Living will requirements in Pennsylvania

Which document is this, really

Pennsylvania’s umbrella term is the advance health care directive, defined in the code as a document that can carry a living will, a Health Care Power of Attorney, or both together. Subchapter B of the health care chapter is titled “Living Wills,” and covers the treatment instructions you write down for yourself. Subchapter C, “Health Care Agents and Representatives,” covers naming the person who decides for you, your agent. You are free to combine the two into one document, but Pennsylvania does not require it; you can execute a living will and a Health Care Power of Attorney as two separate papers instead, and the law treats either approach the same way.

Pennsylvania also does not hand you a form you must use. No Commonwealth agency that licenses or regulates health care may prescribe a mandatory form of an advance health care directive. The code does print an example of a combined form, captioned plainly as “Example,” but any written document that says what the statute asks for is valid, worded however you choose.

This is what Myend’s Healthcare Directive prepares for Pennsylvania: your treatment wishes and your Health Care Power of Attorney, formatted the way Pennsylvania expects, free to use.

Who can make a Pennsylvania advance directive

Pennsylvania’s age line has more than one way to clear it. You can make a living will or a Health Care Power of Attorney if you are 18, or if you have graduated from high school, or if you have married, or if you are an emancipated minor. Any one of those on its own is enough; full legal majority is not strictly required if one of the other three applies to you.

Beyond the age line, the practical test is whether you understand what the document says and does at the moment you sign it: that you are writing down your own treatment wishes, or naming someone to make decisions for you, or both. Pennsylvania’s statute does not ask for a medical evaluation of that understanding before you sign; it is the same everyday judgment a witness or a notary is already in the room to observe.

Signing it so it counts

Pennsylvania runs the same signing rule for both instruments. If you combine your living will and Health Care Power of Attorney into one document, you sign it once. If you keep them apart, each one is executed under its own section of the code, but the requirement is identical either way: your signature and two witnesses.

1. 1You sign

   You sign the document, or direct someone else to sign it in your presence, on the living will, the Health Care Power of Attorney, or the combined form, whichever you are using.

2. 2Two witnesses sign

   Two witnesses, each 18 or older, sign the document. A notary is not an alternative here. Neither execution section mentions notarization, and the combined form printed in the code says as much in its own words, “Notarization of document is not required by Pennsylvania law.” That same form still prints an optional notary block, because a document that is both witnessed and notarized is, in the form’s words, “more likely to be honored by the laws of some other states.”

3. 3Who cannot witness

   A person who signs the document on your behalf, at your direction, cannot also serve as a witness to it. And if a health care provider or its agent gives you health care services, that provider cannot be the one signing on your behalf in the first place.

Naming your agent

Your Health Care Power of Attorney is where you name your agent, the person who makes health care decisions for you once the document takes effect. Pennsylvania bars a narrow group from serving: your attending physician or another of your health care providers, or an owner, operator, or employee of a health care provider where you are currently receiving care. Anyone else you trust can be named.

That bar has a built-in exception. If the person is related to you by blood, marriage, or adoption, the restriction does not apply, even if they happen to be your physician or work at the facility treating you. A related physician, or a related nurse who works where you are being cared for, can still serve as your agent under Pennsylvania law.

When it takes effect

The living will and the Health Care Power of Attorney switch on at different points, though both start the same way: your attending physician has to receive a copy of the document. From there, the living will needs more. Your attending physician must also determine that you are incompetent and that you have an end-stage medical condition or are permanently unconscious. Those two things, the copy and the determination, are what make the living will operative. Promptly afterwards the physician has to certify the end-stage or permanently unconscious finding in writing, which is a duty that follows the determination rather than a step you wait on.

The Health Care Power of Attorney switches on with less. Once your attending physician has a copy and determines you are incompetent, your agent’s authority begins; there is no separate end-stage or unconscious finding required for the power of attorney itself. In both cases, one attending physician’s determination is what the general operative sections ask for, not a second physician’s opinion.

If you are pregnant

Pennsylvania’s pregnancy rule is conditional, not absolute. If you are pregnant, incompetent, and have an end-stage medical condition or are permanently unconscious, life-sustaining treatment, nutrition and hydration must still be provided to you, notwithstanding your living will, a decision by your representative or agent, or any other direction to the contrary. That rule gives way only if your attending physician and an examining obstetrician both certify, to a reasonable degree of medical certainty, that the treatment would not maintain you to permit continuing development and live birth, or that it would be physically harmful to you, or that it would cause you pain that medication cannot alleviate. Any one of those three findings, made by both physicians together, is what lifts the rule.

Changing or cancelling it

You can revoke your living will at any time, in any manner, no matter your mental or physical condition. Destroying it, signing and dating a written statement that says you revoke it, or simply telling someone out loud that you revoke it are all valid. The revocation takes effect once your attending physician or another health care provider is told about it, by you or by a witness to the revocation, and that provider then has to make the revocation part of your medical record. A provider acting in good faith on a document they were never told had been revoked is protected from liability, which is why the telling matters.

The Health Care Power of Attorney is revoked its own way, and the difference matters. You can revoke it only while you are of sound mind, either by a writing signed and witnessed the same way the original was, or by personally telling your attending physician, another health care provider, or your agent that it is revoked. A provider may keep relying on the document until they are told, and an agent who knows it has been revoked may not go on making decisions with it. One thing happens on its own: if your spouse is your agent and either of you files an action in divorce, that appointment is revoked as of the filing, unless the directive itself makes clear you meant it to survive one. If you signed both documents, revoke each on its own terms, and tell your agent and your providers directly so nobody is acting on paperwork you no longer want in effect.

Making sure it is found

Pennsylvania’s health care chapter, all 45 sections of it, sets up no registry where you can file your directive for safekeeping. That makes copies your real safeguard: give one to your agent, your physician, and the hospital you are most likely to use, and keep the signed original somewhere your family already knows to look. A document nobody can find in an emergency works the same as no document at all.

If you are treated in Pennsylvania but signed your directive somewhere else, Pennsylvania law addresses that directly. A living will or Health Care Power of Attorney executed in another state or jurisdiction, in conformity with that state’s own law, is considered valid here, except to the extent it would let you or your agent do something Pennsylvania law itself does not allow.

This is not a POLST

An advance health care directive is something you complete now, for a future you cannot yet see. A POLST-style medical order is a different kind of paper. A clinician signs it with you once you are already facing a serious illness, and it becomes a specific set of medical orders that follows you between the hospital, a nursing facility, home and an ambulance, covering things like resuscitation. These clinician-signed orders go by different names from state to state and from setting to setting. If you have a serious or advancing illness, ask your doctor whether that kind of clinician-signed order makes sense for you. Myend prepares the living will and the Health Care Power of Attorney. It does not, and cannot, produce a clinician-signed medical order.

What is different about Pennsylvania

The bar on a treating physician or facility employee serving as your agent lifts the moment that person is also your relative.

Pennsylvania’s agent-eligibility rule is written narrower than a flat bar. Most people reading it expect an absolute line, that a health care provider cannot also be your agent. Pennsylvania draws that line, then carves a specific exception back out of it. If the physician, the facility owner, the operator, or the employee is related to you by blood, marriage, or adoption, the disqualification simply does not apply to them. A family member who happens to work at the hospital treating you, or who happens to be your own doctor, is not shut out of the role the way an unrelated provider would be.

Revocation carries its own particular shape, too. Pennsylvania lets you revoke a living will orally, in writing, or by destroying it, and none of the three depends on your mental or physical condition at the time. What makes it work in practice is the notification step. A revocation is not effective until your attending physician or another provider actually learns of it, whether from you directly or from a witness to the moment you revoked it. Once told, that provider is required to make the revocation part of your medical record. Say it out loud to the right person, and Pennsylvania treats that as enough. The catch runs the other way too. A provider who goes on following a document in good faith, not knowing it was revoked, is protected from liability, so telling your provider is not a formality here, it is the step that actually does the work.

Common questions

Sources and review