Health care directive in Pennsylvania: form, signing and who decides
The form, who can witness, who can be your agent and who decides if you have no directive in Pennsylvania.
Checked against official sources: October 31, 2026.
Short answer
Health care power of attorney and living will (an advance health care directive; the statute's example form is titled 'Durable Health Care Power of Attorney and Health Care Treatment Instructions (Living Will)')
- How to sign
- Signed in front of two witnesses (no notary)
- Who decides without a directive
- Yes
The document and its form
- Document
- Health care power of attorney and living will (an advance health care directive; the statute's example form is titled 'Durable Health Care Power of Attorney and Health Care Treatment Instructions (Living Will)')
- Official form
- Durable Health Care Power of Attorney and Health Care Treatment Instructions (Living Will) - example combined form, 20 Pa.C.S. 5471Published by Pennsylvania General Assembly (official text of 20 Pa.C.S. Chapter 54; the example form is in section 5471)Version: Statutory example in 20 Pa.C.S. 5471 (current consolidated text)
You do not have to use it.
- Living will
Living will
The living will is a separate document.
A living will states your wishes about starting, continuing, withholding or withdrawing life-sustaining treatment. It can be in any written form, can stand alone, or can be combined with a health care power of attorney. It has the same signing rule: two adult witnesses.
Law: 20 Pa.C.S. §§ 5433, 5447, 5465, 5471; 20 Pa.C.S. §§ 5441-5447, 5433(b)
Signing rules
- How to sign
Sign and date the health care power of attorney and/or living will in front of two adult witnesses. A notary is not required. The same rule applies to each document.
- Who signs
Dated and signed by you (by signature or mark). If you cannot sign, another person can sign for you at your specific direction.
- Notary
- Not required
- Witnesses
- 2
- Who cannot witness
Two witnesses, each 18 or older. The person who signs for you cannot be a witness. A health care provider (or its agent) that gives you care cannot sign for you. The statute's example form says it is preferable that witnesses not be your heirs, your creditors or employees of your health care providers, but the law itself does not bar them.
Law: 20 Pa.C.S. §§ 5442, 5452
Who can be your agent and what the agent can do
- Who cannot be your agent
Unless related to you by blood, marriage or adoption, your health care agent cannot be your attending physician or other health care provider, or an owner, operator or employee of a health care provider where you are receiving care (20 Pa.C.S. 5455(b)).
- When the agent starts
Unless the document says otherwise, it becomes operative when a copy is given to your attending physician and the physician determines you are incompetent, and stops while the physician finds you competent (20 Pa.C.S. 5454). A living will becomes operative only when your physician finds you incompetent and with an end-stage medical condition or permanently unconscious (20 Pa.C.S. 5443).
- Decisions an agent cannot make
Unless you gave specific written authorization, your agent must presume you would not want tube or IV nutrition and hydration withheld or withdrawn (the presumption can be overcome as the law describes) (20 Pa.C.S. 5456(c)(5)(iii)). Life-sustaining treatment must generally be provided to a pregnant woman despite any directive, with medical exceptions (20 Pa.C.S. 5429). The agent cannot consent to health care that state law prohibits, and the law does not change rules on consent to mental health treatment or hospitalization (20 Pa.C.S. 5463). You can countermand your agent's decision by telling your doctor (20 Pa.C.S. 5457).
Revoking and conflicting documents
- Revoking your agent
While of sound mind, you can revoke a health care power of attorney by a writing signed with two witnesses (the same way it is made), or by personally telling your attending physician, health care provider or health care agent that it is revoked (20 Pa.C.S. 5459).
- Revoking your instructions
You can revoke a living will at any time and in any manner, whatever your mental or physical condition. It takes effect when you or a witness to the revocation tells your attending physician or other health care provider (20 Pa.C.S. 5444).
- Telling others
A provider can rely on the health care power of attorney unless notified of its revocation. Providers who are told of a revocation must put it in your medical record (20 Pa.C.S. 5444(c), 5459(b), 5462(d)).
- Divorce ends a spouse's authority
- Yes · Divorce rules in Pennsylvania (Divorce Law Map)
- Conflicting documents
If two advance health care directives conflict, the one signed most recently controls to the extent of the conflict, unless the documents say otherwise (20 Pa.C.S. 5425).
Law: 20 Pa.C.S. §§ 5430, 5444, 5459
If you have no directive
- Who decides without a directive
If your doctor finds you incompetent and you have no available health care agent or court-appointed guardian of the person, a 'health care representative' can decide, in this order of priority. You can set a different order or disqualify people in a signed writing, including your health care power of attorney. If members of the same class disagree, the doctor may follow the majority. A provider may ask the representative for a written declaration under penalty of perjury.
- A person you designated as health care representative by a signed writing or by telling your attending physician or provider
- Your spouse (unless a divorce action is pending) together with your adult children who are not your spouse's children
- An adult child
- A parent
- An adult brother or sister
- An adult grandchild
- An adult who knows your preferences and values, including religious and moral beliefs
Law: 20 Pa.C.S. § 5461
Other states, registry and medical orders
- Signed in another state
A living will or health care power of attorney made in another state under that state's law is valid in Pennsylvania, except to the extent it would allow decisions inconsistent with Pennsylvania law (20 Pa.C.S. 5446(b), 5464).
- POLST (medical orders)
Pennsylvania Orders for Life-Sustaining Treatment (POLST); separately, the statutory Pennsylvania Out-of-Hospital Do-Not-Resuscitate Order
- Mental health directive
You can make a mental health declaration, a mental health power of attorney, or a combined document. Each must be dated, signed and witnessed by two adults; the person who signs for you cannot witness. They last two years from signing unless you revoke them sooner, and stay in effect past two years if they are in use when they would expire (20 Pa.C.S. Chapter 58, including 5822, 5824, 5832).
Free notice: revoke or change a health care directive
Free help in Pennsylvania
- Older Pennsylvanians Legal Assistance Program (Department of Aging; free for residents 60+, including guardianship defense)
- Unified Judicial System of Pennsylvania: Guardianship in Pennsylvania (handbook, training videos)
- Unified Judicial System of Pennsylvania: Alternatives to Guardianship
- Unified Judicial System of Pennsylvania: Orphans' Court forms (guardianship G-forms)
- Pennsylvania Guardian Handbook (AOPC Office of Elder Justice in the Courts)
- Find free legal aid at LawHelp.org
Report abuse or exploitation
Pennsylvania Department of Aging - Elder Abuse Helpline (Older Adults Protective Services, through local Area Agencies on Aging) · 1-800-490-8505
Questions about powers of attorney in Pennsylvania
How do I sign a health care directive in Pennsylvania?
Sign and date the health care power of attorney and/or living will in front of two adult witnesses. A notary is not required. The same rule applies to each document.
Who decides my health care if I have no directive in Pennsylvania?
If your doctor finds you incompetent and you have no available health care agent or court-appointed guardian of the person, a 'health care representative' can decide, in this order of priority. You can set a different order or disqualify people in a signed writing, including your health care power of attorney.