Alabama Living Will Form (Advance Directive)

The Alabama advance directive, also known as a ‘health care proxy’, is a form that allows a person to make their end of life medical decisions through a written statement. The decisions are related to if they should be incapacitated and not able to consciously make a determination of the medical path the hospital or caretaker should conduct. Also, if the patient becomes in a vegetative state with no recourse, they make pre-determined statements that will end their life if the situation is to arise such as switching off feeding and/or breathing devices.

How to Write

Step 1 – Download the form and complete by filling-in the following blank fields located┬áin Section 1;

  • Name of principal;
  • Initial if the principal:
    • would like to have life sustaining treatment if terminally ill or injured
    • would like to have food or water sent through a tube if terminally ill or injured
    • would like food or water if permanently unconscious
  • If there are any other things they would like done they are to write and describe┬áin the four (4) blank fields. If not, initial next to the line that says “No, I do not have any other directions”.

Step 2 – In Section 2, enter the details of the person the person would like to speak for them by writing the following:

  • Initial if the principal does or does not want a proxy

If the principal would like a proxy, the following should be written:

  • First choice for proxy which should include their relationship, address, city, and phone number
  • If there is a second choice as well, enter their information

In the next few lines there will be directions for the proxy such as;

  • Making decisions about food and water through an IV
  • Making decisions strictly based on the directions listed on the document
  • Make decisions on the form and not covered by the document
  • Have the proxy be able to make decisions even if it is said otherwise on the form

Step 3 – in Section 3 the principal should acknowledge the following:

  • In the first blank area enter the people who should listen to the doctor about the positives and negatives of no longer receiving life sustaining food and water.

Step 4 – In section 4 the following signatures are needed:

  • Principal
  • Two (2) Witnesses
  • Proxy