How to Fill Out a Pennsylvania Advance Directive: POA and Living Will

To fill out a Pennsylvania advance directive, download a free template that combines a health care power of attorney and a living will, name the person you want making medical decisions for you, spell out your preferences on life-sustaining treatment, and sign the document in front of two adult witnesses. No attorney or notary is required for it to be legally valid. The rules come from Title 20, Chapter 54 of the Pennsylvania Consolidated Statutes.¹

What the Document Contains

Pennsylvania law recognizes an advance health care directive as a health care power of attorney, a living will, or a written combination of the two.¹ Completing both parts gives the broadest coverage.

The health care power of attorney names a person, called your health care agent, who can make medical decisions for you whenever your attending physician determines you cannot make or communicate them yourself. That authority is broad: approving surgery, refusing treatment, authorizing a transfer between facilities, accessing your medical records.

The living will is narrower. It gives written instructions about life-sustaining treatment such as ventilators, feeding tubes, and CPR, and it applies only when a physician determines you have an end-stage medical condition or are permanently unconscious. When you complete both parts, the living will guides your agent, and the agent handles the situations the living will does not anticipate.

Who Can Create One

You can create either part of the directive if you are of sound mind and meet at least one of the following:²

You are 18 or older.
You have graduated from high school.
You are or have been married.
You are an emancipated minor.

These are alternatives; you only need one. A mental health diagnosis does not by itself disqualify you. “Sound mind” means you understand what the document does, what choices you are making, and who you are appointing.

Step 1: Choose Your Health Care Agent

The agent gains sweeping authority. Unless you limit it in the form, the agent can make any medical decision you could have made yourself, including admission to a nursing facility and consent to or refusal of treatment. That authority can extend past your death to organ donation, disposition of your remains, and consent to an autopsy.³

Choose someone you trust who can handle pressure. Common choices are a spouse, adult child, sibling, or close friend.

Who Cannot Serve

Unless the person is related to you by blood, marriage, or adoption, these people are barred from acting as your agent:⁴

Your attending physician or other health care provider.
An owner, operator, or employee of a facility where you receive care.

A relative who happens to be your doctor or works at your care facility can still serve. The restriction targets unrelated professionals with a potential conflict of interest.

Name Successors

List one or more successor agents on the form. They step in, in the order you list them, if your primary agent is unavailable or unwilling to act.⁴ You can also name multiple agents to act jointly, though that can create problems if they disagree during a crisis. A single primary agent with one or two named successors is usually more practical.

Step 2: Complete the Power of Attorney Section

Standard Pennsylvania templates use fill-in-the-blank fields. For your primary agent and each successor, enter:

Full legal name.
Current home address.
Phone number, plus a second number if you have one. Emergencies do not wait for voicemail.

The form then asks whether you want to limit or expand the agent’s authority. Leave it blank and your agent gets the full scope of decision-making power. To restrict the agent, for example by prohibiting consent to certain procedures or requiring consultation with a specific family member, write those limitations clearly in the designated section. Vague language like “use good judgment” adds nothing, because the law already requires the agent to follow your known wishes and, if those are unclear, to act in your best interest.³

Step 3: Complete the Living Will Section

The living will asks you to declare preferences about life-sustaining treatment if you develop an end-stage medical condition or become permanently unconscious. Most templates break this into specific categories:

Mechanical ventilation: whether you want to be placed on a breathing machine.
Cardiopulmonary resuscitation: whether medical staff should attempt to restart your heart and breathing.
Artificial nutrition and hydration: whether you want tube feeding and IV fluids.
Other life-sustaining measures: dialysis, blood transfusions, antibiotics for infections during an end-stage condition.

For each category, check a box or initial a line indicating whether you want the treatment provided, withheld, or left to your agent’s discretion. Most forms also give you a space for additional instructions. You might, for instance, want antibiotics for comfort but not to prolong dying, or a time-limited trial of ventilation before withdrawal. Be specific. A doctor reading your directive at 2 a.m. should be able to understand your wishes without guessing.

If both sections are complete and your living will instructions conflict with what your agent decides, the living will generally takes priority in end-of-life situations, because it reflects your direct written wishes.

Step 4: Sign With Two Witnesses

Both parts have the same execution requirements. Date and sign the document. If you physically cannot sign, you may direct another person to sign on your behalf. Two witnesses, each at least 18 years old, must watch you sign.²⁵

Two restrictions apply:

If someone signs on your behalf, that person cannot also serve as one of the two witnesses.²
A health care provider or their employee who provides care to you cannot sign the document on your behalf.⁵

Pennsylvania does not require notarization for the directive to be legally valid. Notarizing it anyway is a low-cost precaution if you travel or receive care outside Pennsylvania, since some states do require notarization for their own directives and may question an unnotarized out-of-state form.

Step 5: Distribute Copies

A directive no one can find is a directive that will not be followed. After signing, give copies to:

Your health care agent and any successor agents. The health care power of attorney does not become operative until a copy reaches your attending physician.⁶
Your primary care physician, who will place it in your medical record.
Any hospital or facility where you regularly receive care.
Close family members, even ones not named as agents, so they know your wishes and can locate the document.

Do not store the only copy in a safe deposit box or locked safe. These are often inaccessible during the exact kind of emergency when the directive matters most. Keep the original somewhere your agent can reach quickly, such as a home filing cabinet, a clearly labeled folder, or with the agent directly.

When the Directive Takes Effect

The health care power of attorney becomes operative when two things happen: your attending physician receives a copy, and that physician determines you are incompetent to make the decision at hand. Under Pennsylvania law, “incompetent” means unable to understand the benefits, risks, and alternatives of a proposed treatment, unable to make the decision, or unable to communicate it.¹

You can be found incompetent for some decisions but competent for others. If you can understand and communicate a preference about a specific treatment, physicians should defer to you on that treatment even if your agent is handling other decisions. The physician must record any incompetency determination in your medical record and, when possible, inform both you and your agent.⁷

The living will activates under a narrower set of circumstances: you must be incompetent and either have an end-stage medical condition or be permanently unconscious. If you are incapacitated but your condition is neither terminal nor permanently unconscious, the living will does not apply and your agent handles decisions.

Changing or Revoking It Later

The two parts have slightly different revocation rules.

You can revoke the living will at any time and in any manner, regardless of your mental or physical condition. There is no required format. Tear it up, say aloud that you revoke it, or write a new one. Revocation takes effect once you or a witness communicates it to your attending physician or health care provider, who must note the revocation in your medical record.⁸

Revoking the health care power of attorney requires you to be of sound mind. You can revoke it by signing a new document that meets the same execution requirements or by personally telling your attending physician, health care provider, or health care agent that you are revoking it.⁹ A health care provider can continue to rely on the power of attorney until notified of the revocation, so make sure the revocation reaches everyone who has a copy.

When you create an updated directive, distribute the new version to everyone who received the original and ask them to destroy old copies. Conflicting documents floating around different facilities cause the confusion the directive is meant to prevent.

A Separate Document to Know About

Pennsylvania’s Orders for Life-Sustaining Treatment (POLST) is not the same as an advance directive and does not replace one. A POLST is a medical order signed by a health care professional after a conversation with a patient who is seriously ill or frail, designed to be immediately actionable by emergency responders. Emergency medical personnel are trained to look for and follow a POLST; they generally cannot act on an advance directive because it is a legal planning document rather than a clinical order.¹⁰ If you are healthy, the advance directive is the right document. If you have a serious illness and want emergency crews to follow specific treatment instructions, talk with your doctor about adding a POLST alongside your directive.¹¹

Where to Get a Free Form

Pennsylvania does not mandate a single official form. Any written document that meets the statutory execution requirements is valid. Widely used free templates include:

UPMC’s downloadable PDF, which covers both the health care power of attorney and living will sections.
Penn State Health’s combined template.
CaringInfo, a program of the National Hospice and Palliative Care Organization, which publishes Pennsylvania-specific templates in English and Spanish.

Any of these will walk you through the required fields. You do not need to hire an attorney, though consulting one can be worthwhile if you have a complex family situation, want to coordinate the directive with other estate planning documents, or need to address specific medical conditions in detail. The form itself costs nothing to complete, and the only potential expense is a notary fee if you choose optional notarization.

1
Pennsylvania General Assembly. Pennsylvania Consolidated Statutes Title 20, Chapter 54 – Section 5422
2
Pennsylvania General Assembly. Pennsylvania Code 20-5442 – Execution
3
Pennsylvania General Assembly. Pennsylvania Code 20-5456 – Authority of Health Care Agent
4
Pennsylvania General Assembly. Pennsylvania Code 20-5455 – Appointment of Health Care Agents
5
Pennsylvania General Assembly. Pennsylvania Code 20-5452 – Execution
6
Pennsylvania General Assembly. Pennsylvania Consolidated Statutes Title 20, Chapter 54 – Section 5454
7
Pennsylvania General Assembly. Pennsylvania Consolidated Statutes Title 20, Chapter 54 – Section 5462
8
Pennsylvania General Assembly. Pennsylvania Consolidated Statutes Title 20, Chapter 54 – Section 5444
9
Pennsylvania General Assembly. Pennsylvania Consolidated Statutes Title 20, Chapter 54 – Section 5459
10
National POLST. Learn About POLST Forms
11
Pennsylvania Department of Health. Pennsylvania Orders for Life-Sustaining Treatment POLST Form