West Virginia Advance Directive: Requirements, Forms, and How to File

Heading into surgery or facing a serious diagnosis without an advance directive means your healthcare decisions could default to someone you wouldn't have chosen. In West Virginia, getting your wishes on paper is straightforward — but the execution requirements leave zero room for error.

What Counts as an Advance Directive in West Virginia

Under the West Virginia Health Care Decisions Act (W. Va. Code § 16-30-1 et seq.), the state recognizes four types of advance directives:

• Living Will — Written instructions about withholding or withdrawing life-prolonging treatment if you're terminally ill or in a persistent vegetative state
• Medical Power of Attorney (MPOA) — Names a representative to make healthcare decisions when you're incapacitated
• Combined MPOA and Living Will — Merges both into a single document, preventing conflicting instructions
• Mental Health Advance Directive (MHAD) — Covers psychiatric treatment preferences, including medication, facility, and outpatient therapy choices

For most West Virginians, the combined form is the best starting point. It covers both your treatment wishes and your chosen decision-maker in one legally binding document.

Legal Requirements for a Valid Advance Directive

Every advance directive in West Virginia must satisfy these requirements under W. Va. Code § 16-30-4:

1. Written and dated — oral directives are not recognized
2. Signed by you — or by another person in your presence and at your express direction if you're physically unable to sign
3. Witnessed by two qualified adults present at the time of signing
4. Notarized by a commissioned notary public who is not also serving as a witness

The witness exclusion rules are strict. Neither witness can be: related to you by blood or marriage, entitled to inherit from your estate, financially responsible for your medical care, your attending physician, or your named MPOA representative.

If you're preparing advance directives before a scheduled surgery, plan at least a week in advance. Finding two qualifying witnesses and scheduling a notary appointment takes time.

How to Fill Out the Forms

The West Virginia Center for End-of-Life Care provides the official statutory forms. The combined MPOA and Living Will form walks you through:

1. Naming your representative — Choose a trusted adult (18+) who knows your values and can make difficult decisions under pressure. Name a successor in case your first choice is unavailable.
2. Stating your treatment preferences — Specify your wishes regarding CPR, mechanical ventilation, dialysis, artificial nutrition and hydration, and other life-prolonging interventions.
3. Signing with witnesses and notary — All parties sign in each other's presence at the same ceremony. The notary acknowledges the signatures.

Do not leave sections blank or ambiguous. Hospitals review these documents during intake, and vague language creates exactly the confusion you're trying to prevent.

Registering with the WV e-Directive Registry

After executing your advance directive, submit it to the West Virginia e-Directive Registry by fax (844-616-1415) or mail. The registry is managed by the West Virginia Center for End-of-Life Care and stores your document electronically.

Registration is voluntary but highly recommended. It makes your advance directive instantly accessible to treating physicians and emergency departments across all 55 counties, 24 hours a day. Without registration, first responders and ER doctors may have no way to know your directive exists.

You'll need to complete and include the e-Directive Registry Opt-In Form with your submission.

When Your Advance Directive Takes Effect

A living will only activates when an examining physician certifies that you're in a terminal condition or persistent vegetative state and cannot communicate your decisions. An MPOA activates whenever a physician documents that you lack the capacity to make healthcare decisions — regardless of whether your condition is terminal.

This distinction matters. If you're temporarily incapacitated after an accident or surgery, your MPOA representative can make decisions. Your living will would not activate unless your condition meets the terminal or persistent vegetative threshold.

Updating or Replacing an Existing Directive

West Virginia allows you to revoke an advance directive at any time, regardless of your mental or physical condition. You can revoke by signing a written revocation, physically destroying the document, verbally telling your attending physician, or executing a new advance directive that replaces the old one.

When you revoke or replace, notify the e-Directive Registry, your healthcare representative, and your physicians so outdated documents don't create confusion during a crisis.

Get Everything You Need in One Kit

The West Virginia Advance Directive & Living Will Kit includes every form, an execution safeguard checklist to prevent the witness and notary mistakes that invalidate documents, and step-by-step registry instructions.

See more West Virginia guides →