Free West Virginia Living Will Form

A West Virginia living will is a written document, one of the advance directives recognized under the state’s Health Care Decisions Act. It lets you state which life-prolonging medical treatments you want or refuse if you become terminally ill or otherwise unable to communicate your own health care decisions.

Last Updated: September 2026. This guide is reviewed and updated regularly to reflect current West Virginia law. If you notice an error or outdated information, please contact us.

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The document covers your wishes on life-sustaining medical treatment, artificial nutrition and hydration, pain relief, and other end-of-life care decisions.

Tell your family, your doctor, and any health care agent or medical power of attorney that you have a living will and where to find it. Some people keep a copy with their medical records or in a registry their providers can access.

Signing Requirements and Laws

West Virginia’s living will law, Section 16-30-4 of the state code, sets rules for who may witness your signature and what the notary must do, so your health care decisions hold up when your medical care team needs them. Below is the exact text of the statute, followed by an explanation in plain language.

A living will, medical power of attorney, or combined medical power of attorney and living will made pursuant to this article shall be: in writing; executed by the principal or by another person in the principal’s presence at the principal’s express direction if the principal is physically unable to do so; dated; signed in the presence of two or more witnesses eat least 18 years of age; and signed and attested by such witnesses whose signatures and attestations shall be acknowledged before a notary public.

W. Va. Code § 16-30-4[1.1]

In plain terms, your living will must be written down and dated. If you can sign it yourself, you do. If you are physically unable to sign, someone else can sign for you as long as you are present and you tell them to. You need at least two witnesses who are 18 or older, and their signatures must be notarized before a notary public.[1.1]

Who Cannot Witness Your Signature

West Virginia law does not let just anyone witness your living will. A witness cannot be:[1.1]

  • The person who signed on your behalf at your direction.
  • Related to you by blood or marriage.
  • Entitled to any part of your estate under your will, unless they did not know this when they witnessed.
  • Financially responsible for your medical care.
  • Your attending physician.
  • Your medical power of attorney representative or successor representative.

These limits keep the people who give you medical care, or who benefit from your estate, out of the health care decisions your living will makes for you.

By signing, your witnesses are stating in writing that they did not sign your name for you and are 18 or older. They are also stating that they are not related to you, not in line to inherit from you, not responsible for paying your medical bills, and not your doctor or your named representative.[1.1] This keeps your health care decisions reliable.

Section 16-30-4(g) of the state code sets out this exact declaration and witness language, which is the basis for the West Virginia living will form on this page.[1.2]

Providers must follow a properly executed living will once they know of it. A provider without actual knowledge of it is not liable for failing to follow it (W. Va. Code § 16-30-22(a)).[3.1]

Under W. Va. Code § 16-30-18, only you, or someone acting at your express direction, may revoke your living will, at any time, by destroying it, by a signed and dated written revocation that takes effect on delivery to your attending physician, or by a verbal statement made in front of a witness 18 or older who signs a confirming writing, effective when communicated to your attending physician.[2.1]

West Virginia Living Will Form Details

Document Name West Virginia Living Will Form
State Form Name West Virginia Health Care Decisions Act
Signing Requirements Two Witnesses and Notary Public[1.1]
Validity Requirements § 16-30-4[1.1]
State Laws: West Virginia Code § 16-30-4[1.1]

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Steps to Fill Out the Form

The West Virginia living will form has six parts to complete: your declaration, your medical treatment decisions, any extra instructions, your signature, your witnesses’ signatures, and the notary’s acknowledgment. Completing these steps carefully helps make sure your health care decisions are clear to your family and your medical care team if you become terminally ill.

Two witnesses and a notary public must be present for the signing steps below.[1.1] You can fill in the PDF on your screen with our online PDF editor before you print it.

  1. Complete the Declaration. Fill in the date, your name, and your residence address in the opening declaration paragraph on page 2 of the medical form.
  2. Initial Your Treatment and End-of-Life Care Choices. Initial each life-sustaining medical treatment you want withheld, such as CPR, artificial nutrition and hydration, mechanical ventilation, dialysis, blood transfusions, and organ transplants. Then mark the end-of-life conditions under which you want treatment stopped, such as being unable to communicate, a deteriorated mental condition, an end-stage condition, a terminal condition, or a physician-determined vegetative state.
  3. Add Additional Instructions. Use the blank lines on page 3 for any special directives on funeral arrangements, autopsy, mental health treatment, or organ donation. Leave this section blank if you have none.
  4. Sign the Document. In the presence of your two witnesses, enter the date, sign, and print your name in the signature block on page 8.[1.1]
  5. Complete the Witness Signatures. Each witness reads the witness declaration, then prints their name and address and signs and dates their own line on page 8.[1.1]
  6. Complete the Notarization. A notary public enters the state, county, the names of the principal and witnesses, the date, and the notary’s commission expiration, then signs on page 9 to complete the notarization.[1.1]
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Frequently Asked Questions

What Are the Requirements for a Living Will in West Virginia?

A West Virginia living will must meet five requirements under Section 16-30-4 of the state code. It must be in writing, signed by you or, if you are physically unable, by someone else at your direction, dated, signed in front of at least two witnesses who are 18 or older, and notarized.[1.1]

  • In writing.[1.1]
  • Signed by you, or by another person in your presence at your express direction if you are physically unable to sign.[1.1]
  • Dated.[1.1]
  • Signed in the presence of at least two witnesses who are 18 or older.[1.1]
  • Witnessed and notarized before a notary public.[1.1]

The same signing rules apply to your health care decisions if you create a medical power of attorney, or a combined living will and medical power of attorney, since West Virginia covers all three documents under this one law.[1.1]

General information, not legal or tax advice.

Sources

  1. W. Va. Code § 16-30-4.
    • 1.1 § 16-30-4
    • 1.2 § 16-30-4(g)
  2. W. Va. Code § 16-30-18
    • 2.1 § 16-30-18(a)
  3. W. Va. Code § 16-30-22
    • 3.1 § 16-30-22(a)

Published: Jun 19, 2024
Mara Erlach
Mara Erlach
Writer & Attorney
Mara has been practicing estate planning and trust law in California since 2003, taking pride in helping clients of all backgrounds and asset profiles form a complete and customized estate plan. Her specialties are: estate planning, wills and trusts, trust and probate administration.