Imagine being rushed to an Indiana hospital, unable to speak for yourself. Who decides whether you have surgery, go on a ventilator, or receive comfort care instead? If you have planned ahead, the answer is: the person you chose, following the instructions you left. If you have not, the decision falls to a list set by state law, which may not be who you would have picked.

This guide explains, in plain language, how Indiana’s advance directive laws work: what a healthcare representative is, how to appoint one, what authority they hold, and how living wills and other documents fit together. Whether you are a patient planning ahead, a family member helping an aging parent, or a healthcare provider guiding patients, understanding these tools is the key to making sure medical wishes are documented, honored, and easy to communicate.

Indiana substantially modernized this area of law effective July 1, 2021, and refined it again in 2023, so even directives signed a few years ago are worth a fresh look.

What Is an Indiana Advance Directive?

An advance directive is a legal document that lets you plan your medical care in advance—before a crisis—so your wishes are known if you ever cannot speak for yourself. In Indiana, a single advance directive can do several things at once. Under current law, it may:

• Name a healthcare representative (one or more competent adults) to make medical decisions for you or receive your health information;
• State specific healthcare decisions you want followed;
• Describe your preferences about life-prolonging procedures, palliative care, comfort care, or help with daily activities; and
• Disqualify specific people you do not want making decisions for you. 

A few terms you will see throughout:

• Declarant: the person making the directive (you).
• Healthcare representative (sometimes called a healthcare proxy or agent): the person you authorize to make medical decisions on your behalf.
• Incapacity: being unable to understand or make your own healthcare decisions—for example, while unconscious or in advanced dementia.
• Life-prolonging procedures: treatments that extend life when a condition is terminal or recovery is not expected, such as mechanical ventilation or artificial nutrition.

How to Appoint a Healthcare Representative in Indiana

Naming a healthcare representative is the single most important step for most people, because a trusted person can respond to situations no document could fully anticipate.

Who can serve. You may designate one or more competent adults as your healthcare representative. Most people choose a spouse, adult child, close relative, or trusted friend.

How to sign it. Your advance directive must be signed by you, or by another adult at your direction and in your presence, using one of two methods: in the presence of two adult witnesses, or in the presence of a notarial officer (notary). If someone signs for you, that person cannot also be a witness, the notary, or your designated representative. 

Witness rules. If you use witnesses, there must be two adults, and at least one of them cannot be your spouse or other relative. Alternatively, you can have the directive notarized, including by remote or electronic notarization that meets Indiana’s requirements. Choosing an unrelated witness, or a notary, helps ensure the document holds up if anyone later questions it.

What Authority Does a Healthcare Representative Have?

Unless you expressly limit their authority in the directive, your Indiana healthcare representative generally may:

• Make all healthcare decisions only if you are unable to make those decisions yourself;
• Consult with your providers and give informed consent;
• Make the decisions you would have made, based on your known wishes, or if unknown, your best interests;
• Provide written consent on required forms, including a physician’s order not to resuscitate (DNR) or a POST form;
• Access your health information; and
• Apply for public benefits, including Medicaid and Indiana’s CHOICE program, and access the financial information needed to do so. 

Importantly, your representative’s authority is durable in a practical sense: if a court later appoints a guardian for you, your chosen representative’s authority continues unless the court modifies it after a hearing. In other words, naming a representative can help keep decisions in trusted hands and reduce the need for guardianship court.

When Does the Representative’s Authority Begin?

This is a common point of confusion for patients and families. Under Indiana law, if your directive does not set a delayed start date or a triggering event, it is effective immediately upon proper signing and witnessing. But as long as you have the capacity to decide, you remain in charge. Your own decisions override anything your representative might decide. 

Indiana law presumes you are capable of making your own healthcare decisions. If your capacity is in question, your treating physician evaluates you and, if you lack capacity, enters that finding in your medical record; if the physician cannot reach a conclusion, you continue to be treated as having capacity. Notably, incapacity cannot be assumed simply because someone has been hospitalized for mental illness or has an intellectual disability. 

One practical tip: if you sign a new advance directive later, it generally supersedes and revokes your earlier ones unless it says otherwise—so keep your documents current and consistent. 

Living Wills and Life-Prolonging Procedures Declarations

A living will is a written statement of your wishes about life-prolonging treatment if you are near the end of life. Indiana actually recognizes two related but opposite documents:

1. A living will declaration, which generally expresses a wish not to have life prolonged by artificial means in a terminal situation; and
2. A life-prolonging procedures will declaration, which expresses a wish to receive life-prolonging treatment.

Here is a key difference in how much weight each carries. A living will declaration does not force a physician to withhold or withdraw treatment, but it is presumptive evidence of your wishes and must be given great weight. By contrast, a life-prolonging procedures will declaration does require the physician to provide life-prolonging procedures as requested.

Validity requirements. To be valid, either declaration must be voluntary, in writing, signed (by you or by someone at your direction and in your presence), dated, and signed in the presence of at least two competent adult witnesses or a notary public. 

Who cannot witness a living will. Indiana disqualifies certain witnesses to protect against conflicts of interest. A witness cannot be: the person who signed the declaration for you; your parent, spouse, or child; anyone entitled to part of your estate; or anyone directly financially responsible for your medical care. 

An important limitation: a living will declaration has no effect during pregnancy if the attending physician has diagnosed the declarant as pregnant. 

Indiana POST Forms: Medical Orders for the Seriously Ill

A POST form (Physician Orders for Scope of Treatment) is different from the documents above. It is not something you sign alone at home. This is a set of medical orders designed for people who are seriously ill or frail, translating their wishes into actionable instructions for emergency and treating providers.

In Indiana, a POST form may be executed only by your treating physician, advanced practice registered nurse, or physician assistant, and only after the provider confirms you are a “qualified person” and that the orders are medically appropriate. To be effective, the form must include your name and code-status orders and be signed and dated by both the provider and you (or your representative or proxy). POST forms are especially useful for ensuring that decisions about resuscitation and the scope of treatment travel with the patient across care settings.

What Happens If You Don’t Have an Advance Directive in Indiana?

If you become unable to consent and have not named a healthcare representative, Indiana law provides a default priority list of people who may make decisions for you, in this order:

1. A court-appointed guardian or specially appointed representative;
2. Your spouse;
3. An adult child;
4. A parent;
5. An adult sibling;
6. A grandparent;
7. An adult grandchild;
8. The nearest other adult relative;
9. A qualifying adult friend who knows your wishes and values; and
10. Your religious superior, if you belong to a religious order.

A parallel default-consent list appears in Indiana’s Health Care Consent Act as well. Whoever acts must make the decision you would have made based on your known wishes, or if your wishes are unknown, your best interests. A decision to withhold or withdraw life-prolonging treatment must be supported by evidence of what you would have chosen or that it is in your best interests, and the proxy must try in good faith to follow any instructions you left and any valid POST form. 

The catch: this default list may not reflect your actual preferences. An unmarried partner, a close friend, or a specific adult child you trust most could be outranked or family members of equal rank could disagree. Naming your own representative is how you stay in control and hopefully avoid a legal dispute between members of your own family.

Practical Steps to Protect Your Wishes

For patients and families, translating the law into action comes down to a few concrete steps:

1. Choose your healthcare representative. Pick someone you trust who understands your values and name a backup in case your first choice is unavailable.
2. Talk with the people involved. Tell your representative, family, and physician what you want. Documents work best when the people around you already know your wishes.
3. Sign correctly. Use two qualifying adult witnesses (at least one unrelated) or a notary, and follow the witness-eligibility rules—especially for a living will.
4. Consider a living will or life-prolonging procedures declaration to record your end-of-life preferences, and discuss a POST form with your provider if you are seriously ill.
5. Give copies to the right people. Provide your directive to your representative, your primary physician, and your local hospital, and ask that it be added to your medical record.
6. Keep it current. Review your documents after major life or health changes, and remember that a newer directive generally replaces older ones.