Advance Healthcare Planning
Advance Directive Pennsylvania

Advance Directive Pennsylvania


Jennifer Mcgee


Updated on  

March 17, 2023

8 Mins


When a person chooses to make a Living Will, along with the Medical Power of Attorney, these two legal documents become an Advance Directive. 

An Advance Directive may include your sign, names of witnesses, their signatures, etc. in adherence to your state’s requirements. Every state has different requirements to be followed. Some states ask for witnesses and notaries, others look for different criteria to be followed. 

Likewise, some states consider Living Will and Advance Directive as different and separate documents, whereas others consider both documents the same. In some states, Living Will and Advance Directive are used interchangeably. 

In this article, you will get a complete guide for making an Advance Directive for Healthcare in Pennsylvania.  

Legal Requirements for a valid Advance Directive

  • Written by the grantor (maker of an Advance Directive): Yes
  • Grantor must be:
  • Above the age of 18 years: Yes
  • Sound mind and memory: Yes
  • Signed by the grantor: Yes
  • Signed by Proxy/Agent: No
  • Proxy/agent accepts his role in writing: No
  • Witness required: Yes
  • Number of witnesses: 2
  • Signed by the witnesses: Yes
  • Number of documents required: 1 
  • Other names for a Living Will in Pennsylvania: Living Will
  • Other names for a Healthcare Power of attorney in Pennsylvania: Durable Power of attorney 
  • Proxy can decide on mental health issues: No
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Who can be your witnesses in the Pennsylvania Advance Directive?

Anyone can be your witness in Pennsylvania if;

  • He is an adult i.e., above 18 years of age, and
  • He is a sound-minded person which means that he can understand the consequences of making an Advance Directive and the laws applied to it.
Advance Directive Pennsylvania

Who can be your Proxy in the Pennsylvania Advance Directive?

Anyone can be your Proxy/Agent in Pennsylvania if;

  • He is an adult i.e., above 18 years of age, and
  • He is a sound-minded person which means that he can understand the consequences of making an Advance Directive and the laws applied to it.

Who cannot be your Proxy/Agent:

  • your supervising health care provider, 
  •  if you are receiving care at a community care facility/residential care facility then its operator or its employee.
  •  if you are receiving care  at a health care institution then its employee.

Other than the above legal requirements, the Proxy/Agent should be:

  • Trustable to adhere to your wishes and intentions.
  • Trustable to defend you if there’s any disagreement about your medical care.
  • He wanted to be your Attorney in Fact of his own free will to take care of your health affairs.
  •  He should not be your doctor or one of the caretakers.

Note: You can appoint an Alternate Proxy as well. The alternative Proxy/Agent will step in if the first person you name as a proxy is unable, unwilling, or unavailable to act for you or if you decide to revoke his authority.

When does an Advance Directive come into effect in Pennsylvania?

In Pennsylvania, an Advance Directive becomes legally binding but doesn’t come into effect on signing the form by the grantor, proxy, and witnesses. An Advance directive comes into effect only when the doctor declares that you are incapable of deciding on your behalf and have become debilitated due to illness or injury.

Note: Your Pennsylvania Advance Directive will not be effective in any medical crisis or emergency. Ambulance and hospital emergency department personnel are required to provide cardiopulmonary resuscitation (CPR) unless they are given a separate directive that states otherwise.

How can an Advance Directive be revoked?

You can revoke or terminate your Pennsylvania Advance Directive anytime by:

  • A written revocation,
  • An oral revocation, and
  • Tearing, burning, and obliterating or destroying the document in any other way.
  • Executing a new Advance Directive.

Note: Revocation of the Advance Directive to be effective you or your witness to your revocation must convey and notify your doctor and healthcare agent.

How to amend or change an Advance Directive? 

You can make changes or amend your Advance Directive at any time in Pennsylvania but once you have signed and witnessed/notarized it you have to complete a new document with the required changes. It is recommended to go through, double-check, and make sure of everything before signing the Advance Directive.

Learn about the requirements of Pennsylvania Last Will and Testament and Pennsylvania Last Will and Testament Template.

Pennsylvania rules for divorce after making your Advance Directive 

Divorce from the spouse will not make any effect on the validity of the Pennsylvania Advance Directive unless the spouse was named under Section 2 (Appointment of Healthcare) as the Proxy/Agent, the divorce or annulment of marriage will revoke the Pennsylvania Advance Directive with immediate effect. Then you have to make changes and fill a new document of Advance Directive. 

If you prefer that no effect should be there on the Advance Directive and want your spouse to continue to be your agent after marriage or on divorce, you can reaffirm your health care representative’s appointment in writing.

Pennsylvania rules for pregnancy after making your Advance Directive

A pregnant patient’s Pennsylvania Declaration will not be honored if it is possible that the fetus could develop to the point of live birth with continued application of life-sustaining treatment.

Unless life-sustaining treatment will be a barrier for the development and live birth of the child, will be physically harmful for the mother, or will cause her pain that cannot be eased by medication.

Sections of the Pennsylvania Advance Directive Form

Section 1: Introductory remarks on Healthcare decision making

This section of the Pennsylvania Advance Directive form contains an introduction that describes the uses and effects of this form and general provisions regarding what form allows you to, the competency of the healthcare representative to make decisions, revocation when your Advance Directive will be effective, etc.

This section provides that in Pennsylvania law your health care agent and health care providers are protected from any legal liability if they act in good faith to follow your wishes as expressed in the form or by your health care agent's direction. 

However, it does not otherwise provide them an escape from their professional responsibilities or excuse any negligence while your wishes are followed.

Section 2: Power of attorney for health care

You can fill this form out and provide all the details. The appointment of the Healthcare Proxy/Agent and his details will be filled along with the instructions for the Proxy/Agent to follow.

Pennsylvania Advance Directive Sample Form


I,__________________________ ____, of _ ________________ County, Pennsylvania, appoint the person named below to be my health care agent to make health and personal care decisions for me.


Health care agent: _____________________________________________________________ (Name and relationship) Address: ______________________________________________________ Telephone Number: Home __________________ Work ________________ Email: ________________________________________________________



If my health care agent is not readily available or if my health care agent is my spouse and an action for divorce is filed by either of us after the date of this document, I appoint the person or persons named below in the order named. (It is helpful, but not required, to name alternative health care agents.) First Alternative Health Care Agent: _____________________________________________________________ (Name and relationship) Address: ______________________________________________________ Telephone Number: Home __________________ Work ________________ Email: ________________________________________________________ Second Alternative Health Care Agent: _____________________________________________________________ (Name and relationship

Telephone Number: Home __________________ Work ________________ Email: 

Section 3: Individual’s Instructions (Living Will)

This section states your wishes regarding medical care when your doctor determines that either:

  • that you are terminally ill and to prolong artificially your life you would need artificial life-sustaining procedures or your death will occur with or without the use of life-sustaining procedures, or 
  • that you are in a persistent vegetative state.

Pennsylvania Advance Directive Sample Form


The following health care treatment instructions exercise my right to make my own health care decisions. These instructions are intended to provide clear and convincing evidence of my wishes to be followed when I lack the capacity to understand, make or communicate my treatment decisions:  

1. I direct that I be given health care treatment to relieve pain or provide comfort even if such treatment might shorten my life, suppress my appetite or my breathing or be habit forming. 

2. I direct that all life prolonging procedures be withheld or withdrawn. You may want to consult with your physician and attorney in order to determine whether your designated choices regarding end-of-life care are compatible with anatomical donation…

3. I specifically do not want any of the following as life prolonging procedures: (If you wish to receive any of these treatments, write “I do want” after the treatment).

Heart-lung resuscitation (CPR) ______________ Mechanical ventilator (breathing machine) ______________ Dialysis (kidney machine) ______________ Surgery ______________ Chemotherapy ______________ Radiation treatment ______________ Antibiotics ______________


_____ I want tube feedings to be given 


_____ I do not want tube feedings to be given


_____ My health care agent must follow these instructions 


_____ These instructions are only guidance. 

My health care agent shall have final say and may override any of my instructions (indicate any exceptions here): ______________________________________________


Pennsylvania law protects my health care agent and health care providers from any legal liability for their good faith actions in following my wishes as expressed in this form or in complying with my health care agent’s direction. On behalf of myself, my executors and heirs, I further hold my health care agent and my health care providers harmless and indemnify them against any claim for their good faith actions in recognizing my health care agent’s authority or in following my treatment instructions 

Signature: ________________________ Date: ____________________________

Section 3, Page 10: Donations of Organs at death

Pennsylvania Advance Directive Sample Form


I consent to making an anatomical gift. This does not include hands, facial tissue, limb or other vascularized composite allograft, there is another place in this document for me to do so. I also understand the hospital may provide artificial support, which may include a ventilator, after I am declared dead in order to facilitate donation. I consent to making a gift of the following parts of my body for transplantation or research (please insert any limitations you desire on donation of specific organs or tissues or eyes or any limitation on the use of a donated part of the body): ______________________________________________________________________________________________________________________

Signature: _______________________

Date: ____________________________

Section 4: Execution

You must sign in the presence of two witnesses. The details of the witnesses along with their signs are also required.

Pennsylvania Advance Directive Sample Form


I, __________________________________________ (print your name), 

having carefully read this document, have signed it this _____ day of ____________, 20_____, 

revoking all previous health care powers of attorney and health care treatment instructions. 


WITNESS 1 SIGNATURE: ___________________________ Date: _______ Printed name: ___________________________________ 

WITNESS 2 SIGNATURE: ___________________________ Date: _______ Printed name: ___________________________________

Give photocopies of the signed original to your agent and alternate agent, doctor(s), family, close friends, clergy, and anyone else who might become involved in your health care. If you enter a nursing home or hospital, have photocopies of your document placed in your medical records. 

Be sure to talk to your agent(s), doctor(s), clergy, family, and friends about your wishes concerning medical treatment. Discuss your wishes with them often, particularly if your medical condition changes.

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Frequently Asked Questions

What is an Advance Healthcare Directive Pennsylvania?

An Advance Directive is a legal-written document about your future medical care. It is a gift to family members and friends so that they won't have to guess what you want if you no longer can speak for yourself.

Does an attorney have to draft an advance directive in Pennsylvania?

The procedure of creating advance directives is simple, you do not require an attorney though you may choose to consult one. However, an advance directive either it is written or oral needs to be witnessed by two individuals.

Who makes medical decisions if you are incapacitated in Pennsylvania?

Under Pennsylvania law, incapacity means when a physician declares that the individual can longer give informed consent. Any person may designate someone to make health care decisions on their behalf should they become incapacitated in Pennsylvania.

What are the 2 major challenges with advance directives?

Advance directives have limitations. For example, an older adult may not fully understand treatment options or recognize the consequences of certain choices in the future. Sometimes, people change their minds after expressing advance directives and forget to inform others.

How do I get a medical power of attorney in Pennsylvania?

It is the same as creating a document of Advance Directive. Firstly, choose Your Surrogate/Acting Agent, be specific on what decisions your Power of Attorney can make for you, and fill out your Pennsylvania Medical Power of Attorney Form. Lastly, sign your document before subscribing to witnesses and a Notary Public.
Jennifer Mcgee
Parent to five young children. Estate Planning, Probate, and Family Law Attorney. Volunteer with Victim’s Advocates in the local sheriff's department...
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Jennifer Mcgree
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