Pennsylvania Advance Directive and Living Will Guide

When your parent can no longer speak for themselves in a medical crisis, an advance directive tells doctors exactly what they want — and who gets to decide. Without one, your family is left guessing under pressure, and Pennsylvania's default rules may not match your parent's wishes.

What an Advance Directive Actually Is

In Pennsylvania, a comprehensive advance directive combines two legal tools:

Healthcare Power of Attorney — names a specific person (the healthcare agent) to make medical decisions when your parent can't communicate. Governed by 20 Pa.C.S. Chapter 54.

Living Will — documents your parent's specific instructions about end-of-life care, including which treatments they want and which they refuse. This is the directive that addresses ventilators, feeding tubes, and resuscitation.

You can execute these separately, but combining them in one document ensures both components are signed, witnessed, and stored together.

When a Living Will Takes Effect

A living will in Pennsylvania doesn't activate the moment it's signed. It only takes effect when two specific conditions are met:

1. Two physicians certify that your parent has an "end-stage medical condition" (a condition that will cause death regardless of treatment) or is in a "permanent state of unconsciousness"
2. The treatment in question is life-sustaining — meaning it artificially prolongs dying rather than curing or improving the condition

This is an important distinction. A living will does not apply to routine medical decisions, elective procedures, or even serious surgeries where recovery is expected. It only governs the narrow window where further treatment would merely delay an inevitable death.

Execution Requirements

Pennsylvania's execution rules for advance directives:

• Your parent must sign and date the document
• Two adult witnesses must sign
• Notarization is recommended but not legally required for the healthcare portions
• The witnesses should not be anyone who would benefit financially from your parent's death (healthcare providers, facility employees, or potential heirs have inherent conflicts)

If the document also includes a financial POA component, the stricter Act 95 execution rules apply to that section — including mandatory notarization and the statutory notice requirements.

What to Include

A well-drafted Pennsylvania advance directive addresses:

Medical treatments: Specific instructions about mechanical ventilation, artificial nutrition and hydration (feeding tubes), dialysis, blood transfusions, and CPR/resuscitation.

Pain management: Whether your parent wants maximum comfort care (including palliative sedation) even if it accelerates death.

Organ donation: Pennsylvania allows this preference to be documented in the advance directive, though it can also be registered separately through the state organ donor registry.

HIPAA authorization: A clause releasing medical information to the named healthcare agent. While Pennsylvania law technically authorizes healthcare agents to access records, many hospital systems require explicit HIPAA language before sharing information.

Alternate agents: At least one backup healthcare agent in case the primary person is unavailable or unable to serve.

Where to Get Pennsylvania Advance Directive Forms

The Pennsylvania Department of Aging and many county Area Agencies on Aging provide free advance directive forms. The Pennsylvania Bar Association also publishes templates.

The challenge with free forms is that they rarely include the financial POA component, HIPAA language, or guidance on how to discuss end-of-life preferences with your parent and their physician. A form without context often sits unsigned in a drawer.

The Conversation That Matters Most

The form itself is straightforward. The hard part is the conversation — sitting with your parent and asking what they actually want when the time comes. Common questions to work through:

• If you had a massive stroke and couldn't recover meaningful function, would you want a feeding tube?
• Do you want CPR attempted if your heart stops during a terminal illness?
• Is being alert and communicative more important to you than being free from all pain?
• Who do you trust most to honor these wishes under pressure?

Document the answers, then translate them into the advance directive's legal language.

Making Sure It's Honored

An advance directive that nobody can find during an emergency is worthless. After execution:

• Give copies to your parent's primary care physician, hospital system, and any long-term care facilities
• Upload to the electronic health record if the provider system supports it
• Give the named healthcare agent the original or a notarized copy
• Keep a copy accessible at your parent's home (on the refrigerator door is a common recommendation from emergency responders)

The Pennsylvania Power of Attorney & Guardianship Kit includes advance directive frameworks integrated with the healthcare POA, HIPAA authorization, and a guided conversation worksheet to help families have the difficult discussion.

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