Advance Directive Tennessee: How the Health Care Decisions Act Replaced Living Wills

Tennessee Replaced Separate Living Wills and Health Care POAs With One Document

If you've been searching for a Tennessee living will or a separate medical power of attorney form, you're looking for documents that no longer exist as standalone instruments under state law.

The Tennessee Health Care Decisions Act (T.C.A. § 68-11-1801 et seq.) consolidated those two documents into a single Advance Directive for Health Care. The statutory model form, developed by the Board for Licensing Health Care Facilities, handles both jobs: it lets your parent appoint a health care agent who can make medical decisions on their behalf, and it records their personal treatment preferences for end-of-life care, artificial nutrition, and life-sustaining interventions.

This matters because families still encounter outdated "living will" forms circulating online. A form that only documents treatment preferences but doesn't name a health care agent leaves the family without anyone authorized to make real-time medical decisions during a hospitalization.

What the Advance Directive Actually Controls

The advance directive has two operational parts, and your parent can complete either or both:

Part 1 — Appointment of a Health Care Agent. Your parent names a primary agent (and at least one successor) who gains authority to consent to, refuse, or withdraw medical treatment when a supervising physician determines your parent lacks decision-making capacity. The agent's authority activates only upon that clinical finding, unless the directive specifies otherwise.

Part 2 — Treatment Instructions. Your parent documents their preferences on life-sustaining treatment, mechanical ventilation, tube feeding, dialysis, and organ donation. These instructions guide the agent and the medical team when the parent cannot communicate.

The statutory surrogate hierarchy (T.C.A. § 68-11-1806) is the fallback when no advance directive exists. Under that hierarchy, the spouse makes decisions first, followed by adult children, parents, adult siblings, and then other relatives. But relying on the surrogate hierarchy means no one has clear authority until a physician makes an incapacity finding and works through the priority list — a process that stalls during emergency room admissions.

How to Execute a Valid Tennessee Advance Directive

Tennessee's execution requirements are specific, and a document that fails them is legally void:

Signature. The principal (your parent) must sign the directive while they have decision-making capacity. A diagnosis of early-stage dementia does not automatically disqualify them — they must understand what the document does, who they're appointing, and the scope of authority being granted at the moment of signing.

Witnesses or notarization. The directive must be either notarized or signed in the presence of two competent adults. If using witnesses, at least one must be an independent individual who is not related to the principal by blood, marriage, or adoption and is not entitled to any portion of the principal's estate under an existing will or by operation of intestate law. Neither witness can be the appointed health care agent.

No physician signature required. Unlike some states, Tennessee does not require a physician to co-sign the advance directive. The document takes effect based on a future incapacity determination, not at execution.

Filing. Tennessee has no central advance directive registry. Distribute copies to the named health care agent, the parent's primary care physician, any hospital or care facility, and immediate family members who need to know the directive exists.

The Relationship Between an Advance Directive and a Financial POA

An advance directive only covers health care decisions. It gives the agent zero authority over bank accounts, bill payments, insurance claims, real estate, or tax filings.

For financial authority, your parent needs a separate Durable Financial Power of Attorney under T.C.A. § 34-6-102. That document must contain specific durability language stating the power survives subsequent incapacity — otherwise it dies the moment your parent can no longer make decisions, which is exactly when you need it most.

Families routinely execute both documents in the same meeting: the advance directive for medical decisions, the durable financial POA for everything else. Doing both while capacity exists avoids the need for a court-supervised conservatorship later.

When an Advance Directive Can Be Revoked

Your parent can revoke their advance directive at any time, as long as they retain the capacity to do so. The revocation must be communicated to the health care agent and any providers who hold copies.

If your parent is approaching the point where capacity is uncertain, the priority is getting the advance directive in place now. Once capacity is lost, the option to execute or revoke planning documents disappears, and the family's path forward narrows to either the statutory surrogate hierarchy or a full conservatorship proceeding.

Our Tennessee Power of Attorney & Guardianship Kit walks through both the advance directive and the durable financial POA with Tennessee-specific execution checklists, so your family gets both documents right the first time.

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