Tennessee: Living Will and Advance Health-Care Instruction Requirements
The short answer
Tennessee lets an adult give a binding individual health-care instruction orally or in writing, with no witness or notary required for that instruction alone. A formal written advance directive that may combine treatment instructions with an agent appointment must be signed and either notarized or witnessed by two competent adults; the agent cannot witness, and at least one witness must be unrelated and unable to inherit. No terminal diagnosis is mandatory: the adult may choose a triggering condition, and providers generally must comply subject to conscience, institutional-policy, and medical-standard exceptions with a transfer process.
Ask Ezel about your situation
This is the general rule in Tennessee. Ezel applies current Tennessee law to your specific facts and answers with citations to the statutes.
| Governing law and document | Tennessee Health Care Decisions Act, Tenn. Code §§ 68-11-1801 to -1815. An 'advance directive' includes an individual instruction, living will, or health-care power of attorney; the instruction may stand alone or appear in the optional combined state form (§§ 68-11-1802 to -1805) |
|---|---|
| Who may make an instruction | Adult or emancipated minor (§ 68-11-1803(a)); capacity to give/revoke a directive is presumed, and means understanding significant benefits, risks, alternatives, and communicating a decision (§§ 68-11-1802, -1812) |
| Oral, written, and signature form | Individual instruction alone may be oral or written and may name its own condition; no signature/date rule (§ 68-11-1803(a)). A formal advance directive must be written and signed by the principal; statute states no directed-signature or electronic-specific route (§ 68-11-1803(b)) |
| Witness, notary, and disqualifications | No witness/notary for an individual instruction alone. Formal advance directive: notary OR two competent adult witnesses; agent cannot witness, at least one witness must be unrelated by blood/marriage/adoption and unable to inherit, and written directive needs attestation clause (§ 68-11-1803(b)) |
| Covered conditions and trigger | No mandatory terminal diagnosis or incapacity trigger for the adult's own instruction; adult may specify any condition. Designated physician determines and charts a condition affecting the instruction (§§ 68-11-1803(a), (d), -1808(a)). Incapacity is the default trigger for agent authority, not every instruction |
| Treatment, nutrition, hydration, and comfort | Instruction may consent to, refuse, or withdraw any health care (§ 68-11-1802). Optional state form separately addresses CPR, life support/artificial support, treatment of new conditions, tube feeding/IV nutrition and hydration, comfort and pain management, and other instructions |
| Pregnancy and other statutory limits | No pregnancy-specific limit appears in Part 18 or the state form. Withholding/withdrawal under the Act is not suicide, euthanasia, homicide, mercy killing, or assisted suicide; surrogate authority does not extend to Title 33 matters (§ 68-11-1814) |
| Revocation, notice, and registry | While having capacity, revoke treatment instructions at any time in any manner communicating intent; later conflicting directive revokes to the conflict's extent (§ 68-11-1804). Copy of written revocation equals original (§ 68-11-1813). No mandatory provider-receipt trigger, chart notation, or state registry in Part 18 |
| Provider duties, recognition, and effect | Provider generally complies with instruction/reasonable interpretation. Conscience, timely communicated institutional policy, or medically inappropriate-care objection triggers prompt notice, continuing care, and reasonable transfer effort; no compulsion if transfer fails (§ 68-11-1808). Good-faith reliance protected. Nonresident's out-of-state directive valid if compliant with Tennessee or residence-state law (§§ 68-11-1803(h), -1810) |
Compare this rule across all 50 states + DC →
Tennessee separates an individual instruction from the more formal advance
directive document. An adult may give the instruction orally or in writing. The
instruction can name the condition that makes it operate. If the adult instead
uses the written advance directive—often to combine instructions with an agent
appointment—the signature, notary-or-witness, and attestation rules apply.
Requirements one by one
An instruction may be oral or written
Section 68-11-1803(a) permits an adult or emancipated minor to give an oral or
written individual instruction and to limit it to a specified condition. The Act
does not require an informal individual instruction to be signed, dated,
witnessed, or notarized.
A formal advance directive is different. It must be written and signed by the
principal. Tennessee's statute does not state a directed-signature or
electronic-signature procedure. A copy has the same effect as the original under
§ 68-11-1813.
The formal document uses a notary or two witnesses
For a formal written advance directive, § 68-11-1803(b) allows notarization or
two competent adult witnesses. The agent cannot witness. At least one witness
must be unrelated by blood, marriage, or adoption and not entitled to inherit.
The written directive also needs an attestation clause confirming the witness
qualifications.
That means one witness may be related or able to inherit if the other satisfies
both disinterested-witness conditions. An instruction given orally does not use
this ceremony.
The adult chooses the condition
The Act does not require terminal illness, permanent unconsciousness, or another
diagnosis for every instruction. Section 68-11-1803 lets the adult specify the
condition. When a condition affects an instruction, the designated physician
makes the determination under § 68-11-1803(d); § 68-11-1808 requires prompt
charting and communication.
Incapacity is the default trigger for an appointed agent's authority. It is not
an added prerequisite for every individual instruction.
Treatment choices are broad
The Act defines a health-care decision as consent, refusal, or withdrawal of
consent to health care. Tennessee's optional form supplies separate choices for
CPR, life support and other artificial support, treatment of new conditions, and
tube feeding or IV fluids. It also frames those choices alongside comfort and
pain management and permits added instructions.
Part 18 states no pregnancy-specific restriction. It separately provides that
withholding or withdrawing care under the Act is not suicide, euthanasia,
homicide, mercy killing, or assisted suicide.
Under § 68-11-1810, providers receive good-faith reliance protection; §§ 68-11-1812
to -1814 address capacity, copies, and the Act's legal-effect boundaries.
Treatment instructions have a form-light revocation rule
While having capacity, the adult may revoke the treatment-instruction portion at
any time and in any manner communicating intent. A later conflicting directive
revokes the earlier one only to the extent of the conflict. A copy of a written
revocation has the same effect as the original.
The stricter signed-writing-or-personal-provider-notice rule in § 68-11-1804(a)
applies to revoking an agent designation, not the adult's treatment
instructions. Part 18 creates no state directive registry.
Refusal starts a notice-and-transfer process
Providers generally must comply with the adult's instruction or a reasonable
interpretation of it. A provider may decline for conscience reasons. An
institution may rely on a timely communicated conscience policy, and a provider
or institution may decline medically inappropriate care or care contrary to
generally accepted standards.
The objector promptly informs the patient and authorized decision-maker,
continues care while transfer is pursued, and immediately makes reasonable
transfer efforts unless assistance is refused. If transfer cannot be completed,
the provider or institution is not compelled to comply.
What trips people up
- The formalities depend on the route. An oral individual instruction is not
invalid merely because it lacks the two-witness or notary ceremony used for a
formal written advance directive. - The adult selects the medical trigger. The narrower conditions printed in
the optional form are choices, not universal statutory prerequisites. - Only one witness must be disinterested. The statute does not require both
witnesses to be unrelated and unable to inherit. - The interstate safe harbor is limited. Section 68-11-1803(h) applies when
the directive was signed outside Tennessee by someone who was then a
nonresident.
Common questions
Must a treatment instruction appoint an agent?
No. Section 68-11-1803(a) independently authorizes an oral or written individual
instruction. The official form says its instruction and agent parts may be used
together or independently.
Does Tennessee require a terminal diagnosis?
No universal diagnosis is required. The adult may make an instruction effective
only if a chosen condition arises.
Can a provider refuse the instruction?
Yes, for the statutory conscience, institutional-policy, or medical-standard
grounds. Section 68-11-1808 then requires notice, continuing care, and reasonable
transfer efforts, but does not compel compliance if transfer cannot be effected.
Statutes and sources
- Tenn. Code §§ 68-11-1802 to -1804 — directive architecture, oral and
written instructions, formal execution, conditions, interstate recognition,
and revocation. Official enacted Act
(accessed 2026-07-30). - Tenn. Code §§ 68-11-1808 and -1810 to -1814 — provider compliance,
objections, transfer, immunity, capacity, copies, and legal-effect boundaries.
Official enacted Act
(accessed 2026-07-30). - 2014 Tenn. Pub. Ch. 676 — the only amendment shown in the current-code
history for § 68-11-1803; it changes subsection (i)'s anti-conditioning rule,
not the treatment-instruction dimensions above. Official public chapter
(accessed 2026-07-30). - Tennessee Advance Directive for Health Care — current optional combined
form and its treatment, nutrition/hydration, comfort, and execution choices.
Official state form
(accessed 2026-07-30).
Source links
Every statute quoted above, linked, with the date we checked it.
Get the answer for your situation
You just read how Tennessee handles this in general. Ezel applies current Tennessee law to your facts and answers your specific question, with citations.
Opens in Ezel Pro. Every answer cites the authority it relies on.