Pennsylvania has a trap most families never see coming: unless the document specifically says so, it may not authorize withdrawing a feeding tube — the exact decision families agonize over most.
The Pennsylvania advance directive can be a living will, a health care power of attorney, or — most usefully — a written combination of the two, all under Title 20, Chapter 54 of the Pennsylvania statutes, the law commonly known as Act 169.
This page covers what those documents are, where to get the current official version, how Pennsylvania wants them signed, and two Pennsylvania-specific requirements that quietly undo directives: the agent’s acknowledgment, and the artificial-nutrition rule.
Pennsylvania, in short
- One combined document, or two separate ones. Living will, health care power of attorney, or a written combination.
- Governed by Act 169 — 20 Pa.C.S. Chapter 54.
- Two adult witnesses. Notarization is not required, though it helps if she spends time in other states.
- The agent must sign an acknowledgment accepting the role — the health care POA isn’t complete without it.
- Feeding-tube decisions need specific language. A directive silent on artificial nutrition may not authorize withdrawing it.
- Witnesses can’t be the health care provider or the person who signed on her behalf.
The Pennsylvania documents
The health care power of attorney names a health care agent to make medical decisions when she can’t, and covers all medical care, not just end-of-life situations. This is the broader and generally more useful document, because a named person can respond to anything.
The living will is her written instruction about treatment, and under Pennsylvania law it becomes operative only when she is both determined to be incompetent and has an end-stage medical condition or is permanently unconscious. Outside those specific conditions, it doesn’t govern — which is exactly why the agent matters.
Pennsylvania lets you combine both into a single advance health care directive, which is what most people should do. Why the agent usually matters more than the living will →
Where to get the official Pennsylvania form
Pennsylvania’s statute itself includes a sample combined form you can complete by filling in the blanks. Reliable, free sources:
- The Pennsylvania statute (20 Pa.C.S. Chapter 54) contains a sample living will and health care power of attorney. The Pennsylvania Senate and various county bar associations republish it in plain-language guides.
- The Pennsylvania Medical Society and Pennsylvania hospitals provide advance directive forms and are required to offer information about them.
- County bar associations — the Allegheny County and Philadelphia bar associations, among others, publish free versions.
If you can’t locate one, the Eldercare Locator (1-800-677-1116) connects you to the Area Agency on Aging for her county.
How Pennsylvania wants it signed
The document must be dated and signed by her — or by someone else at her direction if she can’t sign — and witnessed by two individuals, each at least 18 (§ 5442). To execute one at all, she must be 18 or older, a high school graduate, married, or an emancipated minor.
Notarization is not required in Pennsylvania. It’s optional, and worth considering only if she spends significant time in other states, since a notarized document travels more easily.
The witness restrictions under § 5442:
- A witness cannot be the person who signed the directive on her behalf at her direction.
- A witness cannot be her health care provider or an agent of that provider.
- Both witnesses must be at least 18.
The safe approach, as everywhere: two disinterested adults who are not her doctor, not her named agent, and not anyone signing for her.
Two Pennsylvania requirements that catch families out
1. The agent has to sign, too. For the health care power of attorney to work, the person she names as agent must sign an acknowledgment accepting the responsibility. A directive that names an agent who never signed on can leave a gap exactly when it’s needed. Have the agent sign at the same time.
2. Feeding tubes need to be named specifically. Under Pennsylvania law, artificial nutrition and hydration — a feeding tube or IV fluids — may be withheld or withdrawn only if the directive specifically addresses it, or the agent determines she clearly intended it. A directive that is silent on artificial nutrition may not authorize stopping it, even where everything else points that way. If her wishes about a feeding tube matter to her, the document must say so in as many words.
If there’s no directive: the majority rule
One Pennsylvania feature worth knowing even if she never signs anything. Under Act 169, if she has no advance directive, Pennsylvania allows a health care representative — typically a family member — to make decisions. And if several equally-ranked relatives share that role and disagree, providers follow the majority.
Three adult children who can’t agree two-to-one means the two carry it. That’s better than paralysis, but it’s a poor substitute for her having named one person herself — which is the entire argument for doing the power of attorney while she can.
What the Pennsylvania documents don’t do
They won’t stop paramedics from performing CPR. Pennsylvania, like every state, separates an advance directive from an emergency order. Avoiding resuscitation outside a hospital requires Pennsylvania’s out-of-hospital DNR — an order, bracelet, or necklace authorized under Chapter 54, for patients with an end-stage condition, arranged through her physician. More on why a directive alone won’t stop CPR →
They don’t cover money. A health care agent has no authority over finances — that needs a separate durable financial power of attorney. What a financial power of attorney is, and the word that decides whether it works →
After she signs
- Make sure the agent has signed the acknowledgment — the step most likely to be missed.
- Give the agent and any alternate a copy.
- Give copies to her physician and any hospital or facility involved in her care.
- Keep one somewhere obvious at home, and photograph it.
The directive settles who decides. This settles what she needs now.
Getting the documents done is one half of an aging-at-home plan. The other is knowing how much day-to-day help she actually needs — and “she’s slowing down” isn’t something a doctor or an agency can act on.
The care needs checklist walks the same fourteen questions a visiting nurse walks and ends with something specific: which daily tasks need hands-on help, roughly how many hours a week, and which gaps are genuine safety issues.
Take the care needs checklist →Free. No email, nothing stored — it runs in your browser and the answers never reach me.
Where to go next
The full how-to, including the witnessing mistakes that void a document: how to fill out an advance directive →
The financial side is separate: what a power of attorney is →
If she won’t discuss any of it: when an aging parent refuses help →
Questions families ask
What is the Pennsylvania advance directive called?
Pennsylvania uses the term advance health care directive, which can be a living will, a health care power of attorney, or a written combination of the two under Title 20, Chapter 54 — the law known as Act 169. The health care power of attorney names an agent to make medical decisions, while the living will records treatment wishes for end-stage conditions. Most people benefit from combining both into a single document.
Does a Pennsylvania advance directive need to be notarized?
No — Pennsylvania requires two adult witnesses but does not require notarization. Notarizing is optional and mainly useful if the person spends significant time in other states, since a notarized document is recognized more easily elsewhere. The two witnesses, each at least 18, are what the statute requires.
Who can witness a Pennsylvania advance directive?
Two individuals aged 18 or older must witness the signing, and neither may be the person who signed the directive on the principal’s behalf or the principal’s health care provider or its agent. The safest choice is two disinterested adults who are not the named agent, not her physician, and not signing on her behalf. Both witnesses must observe the signing.
Does the health care agent have to sign in Pennsylvania?
Yes — for the health care power of attorney to be effective, the person named as agent must sign an acknowledgment accepting the appointment. A directive that names an agent who never signed can leave a gap at the moment it is needed. The agent should sign at the same time the principal executes the document.
Can a Pennsylvania living will authorize removing a feeding tube?
Only if it specifically addresses artificial nutrition and hydration, or the health care agent determines the principal clearly intended it. Under Pennsylvania law, a directive that is silent on feeding tubes and IV fluids may not authorize withholding or withdrawing them, even when other instructions suggest that outcome. If wishes about a feeding tube matter, the document must state them explicitly.
Where do I get the official Pennsylvania advance directive form?
Pennsylvania’s statute itself includes a sample combined living will and health care power of attorney that can be completed by filling in the blanks, and the Pennsylvania Senate and county bar associations republish it in plain-language guides. The Pennsylvania Medical Society, hospitals, and bar associations such as Allegheny County and Philadelphia also provide free forms. The Eldercare Locator at 1-800-677-1116 can direct you through the local Area Agency on Aging.
What happens in Pennsylvania if there is no advance directive?
Pennsylvania’s Act 169 allows a health care representative, usually a family member, to make decisions when someone has no directive and cannot decide for themselves. If several equally ranked relatives serve and disagree, health care providers follow the majority decision. This avoids paralysis but is far weaker than naming a single agent in advance, which is why completing a health care power of attorney is worthwhile.
Changelog
- 26 July 2026 — Published. Document structure, witness rules, the agent acknowledgment requirement, the artificial-nutrition rule, and the majority-representative rule verified against 20 Pa.C.S. Chapter 54 (Act 169 of 2006), §§ 5422, 5442, and 5423.
This page is reviewed every six months, and immediately if Pennsylvania law changes. When it changes, this list will say so.
Sources
- 20 Pa.C.S. Chapter 54 — Health Care (Act 169 of 2006), including § 5422 (definitions), § 5442 (execution and witnesses), and § 5423 (living will operation and artificial nutrition)
- Pennsylvania Senate — plain-language guide to living wills, health care powers of attorney, and guardianship
- Marshall, Parker & Weber and other Pennsylvania elder law commentary on Act 169’s structure and requirements
- Pennsylvania out-of-hospital do-not-resuscitate provisions, 20 Pa.C.S. §§ 5481–5488
- Thirteen years of the author’s own observation inside home health and hospice referral, labeled as such throughout
Last verified: 26 July 2026 against 20 Pa.C.S. Chapter 54 (Act 169 of 2006) · Next review: January 2027, or immediately on a relevant change in Pennsylvania law
This page is educational and is not legal advice. Mark Duda is not an attorney. It describes Pennsylvania law as of the date shown and may not reflect later changes. Advance directive requirements are exacting and the consequences of an execution error are serious — confirm the current form and rules with the official Pennsylvania source, and consult an attorney licensed in Pennsylvania if anything is unclear, particularly regarding artificial nutrition and hydration. See our disclaimers.
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