Alabama: Living Will and Advance Health-Care Instruction Requirements

Alabama's Natural Death Act uses a written Advance Directive for Health Care.
The document can contain a living will, a health care proxy designation, or
both. This page addresses the adult's own living-will instructions, not the
separate proxy appointment or the chapter's clinician-order and minor-care
provisions.

Requirements one by one

The adult must use a written, witnessed directive

Under § 22-8A-3, a competent adult is at least 19, alert, able to understand
a lay description of the procedures, and able to appreciate the consequences
of providing, withholding, or withdrawing them. Section 22-8A-4(c) requires
the directive to be written, dated, and signed by the
adult or by another person in the adult's presence and at the adult's expressed
direction.

Two witnesses age 19 or older must be present for signing. A witness cannot be
the directed signer, a named health care proxy, a relative by blood, adoption,
or marriage, someone entitled to inherit under intestacy or a will, or someone
directly financially responsible for the adult's medical care. The Natural
Death Act does not offer notarization in place of those witnesses.

Under § 22-8A-4(h), the directive must be substantially in the statutory
form but may add other specific directions. The form puts the living will and
optional proxy designation in one instrument; a proxy is not required for the
adult's treatment instructions to be followed.

Incapacity and a two-physician diagnosis activate it

Execution and operation are separate. Under § 22-8A-4(d), the attending
physician must determine that the adult can no longer understand, appreciate,
and direct medical treatment. Two physicians who personally examined the adult
must also diagnose and document either terminal illness or injury or permanent
unconsciousness. One must be the attending physician, and one must be qualified
and experienced in making the diagnosis.

The chapter defines permanent unconsciousness as a condition that, to a
reasonable degree of medical certainty, will last permanently without
improvement and lacks cognitive thought, sensation, purposeful action, social
interaction, and awareness after enough time under professional standards to
make the diagnosis. The statutory form translates the terminal route as an
incurable condition likely to cause death in the near future.

Treatment and tube feeding are separate choices

Under § 22-8A-4(a), the living will may direct providing, withholding,
or withdrawing life-sustaining treatment and artificially provided nutrition
and hydration. The statutory form asks separately about life-sustaining
treatment and food and water through a tube or IV, once for terminal illness or
injury and again for permanent unconsciousness.

Artificial nutrition and hydration may not be withheld or withdrawn through
the living will unless the document specifically authorizes it. Medication or
treatment that the attending physician considers necessary for comfort or pain
relief is excluded from the chapter's definition of life-sustaining treatment.

Pregnancy suspends the directive

Under § 22-8A-4(e), an advance directive has no effect during the pregnancy
when the attending physician knows the adult is pregnant. The provision states
no viability, gestational-age, prognosis, or live-birth exception.

Section 22-8A-10 separately says the chapter does not authorize mercy
killing, physician-assisted suicide, or another affirmative or deliberate act
or omission to end life beyond allowing the natural dying process provided by
the chapter.

Revocation includes a witnessed verbal route

Section 22-8A-5 permits revocation at any time through intentional
destruction or defacement; a signed, dated writing by the adult or a person
acting at the adult's direction; or a verbal expression before one witness age
19 or older who signs and dates a written confirmation. A verbal revocation
becomes effective when the attending physician or provider receives that
confirmation. The provider records the time, date, and place of notice in the
medical record.

Section 22-8A-14 separately permits optional recording with the probate
judge in the adult's county of residence for $5 plus any other fee required by
law. The filing is not open for general public inspection, does not affect the
living will's validity, and does not require a provider to search probate
records. It is county recording, not a central directive registry.

A refusing provider must assist transfer

The adult is responsible for giving the attending physician and other treating
providers a copy, and the provider places it in the medical record under
§ 22-8A-4(f). While the adult can still decide, the adult's current desires
always supersede the directive under § 22-8A-7.

A provider refusing to comply must promptly advise the adult and any designated
decision-maker, permit transfer, and reasonably cooperate in a timely transfer
to a provider that will follow the living will. During transfer, § 22-8A-8
requires continued life-sustaining treatment, including resuscitation and
artificial nutrition and hydration. Good-faith statutory compliance under
reasonable medical standards receives the immunity stated in § 22-8A-7.

An advance directive executed in another state in compliance with that state's
law or Alabama law is valid for this chapter under § 22-8A-12, but it cannot
authorize care otherwise prohibited by Alabama law.

What trips people up

• Alabama's adult age is 19. The maker and both witnesses must meet that
  age threshold.
• The two medical conditions are alternatives, but incapacity is also
  required. Terminal illness or injury and permanent unconsciousness are the
  condition routes; the attending physician's inability-to-direct-treatment
  finding is a separate part of the trigger.
• Tube feeding must be addressed specifically. A general direction about
  life-sustaining treatment does not itself authorize withholding or withdrawal
  of artificial nutrition and hydration.
• Probate recording is optional. It neither creates validity nor replaces
  giving the document to treating providers.
• Treatment continues during a refusal transfer. Alabama requires all
  life-sustaining measures, resuscitation, and artificial nutrition and
  hydration to be maintained until transfer.

Common questions

Does an Alabama living will need a notary?

No notary substitute appears in the Natural Death Act. The directive must be
signed in the presence of two qualified witnesses age 19 or older.

May I make the living will orally?

No. The directive itself must be written, signed, dated, and witnessed. A
verbal statement is available for revocation, but only with the witness and
written-confirmation steps in § 22-8A-5.

Does my current decision still control after I sign?

Yes. Section 22-8A-7 says the individual's desires always supersede the advance
directive. The document is for the later period after the statutory findings
are made.

Will Alabama recognize a directive signed elsewhere?

Yes, if it complied with the execution law of that state or Alabama. Alabama's
own prohibitions on administering, withholding, or withdrawing care still
apply.

Statutes and sources

• Ala. Code §§ 22-8A-1 and 22-8A-3 — Natural Death Act name and definitions
  of adult, competent adult, advance directive, living will, life-sustaining
  treatment, terminal illness or injury, and permanent unconsciousness.
  Official code
  (accessed 2026-07-31).
• Ala. Code § 22-8A-4 — permitted treatment directions, writing, directed
  signature, date, witness rules, medical trigger, pregnancy, delivery to
  providers, and substantially statutory form.
  Official code
  (accessed 2026-07-31).
• Ala. Code § 22-8A-5 — destruction, signed-writing, and witnessed-verbal
  revocation routes; receipt and medical-record notation.
  Official code
  (accessed 2026-07-31).
• Ala. Code §§ 22-8A-7 and 22-8A-8 — current wishes, good-faith immunity,
  provider refusal, timely transfer, and maintenance of treatment during
  transfer. § 22-8A-7
  and § 22-8A-8
  (accessed 2026-07-31).
• Ala. Code §§ 22-8A-10 and 22-8A-12 — natural-dying boundary and
  out-of-state validity subject to Alabama prohibitions.
  § 22-8A-10
  and § 22-8A-12
  (accessed 2026-07-31).
• Ala. Code § 22-8A-14 — optional county-probate recording, fees, limited
  inspection, no validity effect, and no provider search duty.
  Official code
  (accessed 2026-07-31).