or older may execute the declaration at any time, signed by them or by another at their direction, and attested by two witnesses. One route makes a second document unnecessary: a durable power of attorney for health care properly executed under NRS 162A.790 that addresses the withholding or withdrawal of life-sustaining treatment counts as a properly executed declaration for this chapter. So somebody who already holds that does not need to sign a separate declaration.•

  • New Hampshire

    Either, and the second route is wider than a notary. Two or more subscribing witnesses, who must affirm that the principal appeared to be of sound mind and free from duress and affirmed awareness of the nature of the document and signed it freely. Or a notary public OR A JUSTICE OF THE PEACE, who acknowledges the signature under RSA 456-B. New Hampshire commissions a large number of justices of the peace, so that is a practical alternative rather than a formality, and no other state read here names that officer. If the principal cannot sign, another person may sign the principal's name, but only in the principal's PHYSICAL presence and at their express direction, so that route is not available remotely.•

  • New Jersey

    Either, and the second route is wider than a notary. Two subscribing adult witnesses who attest that the declarant is of sound mind and free of duress and undue influence, or acknowledgment before a notary public, AN ATTORNEY AT LAW, or another person authorized to administer oaths. A family already sitting with a lawyer does not need to find a notary as well. One more thing the section allows, and has allowed since 1991: an advance directive may be SUPPLEMENTED by a video or audio tape recording. Supplemented rather than replaced, so the recording sits alongside the executed document.•

  • New Mexico

    Neither, and New Mexico is the loosest in this comparison by a distance. A power of attorney for health care must be in writing and signed by the principal, and the section asks nothing else: no witnesses, no notary, no date. A document signed at a kitchen table with nobody watching is valid. Two things the same section adds are worth more than the formalities. It reaches an emancipated minor as well as an adult. And unless related by blood, marriage or adoption, the agent may not be an owner, operator or employee of the institution where the principal is receiving care, so the trusted aide at the care home cannot hold the power. A copy has the same effect as the original, so an institution asking for the signed original is asking for something the Act does not require.•

  • New York

    Two adult witnesses who also sign, and who state that the principal appeared to act willingly and free from duress. No notary is required.5

  • North Carolina

    BOTH, and it is the second state read here that stacks them. A North Carolina declaration must be signed in the presence of two witnesses who believe the declarant to be of sound mind and who state their qualifications, AND it must be proved before a clerk or assistant clerk of superior court, or before a notary public who certifies in substantially the form printed in the statute. Not one or the other. The statute prints a form at subsection (d1) that is specifically determined to meet the requirements, and the form opens by telling the reader there is no legal requirement that anybody execute a living will at all.•

  • North Dakota

    Either on its face, and in practice the choice helps less than it looks. A health care directive must be in writing, dated, state the principal's name, be executed by a principal with capacity, include a health care instruction or a power of attorney for health care or both, and carry verification of the signature by a notary public or by at least two subscribing witnesses aged eighteen or older. The catch is that North Dakota applies its disqualifications to the notary as well as to the witnesses, so switching routes does not get a family past them.•

  • Ohio

    Either, and that is unusual. Both Ohio documents — the durable power of attorney for health care and the living will declaration — are validly executed by two qualifying witnesses OR by acknowledgment before a notary public. Two witnesses, or one notary. Pennsylvania requires two witnesses and no notary; Illinois requires one witness for the health care power and two for the living will. The notary alternative is not a formality in Ohio, it is the escape route, because of who the state disqualifies from witnessing. Both documents must also be signed at the end and state the date of execution.••

  • Oklahoma

    Two witnesses aged eighteen or older, and nothing in their place. No notary route is offered. The declarant must be of sound mind and eighteen or older. THE SECOND REQUIREMENT IS ABOUT LAYOUT RATHER THAN SIGNATURES, and it is the one to check on a document a family already has: if the directive is NOT in the form printed in the statute and was executed in Oklahoma, it does not authorize withholding or withdrawing artificially administered nutrition or hydration unless it says so in the declarant's own words, or in a separate section, paragraph or subdivision dealing ONLY with nutrition and hydration, separately initialed, separately signed or otherwise separately marked. A generic form downloaded elsewhere and signed once at the end can be perfectly valid and still not reach the feeding tube. The statutory form carries those separate initial lines already, which is the reason to use it.•

  • Oregon

    Either: witnessed and signed by at least two adults, or notarized by a notary public. On the witness route each witness must witness either the principal signing or the principal acknowledging their signature. And on that route only, one further condition applies where the principal is in a long term care facility, set out under the next question. An advance directive executed in another state in compliance with that state's law, the law where the principal was located, or Oregon law, is validly executed here.•

  • Pennsylvania

    Two witnesses aged 18 or over, and no notary — which is the reverse of Pennsylvania's financial power of attorney, where you need an acknowledgment before a notary as well as two witnesses. A date on the face is required as well. Who may make one is wider than the usual age test: you qualify at 18, or on graduating from high school, or on marrying, or as an emancipated minor. Any one of the four is enough, and the same test governs both the living will and the health care power of attorney.•

  • Rhode Island

    Two subscribing witnesses, and the section offers no notarized route in their place. A competent individual eighteen or older may execute the declaration at any time, signed by them or by another at their direction, in the presence of the two witnesses. Because there is no notary route, the two witnesses are mandatory, and the family restriction described under the next question applies to both of them rather than to one. That combination is the thing to check first on a Rhode Island document.•

  • South Carolina

    Both, plus a sworn affidavit, and that is before the hospital rule. A South Carolina declaration must be dated and signed by the declarant in the presence of an officer authorized to administer oaths AND in the presence of two witnesses, one of whom may be that officer. The two witnesses state their qualifications in an affidavit set out in the statute, and the affidavit must be subscribed by both of them and sworn to by at least one, in the presence of the declarant, of each other, and of the officer. Of the states read here this is the heaviest execution formality, and it is the one most worth arranging in advance rather than improvising.•

  • South Dakota

    Either, on both documents, and they are two documents. The living will declaration must be signed by the declarant or by another at their direction and witnessed by two adults, or by a notary public who then notarizes it. The durable power of attorney for health care asks for the same choice in different words: signed by the principal, or in the principal's conscious presence by somebody they directed, with the signature witnessed by two other adult individuals or by a notary public. Note conscious presence rather than physical presence on the power of attorney. One requirement is easy to miss and is not about who watched: a South Dakota declaration MUST state what the declarant wants about artificial nutrition and hydration. If it does not, the document is still valid and that question falls back to the law that applies where there is no declaration at all.••

  • Texas

    Two witnesses, or a notary instead. The declarant signs in the presence of two competent adult witnesses who both sign — or, in lieu of that, signs and has the signature acknowledged before a notary public. The same rule governs both the written directive and the medical power of attorney.•

  • Utah

    ONE witness, and no notary is mentioned. Utah asks that an advance health care directive be witnessed by a disinterested adult, singular. It also allows the directive to be oral rather than written, and where it is oral the witness has to state the circumstances in which it was made. On paper that is the lightest formality read here alongside Arizona's single adult witness. In practice the count is not the constraint; who qualifies as disinterested is.•

  • Vermont

    Two or more witnesses at least 18 years old, who sign and affirm that the principal appeared to understand the document and to be free from duress or undue influence. A date on the face is required as well. Vermont is the state read here that has answered the remote question yes: since 1 April 2024 a witness may be remote, if the principal and that witness were known to each other, the witness attested over a live audio-video connection or by telephone, and the principal recorded the remote witness's name, contact details and relationship on the directive itself. Digital signatures are expressly permitted. And there is a second condition that has nothing to do with witnesses and can void the document outright, set out under the next question.••

  • Virginia

    Two subscribing witnesses, and nothing else will do: Virginia offers no notarized route. Any adult capable of making an informed decision may make a written advance directive at any time, signed in the presence of those two witnesses. There is also an oral route, but it is narrower than it first sounds: it is open only to an adult who has already been diagnosed by their attending physician as being in a terminal condition, and it must be made in the presence of the attending physician and two witnesses. So speaking instead of signing is not an option for a healthy adult in Virginia.•

  • Washington

    Either, and which one you pick changes who can help. The directive must be signed by the declarer and acknowledged before a notary public or another individual authorized by law to take acknowledgments, OR signed in the presence of two witnesses. Every disinterest restriction Washington imposes is written into the witness branch, so the notary route sidesteps all of them. For a family where everybody available is either a relative or on the hospital payroll, that is the practical route. The section was last amended in 2025.•

  • West Virginia

    BOTH, which is the answer families get wrong most often here. West Virginia asks for two or more witnesses at least 18 years old AND that their signatures and attestations be acknowledged before a notary public. It is not a choice between routes. A document witnessed by two neighbors and never taken to a notary does not meet the section. A date on the face is a listed condition too. Of the states Sahvelo has read for this topic, only West Virginia and North Carolina stack the notary on top of the witnesses instead of offering it in their place.•

  • Wisconsin

    Two witnesses, and Wisconsin offers no notarized route instead of them. Any person of sound mind aged eighteen or older may voluntarily execute the declaration, signed in the presence of the two witnesses. Where the declarant cannot sign, a witness or another person may sign in the declarant's name at their express direction and in their presence, and that proxy signing must either take place or be acknowledged in the presence of the two witnesses.•

  • Wyoming

    Either, and the witness route comes with a sworn statement. The power must be in writing and signed by the principal or by another in the principal's presence at their expressed direction, and then acknowledged before a notarial officer OR signed by at least two witnesses, each of whom witnessed either the signing or the principal's acknowledgement of the signature or of the instrument. Each of those witnesses signs a declaration printed in the statute, under penalty of perjury under the laws of Wyoming, that the person who signed is KNOWN TO THEM to be the principal and signed or acknowledged in their presence. Two consequences: the witness has to actually know the principal, so two strangers in a waiting room do not qualify, and a document carrying two bare signatures with no declaration is worth checking against the subsection. No other state read here asks a witness to swear.•

Who cannot witness

The answer in 43 states

  • Alabama

    Every relative, and the proxy. Out as a witness: the person who signed for the declarant, anybody appointed as the health care proxy in the document, anybody related to the declarant by blood, adoption or marriage, anybody entitled to any portion of the estate under Alabama intestate succession or under a will or codicil, and anybody directly financially responsible for the declarant's medical care. With no notary route to fall back on, the two witnesses have to come from outside the family and outside whoever pays for care. Separately, a patient's health care provider and a nonrelative employee of that provider may never make decisions as health care proxy, and a divorce, dissolution or annulment revokes the designation of a former spouse as proxy unless the document or a court order says otherwise.•

  • Alaska

    Only one of the two has to be disinterested, and the interest that counts is inheritance. Barred absolutely: a health care provider employed where the principal is receiving care, an employee of that provider or facility, and the agent. Then the softer rule, which is where families fit: at least ONE witness must be somebody neither related by blood, marriage or adoption nor entitled to part of the estate under an existing will or by operation of law. So a daughter who is an heir may be one witness as long as the second is neither. A separate restriction lands on the agent rather than the witnesses and catches a common arrangement: unless related by blood, marriage or adoption, the agent may not be an owner, operator or employee of the institution where the principal is receiving care, so the trusted nurse at the care home cannot hold the power.•

  • Arizona

    The statute restricts who may serve as notary or witness in §36-3221(C).1

  • California

    Witnesses must satisfy Probate Code §§4674 and 4675, which the execution section incorporates by reference.3

  • Colorado

    Anybody who stands to inherit, and the test is inheritance rather than relation. Colorado names who may not sign FOR a declarant who cannot sign, then extends that same list to witnesses and notaries: the attending physician or any other physician, an employee of the attending physician or of the facility where the declarant is a patient, anybody with a claim against the estate, and anybody who knows or believes they are entitled to part of the estate as a will beneficiary or an heir at law. That is the opposite shape from Ohio, where every relative by blood, marriage or adoption is out whether or not they inherit: in Colorado an adult child who is an heir cannot witness and a cousin who inherits nothing can. Note the wording turns on the witness's own belief, so somebody who thinks they are in the will is disqualified whether or not they are.•

  • Delaware

    A short list, aimed at conflict of interest rather than at family. The single witness may not be the agent, may not be the agent's spouse, domestic partner or cohabitant, and, where the individual resides or is receiving care in a nursing home or long-term care facility, may not be an owner, operator, employee or contractor of that facility. The witness must also reasonably believe the individual is acting voluntarily and knowingly. No relative of the individual is barred. Separately, somebody is disqualified from serving as AGENT if a court finds they pose a danger to the individual's well-being even without a protection from abuse order, if there is a pending or granted protection from abuse petition or order, if they are subject to a civil or criminal no-contact order, or if they are facility staff, unless they are family, the individual's cohabitant, or a descendant of the cohabitant.•

  • Florida

    The designated surrogate may not witness, and at least one witness must be neither the principal's spouse nor a blood relative.4

  • Hawaii

    Any health care provider, not just the treating one. Out as a witness: a health care provider, an employee of a health care provider or facility, and the agent. That is wider than the states whose bar reaches only the clinician attending the principal, and it rules out a neighbor who happens to be a nurse somewhere else. Then, on one of the two: at least one witness must be neither related to the principal by blood, marriage or adoption, nor entitled to any portion of the estate under a will or codicil existing at execution or by operation of law. The other one may be.•

  • Idaho

    The question does not arise, because no witness is required. Where somebody chooses to have the document witnessed, the statute treats the witnesses' names and contact information as optional content rather than as a validity requirement, and names nobody who is disqualified from being one. Notarization is in the same optional list.•

  • Illinois

    For the health care power of attorney, a closed list that catches the people most likely to be in the room. Out: the principal's attending physician, advanced practice registered nurse, physician assistant, dentist, podiatric physician, optometrist or psychologist, or a relative of any of them; an owner or operator of a health care facility where the principal is a patient or resident, or a relative of one; a parent, sibling or descendant — or the spouse of any of those — of either the principal or any agent or successor agent; and any agent or successor agent. So the daughter who drove you to the hospital cannot witness, and neither can the son being named as agent, nor his wife. The bar on facility operators reaches directors and executive officers but expressly not other employees, so a ward nurse, a social worker or a non-owner chaplain generally can. For the living will the Act states no disqualification at all, and Sahvelo does not assert that Illinois has none — the sensible course is to use witnesses who would pass the health care list, which costs nothing.••

  • Indiana

    For a living will declaration, almost anybody at the bedside. Out: the person who signed for the declarant, a parent, a spouse or a child of the declarant, anybody entitled to any part of the estate whether the declarant dies with a will or without one, and anybody directly financially responsible for the declarant's medical care. That third one reaches further than it looks, because it includes somebody who would inherit if the will were declared INVALID, so an intestate heir is out even where a will leaves them nothing. Two details worth knowing before a document gets rejected for no reason: being nominated as personal representative or as the attorney for the estate does NOT make somebody entitled to part of the estate, and the financial condition is about who pays for care rather than who provides it. An appointment of a health care representative has only one restriction: the witness may not be the representative.••

  • Iowa

    One of the two witnesses has to be outside the third degree of consanguinity, which is a calculation rather than a flat rule. At least one witness must not be a relative of the declarant by blood, marriage or adoption within the third degree. The other one may be. Third degree reaches a great-grandparent, an uncle or aunt, a niece or nephew. Barred outright on both documents: a health care provider attending the declarant on the date of execution, an employee of such a provider, and anybody under eighteen. On the power of attorney the named attorney in fact is also out. The bar attaches to the date of execution, so a provider who starts attending afterwards was never caught by it.••

  • Kansas

    On the witness route: the person who signed for the declarant, anybody related to the declarant by blood or marriage, anybody entitled to any portion of the estate under Kansas intestate succession or under a will or codicil, and anybody directly financially responsible for the declarant's medical care. On the notary route, none of it applies. That is the usable answer for a family where the only people to hand are a spouse, an adult child, and whoever is paying the medical bills.•

  • Kentucky

    A blood relative of the grantor, a beneficiary under Kentucky's descent and distribution statutes, an employee of the health care facility where the grantor is a patient, the grantor's attending physician, and anybody directly financially responsible for the grantor's health care. All five apply to the witness AND to the notary. Two things to hold onto. The facility employee is barred as a witness but expressly permitted to notarize, so the hospital's own notary is usable where its staff cannot witness. And the relative bar is on a BLOOD relative, which does not name a spouse. What it does rule out with no way around it is a document witnessed by two adult children. Separately, an employee, owner, director or officer of the facility where the grantor is a resident or patient may not act as SURROGATE unless related within the fourth degree of consanguinity or affinity, or a member of the same religious or fraternal order.•

  • Maine

    Nobody is named as disqualified from witnessing. The restriction Maine does impose is on the agent: unless related to the principal by blood, marriage or adoption, an agent may not be an owner, operator or employee of a residential long-term health care institution where the principal is receiving care. So the trusted aide at the care home cannot hold the appointment unless she is family.•

  • Maryland

    Almost nobody, including the physician caring for the declarant. Any competent individual may serve as a witness, expressly including an employee of a health care facility, a nurse practitioner, a physician assistant or a physician caring for the declarant, if acting in good faith. Two exceptions: the health care agent may not be a witness, and at least one of the two witnesses must not be knowingly entitled to any portion of the estate or to any financial benefit by reason of the declarant's death. So one may be an heir and the other may not. The agent is restricted more tightly than the witnesses: an owner, operator or employee of the facility the declarant is receiving care from, or their spouse, parent, child or sibling, may not serve unless they would qualify as a surrogate decision maker or were appointed before care began there. Nor may somebody subject to a protective order protecting the declarant, nor a spouse once a separation agreement is executed or either party has filed for divorce, unless the declarant afterwards confirms the appointment or indicates an intent that they serve.••

  • Massachusetts

    Only the agent. No person named as health care agent in the proxy may act as a witness to its execution, and the section names nobody else. No relative is barred, no beneficiary, no clinician. Massachusetts also builds in two presumptions that make a proxy hard to unpick afterwards: every adult is presumed competent, and every health care proxy is presumed properly executed unless a court determines otherwise.•

  • Minnesota

    Very few people, and the express permissions are the useful part. At least one of the witnesses must not be a health care provider giving direct care to the principal, or an employee of such a provider, on the date of execution. One of them may be. Then, in terms: a person notarizing a health care directive MAY be an employee of the provider giving direct care. No relative of the principal is disqualified from witnessing or notarizing. The single flat bar is on the appointee, who may not act as a witness or notary for the directive that appoints them. The comparison worth knowing is North Dakota, whose statute is built from the same model text and even carries the same sentence about the notary, and which then bars every relative by blood, marriage or adoption on both routes. Two near-identical statutes, opposite answers to whether a daughter may witness.••

  • Missouri

    Only one person, and it is a narrow bar. Neither of the two witnesses may be the person who signed the declaration on behalf of and at the direction of the declarant. No family bar, no estate bar, no provider bar. What each witness affirms on the suggested form is that the declarant is known to them, is eighteen or older, of sound mind, and signed voluntarily in their presence.•

  • Montana

    Nobody. The section names no disqualified witness at all, and the 18-years-of-age requirement attaches to the declarant and to a designee rather than to the witnesses. As in Nevada, that makes the document easy to execute and leaves the ordinary caution in place: two witnesses who both stand to inherit satisfy the statute and are still where a later dispute starts.•

  • Nebraska

    Nebraska writes the restriction as a ceiling rather than a ban, which is a more usable answer in a hospital room than a flat bar would be. No MORE THAN ONE witness may be an administrator or employee of a health care provider who is caring for or treating the declarant. So one member of the treating team may witness and the second may not. Separately and absolutely, no witness may be an employee of a life or health insurance provider for the declarant. And none of it reaches the other route: the restrictions upon who may witness expressly do not apply to a notary public. No relative is disqualified.•

  • Nevada

    Nobody. The section disqualifies no witness at all: not a spouse, not an heir, not the attending physician, not an employee of the facility. Of the states read here Nevada imposes the fewest conditions on who the two people may be. Easy to execute, and worth being deliberate about anyway, because a declaration attested by the two people with the most to gain is valid in Nevada and is still the first thing a relative will question.•

  • New Hampshire

    Out as a witness: the agent or surrogate, the principal's spouse or heir at law, anybody entitled to any part of the estate under a will, trust, other testamentary instrument or deed in existence or by operation of law, the attending practitioner, and anybody acting under the direction or control of the attending practitioner. Then a ceiling rather than a ban, which is the part that helps in a facility: no more than one witness may be the principal's health or residential care provider or that provider's employee. So one member of the care team may witness and the second may not. None of this reaches the notary or justice of the peace route.•

  • New Jersey

    Only the designated health care representative. The section names nobody else: no relative, no beneficiary, no clinician, no facility employee. Of the states Sahvelo has read for this topic New Jersey is among the few that leave the choice open, which makes the document easy to execute and leaves the ordinary caution in place about asking the two people with the most to gain.•

  • New Mexico

    The question does not arise: New Mexico requires no witness and no notary. The restriction it does impose lands on the AGENT rather than on a witness, and it catches a common arrangement: unless related to the principal by blood, marriage or adoption, the agent may not be an owner, operator or employee of the health care institution where the principal is receiving care.•

  • New York

    The person appointed as agent may not witness the proxy.5

  • North Carolina

    The witnesses carry a long list and the notary carries none of it, which North Carolina says in terms. A witness must not be related within the third degree to the declarant or to the declarant's spouse, must not know or reasonably expect to be entitled to any portion of the estate under an existing will or codicil or under the Intestate Succession Act, must not be the attending physician, a licensed health care provider who is a paid employee of the attending physician, a paid employee of a health facility where the declarant is a patient, or a paid employee of a nursing home or adult care home where the declarant resides, and must not have a claim against any portion of the estate. Then: a notary who takes the acknowledgement MAY but is not required to be a paid employee of the attending physician, of the facility where the declarant is a patient, or of the home where the declarant resides. So the hospital's own notary can do the second half of the execution even though nobody on its payroll can do the first.•

  • North Dakota

    No relative, on either route. The notary public or any witness may not be, at the time of execution, the agent, the principal's spouse or heir, a person related to the principal by blood, marriage or adoption, a person entitled to any part of the estate on the principal's death under a will or deed in existence or by operation of law, anybody with a claim against the estate, a person directly financially responsible for the principal's medical care, or the attending physician. One express permission cuts the other way: a person notarizing the document MAY be an employee of a health care or long-term care provider giving direct care to the principal, and at least one witness must not be such a provider or employee. So the people in the building may help and the people in the family may not. Minnesota's statute is built from the same model text, carries the same notary sentence, and bars no relative at all.•

  • Ohio

    Every relative. Not a listed class of relatives, as in Illinois — any person related to the principal or declarant by blood, marriage or adoption is ineligible to witness either document. Also out: the attending physician, the administrator of any nursing home where the person is receiving care, and, for the health care power, anyone named in it as attorney in fact or alternate. In a hospital room containing a spouse, two children and a son-in-law there is nobody eligible, which is exactly why Ohio offers the notary instead. A witness who does qualify attests, by signing, that the person appears to be of sound mind and not under duress, fraud or undue influence — and the signatures need not all be on the same page.••

  • Oklahoma

    Anybody who stands to inherit, and the test is inheritance rather than relation: neither witness may be a legatee, a devisee, or an heir at law. A spouse or adult child who would inherit is out; a friend, a neighbor or a colleague who would not is in, and so is a relative who inherits nothing. Nobody else is named, so the attending physician and employees of the facility are not disqualified by this subsection.•

  • Oregon

    A short list, and then a rule about the building. On the date the document is signed or acknowledged a witness may not be the principal's attending physician or attending health care provider, nor the principal's health care representative or alternate representative. No relative is barred and no beneficiary. THE LONG TERM CARE RULE, which needs arranging in advance: if the witness route is used and the principal is a patient in a long term care facility when the document is executed, one of the witnesses must be an individual designated by the facility and qualified as specified by the Department of Human Services by rule. Because it attaches to the witness route, the notary route is not subject to it, which is the practical alternative when no designated witness is available. Vermont and South Carolina attach their own conditions to a directive signed inside an institution, and the three states answer it three different ways.•

  • Pennsylvania

    The statute's express bar is narrower than in most states, and worth reading precisely rather than generously. Someone who signed the document on your behalf, because you could not sign it yourself, may not also witness it. And a health care provider or its agent who provides health care services to you may not sign on your behalf. Pennsylvania states those as bars on signing rather than a general disinterested-witness rule, and Sahvelo does not assert that anyone else is barred from witnessing. A separate and firmer rule governs who may be your agent: not your attending physician or other health care provider, and not an owner, operator or employee of a facility where you are receiving care — unless they are related to you by blood, marriage or adoption.••

  • Rhode Island

    Any relative by blood or marriage, and the bar covers both witnesses rather than one. A declaration signed at a kitchen table by a spouse and an adult child does not meet the section, and there is no notary to fall back on. The witness block in the statutory form also asks each of them to certify that the declarant is personally known to them, so two strangers found in a waiting room are not obviously usable either. What that leaves is friends, neighbors and colleagues, arranged in advance.•

  • South Carolina

    A long list, and then a rule about the room that overrides the rest. The witnesses swear they are not related to the declarant by blood, marriage or adoption as spouse, lineal ancestor, descendant of the declarant's parents or spouse of any of them, not directly financially responsible for the person's medical care, not entitled to a portion of the estate under an existing will or as an heir by intestate succession, and not a beneficiary of a life insurance policy of the declarant. No more than one may be an employee of the health facility where the declarant is a patient, and none may be the attending physician, an employee of that physician, or a person with a claim against the estate. THE ROOM RULE. If the declarant is a patient in a hospital or a resident in a nursing care facility when the declaration is executed, one of the two witnesses must be an ombudsman designated by the State Ombudsman, Office of the Governor, with the same qualifications as any other witness. The statute explains itself: some residents may be so insulated from a voluntary decision-making role by the custodial nature of their care as to require special assurance. Arranging an ombudsman takes time, which is the reason to know about it early.•

  • South Dakota

    Nobody named, on either document. Neither statute disqualifies a relative, an heir, a beneficiary, the attending physician nor an employee of the facility. That makes South Dakota easy to execute and worth being deliberate about anyway: two witnesses who both stand to inherit will satisfy the statute and will still be the first thing a relative questions later.••

  • Texas

    Looser than most states, and the wording matters: only ONE of the two witnesses has to be disinterested. That one must not be the person being appointed as agent, a relative by blood or marriage, someone entitled to part of the estate, the attending physician or their employee, certain facility employees, or anyone with a claim against the estate. The second witness may be any competent adult, including a relative or a beneficiary.•

  • Utah

    The longest disqualification list Sahvelo has read for this topic, and the entries about accounts and deeds are the ones that catch people. The single witness may not be the person who signed for the declarant, related to the declarant by blood or marriage, entitled to any portion of the estate under intestate succession or under any will or codicil, the beneficiary of a life insurance policy, a trust, a qualified plan, a pay on death account or a transfer on death deed held or made by or for the declarant, entitled to benefit financially on the declarant's death, entitled to an interest in real or personal property on that death, directly financially responsible for the declarant's medical care, a health care provider treating the declarant or an administrator at the facility where they are receiving care, or the appointed agent. A nephew who is nobody's heir and not in the will is still out if he is named on a payable-on-death bank account. The agent is separately restricted: not a health care provider for the declarant, and not an owner, operator or employee of the facility where they are receiving care, unless related by blood, marriage or adoption.•

  • Vermont

    Close family, which is the reverse of the usual arrangement. Out: the agent, and the principal's spouse, parent, adult sibling, adult child or adult grandchild. Meanwhile a health care provider MAY serve as a witness, and where the principal is being admitted to or resident in a nursing home, residential care facility or hospital, the person who gave the statutory explanation may also be one of the witnesses. THE SEPARATE INSTITUTIONAL RULE IS THE ONE TO CHECK FIRST. A Vermont advance directive executed while the principal is being admitted to, or is a resident of, a nursing home or residential care facility, or being admitted to or a patient in a hospital, is NOT EFFECTIVE unless one of a listed set of people explained its nature and effect and signed a statement saying so: an ombudsman, a recognized member of the clergy, a Vermont attorney, a Probate Division designee, a hospital-designated individual, a mental health patient representative, and for facilities also an unpaid trained volunteer or a clinician not employed there. The explanation may be given in person, over audio-video or by telephone. The statute says why, which is unusual: to ensure residents are willingly and voluntarily executing advance directives. Before reading anything else in a parent's Vermont directive, find out where it was signed.••

  • Virginia

    Nobody. The section names no disqualified witness at all: no family bar, no beneficiary bar, no provider bar. Of the states read here Virginia is among the few that leave the choice entirely open, which makes the document easy to execute and leaves the ordinary caution in place, that two witnesses who both stand to inherit are the ones a later dispute will start with.•

  • Washington

    On the witness route, a long list. A witness may not be related to the declarer by blood or marriage, nor entitled to any portion of the declarer's estate under an existing will or codicil or by operation of law, nor the attending physician, nor an employee of the attending physician or of the health facility where the declarer is a patient, nor anybody with a claim against any portion of the estate at the time of execution. On the notary route, none of that applies. That is the whole reason to read which branch a Washington document used before deciding whether it holds up.•

  • West Virginia

    No family at all, and not the treating team. Out as witnesses: the person who signed for the principal, anybody related to the principal by blood or marriage, anybody entitled to any portion of the estate under the principal's will or a codicil, anybody directly financially responsible for the principal's medical care, the attending physician, and the representative or successor representative. So no spouse, no adult child, no sibling. Combine that with the notary requirement and the practical sequence is: find two unrelated people who are not on the care team, then reach a notary. Separately, the person appointed cannot be a treating health care provider, an employee of one who is not related to the principal, an operator of the facility serving the principal, or an employee of that operator who is not related. Family who work in health care are carved out of the appointee bar; the treating provider is not.••

  • Wisconsin

    Every relative, with one carve-out that is the useful part. Out: anybody related to the declarant by blood, marriage or adoption; anybody who knows they are entitled to or have a claim on any part of the estate; anybody directly financially responsible for the declarant's health care; a health care provider serving the declarant, or an employee of that provider or of an inpatient facility where the declarant is a patient; and anybody under eighteen. THE CARVE-OUT: the employee bar expressly excepts a chaplain or a social worker. So where a family is at a bedside with no unrelated outsider to hand, Wisconsin names two roles on the facility's own staff who may witness. Wisconsin also limits what the declaration can reach: a declarant may not authorize withholding medication, a life-sustaining procedure or a feeding tube where the attending professional advises it would cause pain or reduce comfort that pain relief cannot address, and may not authorize withholding nutrition or hydration received other than through a feeding tube unless that professional advises administering it is medically contraindicated.•

  • Wyoming

    Four categories, none of them family. Out as a witness: a treating health care provider or an employee of that provider; the attorney-in-fact nominated in the document; the operator of a community care facility or an employee of the operator or facility; and the operator of a residential care facility or an employee of the operator or facility. No relative is barred, and no heir or beneficiary. The agent is separately restricted: unless related to the principal by blood, marriage or adoption, an agent may not be an owner, operator or employee of a residential or community care facility where the principal is receiving care.•

What the document is called there

The answer in 43 states

  • Alabama

    An "advance directive for health care", which Alabama uses as the umbrella for a "living will" and a "health care proxy" designation that may be a separate paper or part of the living will. The part to read first is what the document reaches: artificially provided nutrition and hydration is not withheld or withdrawn under either the living will or the proxy designation unless the document specifically authorizes it. Silence means the tube stays. That is the opposite default from South Dakota, where a statement about artificial nutrition and hydration is a required element and silence sends the question to general law. A proxy's powers beyond life-sustaining treatment are limited to those permitted under the Alabama Durable Power of Attorney Act. The directive becomes effective when the attending physician finds the declarant can no longer understand, appreciate and direct their treatment and two physicians have examined and documented either a terminal illness or injury or permanent unconsciousness, and it is suspended during a pregnancy known to the attending physician.•

  • Alaska

    An "individual instruction" is what somebody says or writes about their own care, and it may be oral. A "durable power of attorney for health care" is the document that appoints an agent, and it may carry individual instructions too, so in Alaska one document can do both jobs. The default timing is the thing to get right: unless the document says otherwise, the agent's authority begins only when somebody determines the principal lacks capacity, and it ENDS again if capacity returns. A principal who wants the agent able to talk to a doctor or collect records immediately has to say so. Alaska also provides for surrogates where nobody was appointed, for decisions by a guardian, and for a do not resuscitate protocol with its own identification requirements.•

  • Arizona

    Health care power of attorney.1

  • California

    Advance health care directive.3

  • Colorado

    Four instruments with four names, and the one that appoints a person is not filed with the others. The living will is a "declaration as to medical treatment". The document that names somebody is a "medical durable power of attorney", and it sits in the powers of attorney part of the code rather than in the medical treatment article. Beside those, Colorado provides proxy decision-makers for a patient who appointed nobody, and a separate CPR directive that emergency medical service personnel act on. A family looking for one advance directive will find a living will that appoints nobody, and may never reach the appointing document.•

  • Delaware

    Delaware splits the job into a "health-care instruction" and a "power of attorney for health care", either or both of which can sit in one record, and adds an "advance mental health-care directive" that addresses mental health care only and can carry preferences about facilities, medications, admission and its duration, and crisis intervention. Chapter 25 was rewritten by 84 Del. Laws c. 467. One thing worth knowing before a family is told a parent cannot decide: capacity is presumed, and rebutting the presumption needs a contemporaneous examination by a named professional, the person must be told of the finding, they may object orally or by any act that clearly indicates objection, an objection means the finding is not sufficient to rebut the presumption, and the Court of Chancery may decide the question only on clear and convincing evidence.•

  • Florida

    Designation of health care surrogate.4

  • Hawaii

    Uniform Health-Care Decisions Act vocabulary, so there is no living will to find. An "individual instruction" is what somebody says or writes about their own care and may be oral. A "power of attorney for health care" appoints the agent, remains in effect notwithstanding later incapacity, and may include individual instructions, so one document can carry both. The agent's authority is springing by default and ends if capacity returns, a decision by the agent is effective without judicial approval, and a written directive may nominate a guardian. Hawaii also accepts a directive executed in compliance with the law of the state where it was made.•

  • Idaho

    An "advance care planning document", abbreviated ACPD in the statute itself. One document does every job: it may nominate one or more health care agents, carry resuscitation instructions, address pregnancy, cover release of information protected by HIPAA, give end-of-life instructions and describe treatment objectives. There is no separate living will and no separate power of attorney for health care to go looking for, which is unlike most states read here.•

  • Illinois

    Two documents in two separate acts, and the difference is what each one can reach. The Illinois statutory short form power of attorney for health care, under Article IV of the Power of Attorney Act, appoints an agent to make personal and health care decisions generally. The living will, under the Illinois Living Will Act, does one narrow thing: it directs that death delaying procedures not be used if the person is suffering from a terminal condition. A family who thinks the living will covers every medical decision is thinking of the power of attorney. Neither is undermined by the other, and neither is a suicide or a threat to a life insurance policy — the Living Will Act says so in terms, and adds that nobody may require a declaration as a condition of being insured for or receiving health care, and that not having one creates no presumption either way.•••

  • Indiana

    Indiana publishes TWO opposite declarations, which no other state read here does: a "living will declaration" for declining life prolonging procedures and a "life prolonging procedures will declaration" for asking for them. A reader who only knows the phrase living will may never find the one they want. The document that appoints a person is an "appointment of a health care representative", and its authority is springing by law rather than by drafting: it does not commence until the appointor becomes incapable of consenting, and it stops being effective if capacity returns. Two things to hold onto. A living will declaration is presumptive evidence of what the patient wanted rather than an instruction the physician must follow, and it has no effect during pregnancy where the attending physician has diagnosed it. And an appointment that is meant to authorize withdrawing care from somebody with a terminal condition must carry specific statutory language or it does not do that job.•••

  • Iowa

    A "declaration" is the living will and it is chapter 144A. The appointing document is a "durable power of attorney for health care" in a separate chapter, 144B, and the appointee is the "attorney in fact". A reader who finds 144A and stops has the document that names nobody. Both chapters honor a directive executed in another state under that state's law, and both expressly validate a document that complies with the federal Department of Veterans Affairs advance directive requirements, which matters when a parent's paperwork came from the VA rather than from an Iowa form.•

  • Kansas

    A "declaration" is the living will, in the Natural Death Act at K.S.A. 65-28,101 and following, and it addresses life-sustaining procedures in a terminal condition. The document that appoints somebody is a durable power of attorney for health care under a different chapter, 58, and is not created by the declaration statute. The statutory declaration form is optional, and a declaration may add other specific directions beyond the printed ones.•

  • Kentucky

    A "living will directive" is the document, and the person appointed is a "surrogate" rather than an agent or a proxy. One directive can do four things, each optional: direct the withholding or withdrawal of life-prolonging treatment, direct the withholding or withdrawal of artificially provided nutrition or hydration, designate one or more surrogates and successors, and direct an anatomical gift. TWO THINGS THAT CHANGE OUTCOMES. Kentucky permits more than one surrogate to serve at once and then requires UNANIMOUS CONSENT of all the acting surrogates unless the directive provides otherwise, so naming two children so neither feels excluded gives each of them a veto. What most families want is a successor rather than a joint surrogate, and the difference is in the drafting. And a wish not to be resuscitated reaches an ambulance crew only on a form or identification approved by the Kentucky Board of Medical Licensure, or an approved medical order for scope of treatment form: a living will in a drawer does not.•

  • Maine

    Maine uses the Uniform Health-Care Decisions Act vocabulary, so the phrase living will does not appear. An "individual instruction" is what somebody says or writes about their own care, and it may be oral, valid if made either to a health care provider or to somebody who could serve as a surrogate. That second route is broader than the states that require a clinician. A "power of attorney for health care" appoints the agent and may carry individual instructions too, so one document can do both jobs. By default the agent's authority is springing and reversible: effective only on a determination that the principal lacks capacity, and it ends if capacity returns. The chapter sits inside the Probate Code at 18-C M.R.S. 5-803 rather than in the health statutes.•

  • Maryland

    An "advance directive", written, electronic or oral, and one document can both appoint an agent and give instructions. Two routes exist that no other state read here offers. The State-designated health information exchange may accept as valid an UNWITNESSED electronic advance directive in the form of a video record or file, if it is dated and stored by an electronic advance directives service recognized by the Maryland Health Care Commission, so this depends on using a recognized service rather than recording something on a phone. And any competent individual may make an ORAL advance directive, before the attending physician, physician assistant or nurse practitioner and one witness, documented in the medical record and signed by that clinician and the witness. It then has the same effect as a written one. Virginia next door opens its oral route only to somebody already diagnosed as terminal. A Maryland directive becomes effective when the attending physician and a second physician certify in writing that the patient cannot make an informed decision, and the second certification is not needed if the patient is unconscious or unable to communicate.••

  • Massachusetts

    A "health care proxy", and the appointee is a "health care agent". An alternate agent may be designated in the same proxy, to serve when the named agent is unavailable, unwilling, not competent, or disqualified under the chapter. What chapter 201D provides is the appointing document; a reader looking for a Massachusetts statute that prescribes a living will form will not find one in this chapter, so a written statement of wishes there usually travels with the proxy rather than as a separate statutory instrument.•

  • Minnesota

    A "health care directive", one document, which must include a health care instruction, a health care power of attorney, or both. The appointee is a "health care agent" and an alternate may be named. The power of attorney takes effect when the principal, in the judgment of the attending physician, advanced practice registered nurse or physician assistant, lacks decision-making capacity, unless the directive says otherwise. Minnesota's agent-eligibility rule names blood, marriage, registered domestic partnership or adoption as the relationships that exempt a provider or provider's employee from the bar on serving as agent.•

  • Missouri

    A "declaration" is the living will, at RSMo 459.015, and it speaks of withholding or withdrawing "death-prolonging procedures" rather than life-sustaining treatment. The document that appoints somebody is a durable power of attorney for health care under a different chapter, 404, and is not created by the declaration statute. The suggested declaration form carries its own revocation block, so the paper a family is holding may already contain the mechanism for undoing it.•

  • Montana

    A "declaration" under the Rights of the Terminally Ill Act at MCA 50-9-103, governing the withholding or withdrawal of life-sustaining treatment. The same section lets the declarant designate another adult of sound mind to make those decisions, so in Montana one document can name a person without a separate instrument. The optional form names the advanced practice registered nurse alongside the physician throughout, so a Montana record or document that refers only to a physician is not the whole picture.•

  • Nebraska

    A "declaration" under the Rights of the Terminally Ill Act at Neb. Rev. Stat. 20-404, addressing the withholding or withdrawal of life-sustaining treatment. The declaration statute does not itself create the appointing document; Nebraska's power of attorney for health care sits in chapter 30. A provider furnished with a copy must place it in the record and, if unwilling to comply with it, must promptly say so to the declarant, which is a useful thing to know before an admission rather than after.•

  • Nevada

    A "declaration" governing the withholding or withdrawal of life-sustaining treatment, at NRS 449A.433. The same section lets the declarant designate another adult of sound mind to make those decisions, and the chapter prints two optional forms: one directing a physician or advanced practice registered nurse, and a second designating another person to decide. Note that Nevada's statutes name the advanced practice registered nurse alongside the physician throughout, so a document or a record that refers only to a physician is not the whole picture.•

  • New Hampshire

    An "advance directive", under a chapter whose own title says what it is for: Written Directives for Medical Decision Making for Adults Without Capacity to Make Health Care Decisions, RSA 137-J. The chapter carries both the living will and the durable power of attorney for health care, and the appointee is an "agent". It also provides for a "surrogate" where nobody was appointed, which is why the witness bar names the surrogate as well as the agent.•

  • New Jersey

    An "advance directive for health care", and the person appointed is a "health care representative". Pregnancy is handled by invitation rather than by override: a female declarant MAY include information about what effect the directive should have if she is pregnant, where Kansas, Alabama and Kentucky suspend a directive during a pregnancy known to the attending physician by operation of the statute. New Jersey's section is short, from L.1991 c.201, and its own address moves: the Legislature serves N.J.S.A. through a gateway whose node path is an ordinal position, so the path is never a citation and has to be resolved each time.•

  • New Mexico

    An "individual instruction" is what somebody says or writes about their own care, and a "power of attorney for health care" appoints an agent; one document may carry both. A reader arriving with the phrase living will will not find it in the chapter. The instruction MAY BE ORAL, with one condition that is easy to miss: it must be made by personally informing a health care provider, so a wish stated firmly to a spouse and three children is not an individual instruction. The statutory form is optional by its own terms and may be completed or modified in whole or in part. And the default timing is springing: unless the document says otherwise, the agent's authority begins only on a determination that the principal lacks capacity and ends if capacity returns.••

  • New York

    Health care proxy.5

  • North Carolina

    An "advance directive for a natural death", which the statute itself puts in quotation marks as a LIVING WILL, at G.S. 90-321. The document that appoints somebody is a health care power of attorney under a different article, G.S. 32A. What is distinctive is not the name but the reach: a North Carolina declaration may address ADVANCED DEMENTIA by name, or any other condition causing a substantial and irreversible loss of cognitive ability, alongside a terminal condition and permanent unconsciousness, and the declarant chooses which of the three to include. Most statutes read for this topic name only the latter two, so a declaration drafted to the common pattern says nothing about the situation families ask about most.•

  • North Dakota

    A "health care directive", one document, which may carry a health care instruction, a power of attorney for health care, or both. The appointee is an "agent". The chapter's suggested-form section lists what a directive may include: alternate agents, instructions to joint agents on how to reach a decision and whether they may act independently, limits on the agent's access to medical records, limits on nominating the agent as guardian, an anatomical gift document, what a divorce or annulment does to the appointment, and instructions on artificially administered nutrition or hydration.•

  • Ohio

    Two documents, and Ohio names them differently from most states. The durable power of attorney for health care appoints an attorney in fact to make health care decisions, and switches on when the attending physician determines the person has lost the capacity to make informed decisions — though it can separately authorize the agent to obtain health information immediately, regardless of capacity, which is the clause that gets answers before a crisis. The living will is called a declaration, and it will not work by accident: it has to name the situation it applies to, using and explaining the statutory terms terminal condition or permanently unconscious state, and withdrawing food and water in a permanently unconscious state has to be authorized separately, in conspicuous type, with the person's initials beside it. A physician furnished with a declaration must put it in the medical record — but may refuse to comply on grounds of conscience or otherwise, so having the document is not the same as having agreement.••

  • Oklahoma

    An "advance directive for health care" under the Oklahoma Advance Directive Act, 63 O.S. 3101.4, and the statutory form is organized into a Living Will part and a part appointing a health care proxy, so one document does both jobs. The form defines a terminal condition as an incurable and irreversible condition that even with life-sustaining treatment will, in the opinion of the attending physician and another physician, result in death WITHIN SIX MONTHS, where most states read for this topic say a relatively short time and leave it there. The form also separates the case where the declarant is persistently unconscious from the terminal case, and asks for an initial on each.•

  • Oregon

    Two statutory forms with two names. An "advance directive" is printed at ORS 127.529, and a "form appointing a health care representative" at ORS 127.527, and the appointee is a "health care representative" rather than an agent or proxy. The forms are maintained by an Advance Directive Advisory Committee under ORS 127.532 and 127.533, which is unusual: the content of an Oregon advance directive is a standing administrative responsibility rather than a fixed block of statutory text, so the current form is the one to work from.•

  • Pennsylvania

    Two documents under one umbrella. Pennsylvania calls the whole category an advance health care directive, comprising a living will and a health care power of attorney, and the difference between them decides who is deciding this week. The health care power of attorney switches on when a copy reaches your attending physician and they determine you are incompetent — that is all. The living will needs incompetence AND an end-stage medical condition or permanent unconsciousness. So your agent may have authority long before your living will has any application. Both share the requirement people most often miss: neither is operative until the physician actually has a copy. A directive in a drawer at home is operative in no sense at all. Two Pennsylvania rules change what either document does. If you named your spouse as health care agent, that appointment is revoked the moment either of you files for divorce — the filing, not the decree — though the rest of the directive survives and your named successor takes over. And for a pregnant patient who is incompetent and has an end-stage condition or is permanently unconscious, Pennsylvania requires life-sustaining treatment, nutrition and hydration to be provided notwithstanding any living will or any decision by an agent, unless two physicians certify on the record that it will not permit the continuing development and live birth of the child, will be physically harmful to her, or will cause pain that medication cannot relieve. If that matters to you, your document does not settle it and the conversation to have is with your physician and your lawyer.•••

  • Rhode Island

    A "declaration" is the living will, in chapter 23-4.11, the Rights of the Terminally Ill Act. The document that appoints somebody is a durable power of attorney for health care in a different chapter, 23-4.10, and is not created by the declaration statute. The optional form carries a single check-box choosing whether the authorization includes withholding or withdrawing artificial feeding. A declaration has operative effect only once it has been communicated to the attending physician, the declarant has been determined by that physician to be in a terminal condition, and the declarant is unable to make treatment decisions.•

  • South Carolina

    A "declaration" under the Death With Dignity Act at S.C. Code 44-77-40, which despite the chapter's name is a living will statute about withholding life-sustaining procedures. It reaches two conditions: terminal, and permanent unconsciousness, the latter defined and gated behind ninety consecutive days of unconsciousness unless there is evidence of massive destruction or atrophy of the cortex. Two physicians who have personally examined the declarant must certify, one of them the attending physician. And active treatment must be administered for at least six hours after the diagnosis before a physician may give effect to the declaration.•

  • South Dakota

    A "declaration" is the living will, and it lives in title 34 with the health statutes. The document that appoints somebody is a "durable power of attorney for health care" and it lives in title 59 with agency law, at SDCL 59-7-2.1. That split is the thing to know, because a family that finds chapter 34-12D and stops has found the half that names nobody. The appointee is called the attorney-in-fact or agent, and the authority runs at any time during which the principal lacks capacity.•

  • Texas

    Two documents, not one. The living will is a Directive to Physicians and Family or Surrogates. The appointment of a person is a Medical Power of Attorney, and Texas publishes a statutory form of it. Families frequently sign one and believe they have both — and the medical power of attorney takes effect only once the attending physician certifies in writing, and files in the medical record, that the principal is incompetent.••

  • Utah

    An "advance health care directive", and it may be oral or written. One document appoints a health care agent, gives directions for care after capacity is lost, states conditions that must be met before life sustaining treatment may be withheld, nominates a guardian, authorizes consent to medical research or organ donation, expands or limits the agent's powers, and sets the agent's access to medical records. Utah also allows the person to choose NOT to appoint an agent and NOT to give directions, in the same section, which is unusual to see written out.•

  • Vermont

    One document, called an "advance directive", covering both jobs, and the chapter covers disposition of remains and surrogate decision making alongside. The appointee is an "agent". A durable power of attorney for health care, a terminal care document or an advance directive executed before this chapter remains a valid advance directive if it complied with the requirements in force when it was signed, so an older Vermont document is not void for using the old name.•

  • Virginia

    An "advance directive", and one document does everything: it may specify the care the declarant does or does not authorize, appoint an agent, and specify an anatomical gift. Virginia also runs a place to put it. A written advance directive may be submitted to the state's Advance Health Care Planning Registry, which is optional, and filing does not move the duty of getting it read: it remains the declarant's responsibility to give the attending physician what they need to reach it. An invalid portion of a Virginia directive does not affect the rest.•

  • Washington

    A "health care directive", sometimes called a directive, is the living will, at RCW 70.122.030, and it reaches two conditions rather than one: a terminal condition and a permanent unconscious condition, each defined in the chapter. The printed form asks the declarer to check whether they do or do not want artificially provided nutrition and hydration. The document that appoints somebody is a durable power of attorney for health care under RCW 11.125 and is not created by this section. Withdrawal also needs a written diagnosis in the record first: a terminal condition certified by the attending physician, or a permanent unconscious state by two physicians.•

  • West Virginia

    Three documents, not two. A "living will", a "medical power of attorney", and a "combined medical power of attorney and living will" that does both jobs in one paper. The code prints an optional form for each, and the person appointed is a "medical power of attorney representative" rather than an agent or a proxy. Two practical points the same section settles: a facility may not condition admission on having any of them, and the forms were updated with effect from 1 January 2023 while documents signed before then remain in full force, so an older West Virginia document is not stale merely because the printed form changed.•

  • Wisconsin

    A "declaration to health care professionals" is the living will, at Wis. Stat. 154.03, and it reaches a terminal condition or a persistent vegetative state. It takes effect on the date of execution. The document that appoints somebody is a power of attorney for health care under chapter 155, which is where the definition of health care provider used in the witness bar comes from. The Department prepares and distributes copies of the declaration and accompanying information, so an official blank is obtainable without buying a form.•

  • Wyoming

    Uniform Health-Care Decisions Act vocabulary again, so the phrase living will does not appear in the section. An "individual instruction" is what somebody says or writes about their own care and may be oral. A "power of attorney for health care" appoints an agent, remains in effect notwithstanding later incapacity, and may include individual instructions, so one document can do both jobs. The chapter also provides a "healthcare surrogate" where nobody was appointed, and it defines a residential care facility as a public or private facility providing for the residential and health care needs of the elderly or of people with disabilities or chronic mental illness, which is the definition the witness bar runs on. The agent's authority is springing by default and ends if capacity returns.•

Sahvelo has read all 43 of these states at their own sources. Another state's rule may differ, and we would rather say that than generalize. A directive that satisfies one state's rules may not satisfy another's.

Questions people ask about this

  • Do we need a lawyer for this?

    Not necessarily. Every state Sahvelo has read for this publishes a statutory form or accepts a document that meets a short list of requirements, and hospitals routinely provide blank forms. A lawyer is worth it when the family situation is complicated — a contested second marriage, estranged children, or strong wishes about specific treatments.

  • My parent signed one in another state. Does it still work?

    Often yes, but not reliably. Many states honor a directive that was valid where it was signed, and a hospital's own review is a separate question from the law. If a parent has moved, signing a fresh one under the new state's rules removes the argument entirely.

  • What happens if there is no proxy?

    State law supplies a default order of decision-makers, usually starting with a spouse and adult children. That order may not match what the patient would have chosen, and where the people at the top of it disagree, the disagreement is resolved slowly and sometimes in court.

  • Is this the same as a DNR?

    No. A do-not-resuscitate order is a medical order signed by a physician and effective immediately; a directive is a legal document about future circumstances. Some states also use portable medical order forms such as POLST or MOLST, which are again different documents. Sahvelo has not verified the specific rules for those and does not cover them yet.

  • Is there a particular form we have to use?

    No state in this comparison requires one. Arizona goes furthest in saying so: the statute publishes a complete sample health care power of attorney and states that any writing meeting the statutory requirements may be used, and that the sample does not prevent someone using other language or another form. That cuts both ways usefully — a document downloaded from a hospital or another state is not invalid for looking different, and someone with no lawyer and no form has a usable one published by the legislature, with an autopsy election and an organ-donation election already in it. What matters is not the form but the execution: the signature, the date, and the witnessing or notarization the state requires.2

Where this sits in the process

Related

Sources

The state-specific requirements are quoted directly from each state's statute. The federal document rule comes from the regulation itself.

  1. A.R.S. §36-3221 (Health care power of attorney; scope; requirements)

    Arizona: notarized or one qualified witness, and the statutory sample form.

    azleg.gov Checked 2026-08-12

  2. A.R.S. §36-3224 (Sample health care power of attorney) — Arizona State Legislature

    Arizona's statutory sample health care power of attorney, and the statement that no particular form is required.

    azleg.gov Checked 2026-08-12

  3. California Probate Code §4673 (Legally sufficient advance health care directive)

    California: notary or two witnesses, and the notary requirement for electronic directives.

    leginfo.legislature.ca.gov Checked 2026-08-12

  4. Fla. Stat. §765.202 (Designation of a health care surrogate)

    Florida: two adult witnesses, one of whom may not be a spouse or blood relative.

    flsenate.gov Checked 2026-08-12

  5. N.Y. Public Health Law §2981 (Appointment of health care agent; health care proxy)

    New York: two adult witnesses who sign, and the agent's disqualification.

    nysenate.gov Checked 2026-08-12

  6. 45 C.F.R. §164.508 (Uses and disclosures for which an authorization is required)

    Why access to medical records is a separate federal document.

    ecfr.gov Checked 2026-08-12

Sources last reviewed 2026-08-12. Where a source is marked pending re-verification, the page says so wherever the claim appears.

The execution requirements here are quoted from each state's statute. Everything else is general. Sahvelo is not a law firm, and a hospital's own review of a document is a separate question from whether it satisfies the statute.