Alabama: Health Care Power of Attorney Requirements

Alabama packages advance-care planning into a single document. The Advance
Directive for Health Care, governed by the Alabama Natural Death Act at Ala.
Code §§ 22-8A-1 to 22-8A-18, has two parts: a living will (your own
instructions about life support) and a health care proxy designation (naming
someone to decide for you). This page is about the second part — appointing the
agent, whom Alabama calls your health care proxy. Two things about Alabama
are worth knowing up front: the adult age here is 19, not 18, and the
document is built around end-of-life decisions, so the proxy's authority is tied
closely to life-sustaining treatment.

Requirements one by one

Governing law and form

Under § 22-8A-4(b), "[a] competent adult may execute at any time a living
will that includes a written health care proxy designation appointing another
competent adult" to make decisions about life-sustaining treatment and
artificial nutrition and hydration. The proxy designation "may be a separate
document or part of a living will." Alabama publishes a mandatory statutory
form: § 22-8A-4(h) says the directive "shall be substantially in the following
form," and the Alabama Department of Public Health distributes that form. You are
not required to have a directive at all — but if you make one, it must track the
statutory form and rules.

One step people miss: the proxy has to say yes in writing. "A proxy designation
made pursuant to this section shall be accepted in writing by the individual
being appointed," and "[t]he acceptance shall be evidenced in writing and
attached to the proxy designation" (§ 22-8A-4(b)). The state form has a signature
line for exactly this.

Witnesses or notary

Alabama requires two witnesses and no notary. Section 22-8A-4(c) says the
directive must be "[i]n writing," "[s]igned by the person making the advance
directive ... or by another person in the declarant's presence and by the
declarant's expressed direction," "[d]ated," and "[s]igned in the presence of two
or more witnesses at least 19 years of age." There is no notarization
requirement; the notary block on the ADPH form is optional, added only for extra
proof.

Who can't witness or serve

The two witnesses are tightly restricted. Under § 22-8A-4(c)(4), a witness may not
be the person who signed for the declarant, the person "appointed as the health
care proxy," a relative "by blood, adoption, or marriage," anyone "entitled to any
portion of the estate," or anyone "directly financially responsible for
declarant's medical care." Separately, there is a hard bar on who may serve as
proxy: "[u]nder no circumstances shall the patient's health care provider or a
nonrelative employee of the patient's health care provider make decisions in the
capacity of a health care proxy" (§ 22-8A-4(b)(4)).

When the agent can act

Your proxy's authority is springing, and Alabama sets a demanding trigger.
Under § 22-8A-4(d), the directive "shall become effective when" two things are
true: (1) the attending physician "determines that the declarant is no longer able
to understand, appreciate, and direct his or her medical treatment"; and (2) "two
physicians, one of whom shall be the attending physician," have personally examined
you and "diagnosed and documented in the medical record" that you have "either a
terminal illness or injury or [are] in a state of permanent unconsciousness." So
the proxy's power over life-sustaining care does not switch on for ordinary,
recoverable illness. Two further rules matter: the directive "shall have no effect
during the course of the declarant's pregnancy" if the attending physician knows
you are pregnant (§ 22-8A-4(e)), and your own contemporaneous wishes always win —
"[t]he desires of an individual shall at all times supersede the effect of an
advance directive" (§ 22-8A-7).

Agent's powers and limits

Within its scope, the proxy decides about "providing, withholding, or withdrawal
of life-sustaining treatment and artificially provided nutrition and hydration"
(§ 22-8A-4(b)), and must follow your instructions and intent — the duty
§ 22-8A-6 heads "Proxy to Comply with Instructions, Intent of Patient." Two
limits are built in. First, tube feeding is opt-in: artificial nutrition and
hydration "shall not be withdrawn or withheld pursuant to the proxy designation
unless specifically authorized therein" (§ 22-8A-4(b)). Second, any authority to
make general health care decisions that are not about life-sustaining treatment
is "limited to those powers permitted under the Alabama Durable Power of Attorney
Act, Section 26-1-2" (§ 22-8A-4(b)(2)) — so a broad, day-to-day medical agency
rides on the separate durable-POA statute, not on the Natural Death Act alone.
Where you have both a living will and a proxy, the proxy's decisions "take
precedence over" the living will unless the document says otherwise
(§ 22-8A-4(g)).

How to revoke

You keep control. Under § 22-8A-5, you may revoke "at any time" by any of three
methods: destroying or defacing the document "in a manner indicating intention to
cancel"; signing and dating a written revocation; or making "a verbal expression of
the intent to revoke ... in the presence of a witness 19 years of age or older who
signs and dates a writing confirming" it — with a verbal revocation effective "upon
receipt by the attending physician or health care provider of the above mentioned
writing." Note what is not on the list: Alabama's Act has no rule that divorce,
annulment, or legal separation cancels a spouse you named as proxy. If your
marriage ends, revoke and sign a new directive to change your proxy.

Out-of-state directives

Alabama honors directives from elsewhere. Section 22-8A-12 provides that "[a]n
advance health care directive executed in another state in compliance with the law
of that state or of this state is valid for purposes of this chapter" — though it
does not authorize care that Alabama law otherwise forbids.

What trips people up

• The adult age is 19. In Alabama you must be 19 to make the directive, and
  each of the two witnesses must be 19 or older (§ 22-8A-3(1); § 22-8A-4(c)(4)).
• Your proxy must sign an acceptance. A designation is not enough — the person
  you name has to accept in writing, and that acceptance is attached to the
  document (§ 22-8A-4(b)).
• The proxy's power waits for a serious diagnosis. It activates only when you
  cannot direct your care and two physicians document a terminal condition or
  permanent unconsciousness (§ 22-8A-4(d)). For a routine, recoverable illness, the
  proxy's life-sustaining-treatment authority is not yet in effect.
• Tube feeding is opt-in. Your proxy cannot stop artificial nutrition and
  hydration unless your document specifically grants that power (§ 22-8A-4(b)).
• Divorce does not cancel your proxy. Unlike many states, Alabama's Act has no
  automatic revocation on divorce (§ 22-8A-5 lists the only three ways to revoke).
  A former spouse stays your proxy until you revoke.

Common questions

Does my Alabama advance directive need to be notarized?
No. It must be signed and dated in front of two witnesses who are at least 19; a
notary is not required (§ 22-8A-4(c)). Notarizing it is optional.

Can my spouse or child witness the document?
No. A witness cannot be related to you by blood, adoption, or marriage, cannot be
your proxy, and cannot be someone who would inherit from you or who is financially
responsible for your medical care (§ 22-8A-4(c)(4)). Pick unrelated,
disinterested witnesses.

Can my proxy make all my medical decisions right away?
No. The proxy's authority over life-sustaining treatment turns on only after your
doctor and a second physician document that you cannot direct your care and have a
terminal condition or permanent unconsciousness (§ 22-8A-4(d)). Broader everyday
decision-making comes only through the separate durable-power-of-attorney route
(§ 22-8A-4(b)(2)).

Will a health care directive I signed in another state work in Alabama?
Yes. A directive executed in another state in compliance with that state's law (or
Alabama's) is valid in Alabama (§ 22-8A-12).

Statutes and sources

• Ala. Code § 22-8A-3 — definitions: "adult" (19+), "competent adult,"
  "attending physician," "health care proxy," "advance directive for health care."
  https://alison.legislature.state.al.us/code-of-alabama?section=22-8A-3 (accessed 2026-07-16)
• Ala. Code § 22-8A-4 — the advance directive and health care proxy
  designation: competent-adult appointment, written acceptance, opt-in nutrition
  and hydration, § 26-1-2 cap on general decisions, provider/employee proxy bar,
  execution formalities (§ 22-8A-4(c)), effectiveness trigger (§ 22-8A-4(d)),
  pregnancy exception (§ 22-8A-4(e)), proxy precedence (§ 22-8A-4(g)), statutory
  form (§ 22-8A-4(h)).
  https://alison.legislature.state.al.us/code-of-alabama?section=22-8A-4 (accessed 2026-07-16)
• Ala. Code § 22-8A-5 — revocation at any time by destruction, signed writing,
  or witnessed verbal statement.
  https://alison.legislature.state.al.us/code-of-alabama?section=22-8A-5 (accessed 2026-07-16)
• Ala. Code § 22-8A-6 — proxy must comply with the patient's instructions and
  intent.
  https://alison.legislature.state.al.us/code-of-alabama?section=22-8A-6 (accessed 2026-07-16)
• Ala. Code § 22-8A-7 — the patient's own desires supersede the directive at
  all times; competency presumption for providers.
  https://alison.legislature.state.al.us/code-of-alabama?section=22-8A-7 (accessed 2026-07-16)
• Ala. Code § 22-8A-12 — a directive executed in another state under that
  state's law (or Alabama's) is valid in Alabama.
  https://alison.legislature.state.al.us/code-of-alabama?section=22-8A-12 (accessed 2026-07-16)