GSC Advance Health Care Planning Documents.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 1
HOUSE BILL 1115

Short Title: GSC Advance Health Care Planning Documents. (Public)
Sponsors: Representative Davis.
For a complete list of sponsors, refer to the North Carolina General Assembly web site.
Referred to: Judiciary 1, if favorable, Rules, Calendar, and Operations of the House
April 30, 2026
*H1115-v-1*
A BILL TO BE ENTITLED 1
AN ACT TO MODIFY THE GENERAL STATUTES RE GARDING HEALTH CARE 2
POWERS OF ATTORNEY, ADVANCE HEALTH CARE DIRECTIVES, AND 3
ADVANCE INSTRUCTIONS FOR MENTAL HEALTH T REATMENT BASED, IN 4
PART, ON PROPOSALS I N THE UNIFORM HEALTH -CARE DECISIONS ACT, AS 5
RECOMMENDED BY THE GENERAL STATUTES COMMISSION. 6
The General Assembly of North Carolina enacts: 7
8
PART I. FINDINGS 9
SECTION 1. The General Statutes Commission, pursuant to its charge under 10
G.S. 164-13, finds that the adoption of certain proposals in the 2023 Uniform Health -Care 11
Decisions Act would improve the laws of this State. Among these proposals is simplifying 12
execution requirements for health care powers of attorney, advance health care directives ("living 13
wills"), and advance instructions for mental health treatment. 14
The Commission further finds that House Bill 349, 2025 Regular Session, would 15
simplify execution requirements for health care powers of attorney and advance health care 16
directives ("living wills"), two of the three documents for whi ch the General Statutes 17
Commission recommends simplifying execution requirements. In addition to making technical 18
corrections, this act in its entirety provides for all recommendations of the General Statutes 19
Commission resulting from its consideration of the 2023 Uniform Health -Care Decisions Act. 20
Parts II and III of this act would ensure the enactment of all of the Commission's 21
recommendations if House Bill 349 does or does not become law. 22
23
PART I-A. EXPLAIN TH E RELATIONSHIP BETWE EN A HEALTH CARE POW ER 24
OF ATTORNEY AND OTHER ADVANCE HEALTH CARE PLANNING DOCUMENTS 25
SECTION 1A.(a) G.S. 32A-15 reads as rewritten: 26
"§ 32A-15. General purpose of this Article. 27
… 28
(c) This Article is intended and shall be construed to be consistent with the provisions of 29
Article 23 (Advance Directive For A Natural Death ("Living Will")) of Chapter 90 of the General 30
Statutes provided that in Statutes. In the event of a conflict between the provisions of this Article 31
and Article 23 of Chapter 90, 90 of the General Statutes, the provisions of Article 23 of Chapter 32
90 of the General Statutes control. No conflict between these Chapters exists when either a health 33
care power of attorney or a declaration provides that the declaration is subject to decisions of a 34
health care agent. If no declaration has been executed by the principal as provided in G.S. 90-321 35
General Assembly Of North Carolina Session 2025
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that expressly covers the principal's present condition and if the health care agent has been given 1
the specific authority in a health care power of attorney to authorize the withholding or 2
discontinuing of life -prolonging measures when the principal is in such that condition, the 3
measures may be withheld or discontinued as provided in the health care power of attorney upon 4
the direction and under the supervision of the attending physician, as G.S. 90-322 shall does not 5
apply in such this case. Nothing in this Article shall be construed to authorize authorizes any 6
affirmative or deliberate act or omission to end life other than to permit the natural process of 7
dying. 8
(d) This Article is intended and shall be construed to be consistent with the provisions of 9
Part 3A (Revised Uniform Anatomical Gift Act) of Article 16 of Chapter 130A of the General 10
Statutes. In the event of a conflict between the provisions of this Article a nd Part 3A of Article 11
16 of Chapter 130A, the provisions of Part 3A of Article 16 of Chapter 130A of the General 12
Statutes control." 13
SECTION 1A.(b) Article 3 of Chapter 32A of the General Statutes is amended by 14
adding a new section to read: 15
"§ 32A-15.1. Combining health care planning documents. 16
(a) A health care power of attorney may be combined with any other advance health care 17
planning document, such as: 18
(1) An advance directive for a natural death ( "living will") prepared pursuant to 19
Article 23 of Chapter 90 of the General Statutes. 20
(2) An advance instruction for mental health treatment prepared pursuant to Part 21
2 of Article 3 of Chapter 122C of the General Statutes. 22
(b) A health care power of attorney that is combined with other advance health care 23
planning documents shall be clearly titled as combined, and each type of advance health care 24
planning document within it shall also be individually titled." 25
SECTION 1A.(c) G.S. 32A-16(1), (1a), (7), and (8) are recodified as 26
G.S. 32A-16(1d), (1f), (1), and (4b), respectively. 27
SECTION 1A.(d) G.S. 32A-16, as amended by Section 1A(c) of this act, reads as 28
rewritten: 29
"§ 32A-16. Definitions. 30
The following definitions apply in this Article: 31
(1) Advance instruction for mental health treatment or advance instruction. – As 32
defined in G.S. 122C-72(1).Defined in G.S. 122C-72. 33
(1a) Recodified. 34
(1b) Reserved. 35
(1c) Reserved. 36
(1d) Disposition of remains. – The decision to bury or cremate human remains, as 37
human remains are defined in G.S. 90-210.121, and, subject to 38
G.S. 32A-19(b), arrangements relating to burial or cremation. 39
(1e) Reserved. 40
(1f) Health care. – Any care, treatment, service, or procedure to maintain, 41
diagnose, treat, or provide for the prin cipal's physical or mental health or 42
personal care and comfort comfort, including life -prolonging measures. 43
"Health care" The term includes mental health treatment as defined in 44
subdivision (8) of this section. 45
(2) Health care agent. – The person appointed as a health care attorney-in-fact. 46
(3) Health care power of attorney. – Except as provided in G.S. 32A-16.1, a 47
written instrument that substantially meets the requirements of this Article, 48
that is signed in the presence of two qualified witnesses, and ack nowledged 49
before a notary public, pursuant to which and that appoints an attorney-in-fact 50
or agent is appointed to act for the principal in matters relating to the health 51
General Assembly Of North Carolina Session 2025
House Bill 1115-First Edition Page 3
care of the principal. The notary who takes the acknowledgement may but is 1
not required to be a paid employee of the attending physician or mental health 2
treatment provider, a paid employee of a health facility in which the principal 3
is a patient, or a paid employee of a nursing home or any adult care home in 4
which the principal resides. 5
(4) Life-prolonging measures. – Medical procedures or interventions which that, 6
in the judgment of the attending physician physician, would serve only to 7
postpone artificially the moment of death by sustaining, restoring, or 8
supplanting a vital function, in cluding mechanical ventilation, dialysis, 9
antibiotics, artificial nutrition and hydration, and similar forms of treatment. 10
Life-prolonging measures do not include care necessary to provide comfort or 11
to alleviate pain. 12
(4a) Reserved. 13
(4b) Mental health tre atment. – The process of providing for the physical, 14
emotional, psychological, and social needs of the principal for the principal's 15
mental illness. "Mental health treatment" The term includes electroconvulsive 16
treatment, treatment of mental illness with psychotropic medication, and 17
admission to and retention in a facility for care or treatment of mental illness. 18
(4c) Reserved. 19
(4d) Present condition. – The condition of the principal when a physician seeks 20
informed consent to withhold or discontinue life-prolonging measures for the 21
principal. 22
(5) Principal. – The person making the health care power of attorney. 23
(6) Qualified witness. – Except as provided in G.S. 32A-16.1, a witness in whose 24
presence the principal has executed the health care power of attor ney, who 25
believes the principal to be of sound mind, and who states that he or she (i) is 26
not related within the third degree to the principal nor to the principal's spouse, 27
by blood, marriage, or adoption, (ii) does not know nor have a reasonable 28
expectation that he or she would be entitled to any portion of the estate of the 29
principal upon the principal's death under any existing will or codicil of the 30
principal or under the Intestate Succession Act as it then provides, Act, 31
Chapter 29 of the General Statutes, (iii) is not the attending physician or 32
mental health treatment provider of the principal, nor a licensed health care 33
provider who is a paid employee of the attending physician or mental health 34
treatment provider, nor a paid employee of a health facility in which the 35
principal is a patient, nor or a paid employee of a nursing home or any adult 36
care home in which the principal resides, and (iv) does not have a claim 37
against any portion of the estate of the principal a t the time of the principal's 38
execution of the health care power of attorney. 39
(7) Recodified. 40
(8) Recodified." 41
SECTION 1A.(e) G.S. 32A-19 reads as rewritten: 42
"§ 32A-19. Extent of authority; limitations of authority. 43
… 44
(a1) A health care power of attorney may incorporate or be combined with an advance 45
instruction for mental health treatment prepared pursuant to Part 2 of Article 3 of Chapter 122C 46
of the General Statutes. A health care agent's decisions about mental health treatment shall be 47
consistent with any statements the principal has expressed in an advance instruction for mental 48
health treatment under Part 2 of Ar ticle 3 of Chapter 122C of the General Statutes, if one so 49
exists, and if none exists, shall be consistent with what the agent believes in good faith to be the 50
manner in which the principal would act if the principal did not lack capacity to make or 51
General Assembly Of North Carolina Session 2025
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communicate health care decisions. A health care agent is not subject to criminal prosecution, 1
civil liability, or professional disciplinary action for any action taken in good faith pursuant to an 2
advance instruction for mental health treatment. 3
(b) A health care power of attorney may authorize the health care agent to exercise any 4
and all rights the principal may have with respect to anatomical gi fts, the authorization of any 5
autopsy, and the disposition of remains; provided this remains, so long as this authority is limited 6
to incurring reasonable costs related to exercising these powers, and a health care power of 7
attorney does not give the health care agent general authority over a principal's property or 8
financial affairs.powers. 9
(c) A health care power of attorney may contain, and the authority of the health care agent 10
shall be is subject to, the specific limitations or restrictions as the principal deems appropriate. 11
(d) The powers and authority granted to the health care agent pursuant to a health care 12
power of attorney shall be are limited to the matters addressed in it, and, except as necessary to 13
exercise such those powers and authority relating to health care, shall do not confer any power 14
or authority with respect to the property or financial affairs of the principal. 15
(e) This Article shall not be construed to does not invalidate a power of attorney that 16
authorizes an agent to make health care decisions for the principal, which principal that was 17
executed prior to October 1, 1991. 18
…." 19
SECTION 1A.(f) G.S. 32A-25.1 reads as rewritten: 20
"§ 32A-25.1. Statutory form health care power of attorney. 21
(a) The use of the following form in the creation of a health care power of attorney is 22
lawful and, when used, it shall meet meets the requirements of and be construed in accordance 23
with the provisions of this Article: 24
25
HEALTH CARE POWER OF ATTORNEY 26
… 27
1. Designation of Health Care Agent. 28
29
I, __________________, being of sound mind, hereby appoint the following person(s) to serve 30
as my health care agent(s) to act for me and in my name (in any way I could act in person) to 31
make health care decisions for me as authorized in this document. My designated health care 32
agent(s) shall serve alone, in the order named. 33
… 34
Any successor health care agent designated shall be vested with the same power and duties as if 35
originally named as my health care agent, agent and shall serve any time his or her predecessor 36
is not reasonably available or is unwilling or unable to serve in that capacity. 37
38
2. Effectiveness of Appointment. 39
40
My designation of a health care agent expires only when I revoke it. Absent revocation, the 41
authority granted in this document shall become becomes effective when and if one of the 42
physician(s) listed below determines that I lack capacity to make or commun icate decisions 43
relating to my health care, care and will continue in effect during that incapacity, incapacity or 44
until my death, except death; however, if I authorize my health care agent to exercise my rights 45
with respect to anatomical gifts, autopsy, o r disposition of my remains, this authority will 46
continue after my death to the extent necessary to exercise that authority. 47
… 48
4. General Statement of Authority Granted. 49
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General Assembly Of North Carolina Session 2025
House Bill 1115-First Edition Page 5
Subject to any restrictions set forth in Section 5 below, I grant to my health care agent full power 1
and authority to make and carry out all health care decisions for me. These decisions include, but 2
are not limited to: 3
4
A. Requesting, reviewing, and receiving any information, verbal or written, 5
regarding my physical or mental health, including, but not limited to, medical 6
and hospital records, and to consent consenting to the disclosure of this 7
information. 8
… 9
F. Giving consent for, withdrawing consent for, or withholding consent for, for 10
X-ray, anesthesia, medication, surgery, and all other diagnostic and treatment 11
procedures ordered by or under the authorization of a licensed physician, 12
dentist, podiatrist, or other health care provider. This authorization 13
specifically includes the power to consent to measures for relief of pain. 14
15
G. Authorizing the withholding or withdrawal of life-prolonging measures. 16
17
H. Providing my medical information at the request of any individual acting as 18
my attorney -in-fact under a durable power of attorney or as a Trustee or 19
successor Trustee under any Trus t Agreement of which I am a Grantor or 20
Trustee, or at the request of any other individual whom my health care agent 21
believes should have such this information. I desire that such this information 22
be provided whenever it would expedite the prompt and proper handling of 23
my affairs or the affairs of any person or entity for which I have some 24
responsibility. In addition, I authorize my health care agent to take any and all 25
legal steps necessary to ensure compliance with my instructions providing 26
access to my pr otected health information. Such These steps shall include 27
resorting to any and all legal procedures in and out of courts as may be 28
necessary to enforce my rights under the law and shall include attempting to 29
recover attorneys' fees against anyone who that does not comply with this 30
health care power of attorney. 31
… 32
J. Taking any lawful actions that may be necessary to carry out these decisions, 33
including, but not limited to: (i) signing, executing, delivering, and 34
acknowledging any agreement, release, authorization, or other document that 35
may be necessary, desirable, convenient, or proper in order to exercise and 36
carry out any of these powers; (ii) granting releases of liability to medical 37
providers or others; and (iii) incurring reasonable costs on my behalf related 38
to exercising these powers, provided that this powers. This health care power 39
of attorney shall not attorney, however, does not give my health care agent 40
general authority over my property or financial affairs. 41
42
5. Special Provisions and Limitations. 43
… 44
______________ B. Limitations Concerning Health Care Decisions. In exercising 45
(Initial) the authority to make health care decisions on my behalf, the 46
authority of my health care agent is subject to the following 47
special provisions : (Here you may include any specific 48
provisions you deem appropriate such as: your own definition 49
of when life -prolonging measures should be withheld or 50
discontinued, or instructions to refuse any specific types of 51
General Assembly Of North Carolina Session 2025
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treatment that are inconsistent with your religious beliefs, beliefs or 1
are unacceptable to you for any other reason.) 2
__________________________________________________ 3
__________________________________________________ 4
NOTE: DO NOT initial unless you insert a limitation. 5
… 6
8. Reliance of Third Parties on Health Care Agent. 7
8
A. No person who relies in good faith upon the authority of or any representations 9
by my health care agent shall be is liable to me, my estate, my heirs, 10
successors, assigns, or personal representatives, representatives for actions or 11
omissions in reliance on that authority or those representations. 12
B. The powers conferred on my health care agent by this document may be 13
exercised by my health care agent alone, and my health care agent's signature 14
or action taken under the authority granted in this document may be accepted 15
by persons as fully authorized by me and with the same force and effect as if 16
I were personally present, competent, and acting on my own behalf. All acts 17
performed in good faith by my he alth care agent pursuant to this power of 18
attorney are done with my consent and shall have the same validity and effect 19
as if I were present and exercised the powers myself, myself and shall inure 20
to the benefit of and bind me, my estate, my heirs, successors, assigns, and 21
personal representatives. The authority of my health care agent pursuant to 22
this power of attorney shall be is superior to and binding upon my family, 23
relatives, friends, and others. 24
25
9. Miscellaneous Provisions. 26
27
A. Revocation of Prior Powers of Attorney. I revoke any prior health care power 28
of attorney. The preceding sentence is not intended to revoke any general 29
powers of attorney, some of the provisions of which may relate to health care; 30
however, this power of attorney shall take takes precedence over any health 31
care provisions in any valid general power of attorney I have not revoked. 32
33
B. Jurisdiction, Severability, and Durability. This Health Care Power of Attorney 34
is intended to be valid in any jurisdiction in which it is presented. The powers 35
delegated under this power of attorney are severable, severable so that the 36
invalidity of one or more powers shall does not affect any others. This power 37
of attorney shall will not be affected or revoked by my incapacity or mental 38
incompetence. 39
… 40
D. No Civil or Criminal Liability. No act or omission of my health care agent, or 41
of any other person, en tity, institution, or facility acting in good faith in 42
reliance on the authority of my health care agent pursuant to this Health Care 43
Power of Attorney shall be considered suicide, nor the cause of my death for 44
any civil or criminal purposes, nor shall it be considered unprofessional 45
conduct or as lack of professional competence. Any person, entity, institution, 46
or facility against whom which criminal or civil liability is asserted because 47
of conduct authorized by this Health Care Power of Attorney may inte rpose 48
this document as a defense. 49
50
General Assembly Of North Carolina Session 2025
House Bill 1115-First Edition Page 7
E. Reimbursement. My health care agent shall be is entitled to reimbursement 1
for all reasonable expenses incurred as a result of carrying out any provision 2
of this directive. 3
… 4
I hereby state that the principal, _______________, being of sound mind, signed (or directed 5
another to sign on the principal's behalf) the foregoing health care power of attorney in my 6
presence, and that I am not related to the principal by blood or marri age, blood, marriage, or 7
adoption, and I would not be entitled to any portion of the estate of the principal under any 8
existing will or codicil of the principal or as an heir under the Intestate Succession Act, Chapter 9
29 of the General Statutes, if the principal died on this date without a will. I also state that I am 10
not the principal's attending physician, nor physician or mental health treatment provider and that 11
I am not a licensed health care provider or mental health treatment provider who is (1) an 12
employee of the principal's attending physician or mental health treatment provider, (2) an 13
employee of the health facility in which the principal is a patient, or (3) an employee of a nursing 14
home or any adult care home where the principal resides. I furt her state that I do not have any 15
claim against the principal or the estate of the principal. 16
…." 17
SECTION 1A.(g) G.S. 32A-26 is repealed. 18
19
PART I-B. EXPLAIN TH E RELATIONSHIP BETWE EN AN ADVANCE DIRECT IVE 20
("LIVING WILL") AND OTHER ADVANCE HEALTH CARE PLANNIN G 21
DOCUMENTS; UPDATE TH E LIST OF INDIVIDUAL S WHO CAN PROVIDE 22
CONSENT ON BEHALF OF A PATIENT WHO LACKS CAPACITY AND HAS NO 23
LIVING WILL IN PLACE 24
SECTION 1B.(a) The title of Article 23 of Chapter 90 of the General Statutes reads 25
as rewritten: 26
"Article 23. 27
"Right to Natural Death; Brain Death.Advance Directive For A Natural Death ("Living Will")." 28
SECTION 1B.(b) G.S. 90-320 reads as rewritten: 29
"§ 90-320. General purpose of Article. 30
(a) The General Assembly recognizes as a matter of public policy that an indiv idual's 31
rights include the right to a peaceful and natural death and that a patient or the patient's 32
representative has the fundamental right to control the decisions relating to the rendering of the 33
patient's own medical care, including the decision to ha ve life-prolonging measures withheld or 34
withdrawn in instances of a terminal condition. This The purpose of this Article is to establish an 35
optional and nonexclusive procedure by which a patient or the patient's representative may 36
exercise these rights. A military advanced medical directive executed in accordance with 10 37
U.S.C. § 1044 or other applicable law is valid in this State. 38
(b) Nothing in this Article shall be construed to authorize authorizes any affirmative or 39
deliberate act or omission to end life other than to permit the natural process of dying. Nothing 40
in this Article shall impair or supersede impairs or supersedes any legal right or legal 41
responsibility which any a person may have to effe ct the withholding or withdrawal of 42
life-prolonging measures in any lawful manner. In such respect the provisions of this Article are 43
cumulative." 44
SECTION 1B.(c) Article 23 of Chapter 90 of the General Statutes is amended by 45
adding a new section to read: 46
"§ 90-320.1. Combining health care planning documents. 47
(a) An advance directive under this Article may be combined with any other advance 48
health care planning document, such as: 49
(1) A health care power of attorney prepared pursuant to Article 3 of Chapter 32A 50
of the General Statutes. 51
General Assembly Of North Carolina Session 2025
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(2) An advance instruction for mental health treatment prepared pursuant to Part 1
2 of Article 3 of Chapter 122C of the General Statutes. 2
(b) An advance directive for a natural death ( "living will") that is combined with other 3
advance health care planning documents shall be clearly titled as combined, and each type of 4
advance health care planning document within it shall also be individually titled." 5
SECTION 1B.(d) G.S. 90-321 reads as rewritten: 6
"§ 90-321. Right to a natural death. 7
(a) The following definitions apply in this Article: 8
… 9
(2a) Life-prolonging measures. – As defined in G.S. 32A-16(4).Defined in 10
G.S. 32A-16. 11
(3) Physician. – Any person licensed to practice medicine under Article 1 of 12
Chapter 90 of the laws of the State of North Carolina.General Statutes. 13
(3a) Present condition. – The condition of the principal when a physician seeks 14
informed consent to withhold or discontinue life-prolonging measures for the 15
principal. 16
(4) Repealed by Session Laws 2007-502, s. 11(a), effective October 1, 2007. 17
(b) If a person has expressed through a declaration, in accordance with subsection (c) of 18
this section, a desire that the person's life not be prolonged by life-prolonging measures, and the 19
declaration has not been revoked in accordance with subsection (e) of this section; andsection, 20
then the life -prolonging measures identified by the declarant shall or may, as specified by the 21
declarant, be withheld or discontinued at the direction and under the supervision of the attending 22
physician when both of the following apply: 23
(1) It is determined by the att ending physician that the declarant's present 24
condition is a condition described in subsection (c) of this section and 25
specified in the declaration for applying the declarant's directives, 26
anddirectives. 27
(2) There is confirmation of the declarant's present condition as set out in 28
subdivision (b)(1) of this section by a physician other than the attending 29
physician;physician. 30
then the life-prolonging measures identified by the declarant shall or may, as specified by the 31
declarant, be withheld or discontinued upon the direction and under the supervision of the 32
attending physician. 33
(c) The attending physician shall follow, subject to subsections (b), (e), and (k) of this 34
section, a declaration:declaration to which all of the following apply: 35
(1) That It expresses a desire of the declarant that life -prolonging measures not 36
be used to prolong the declarant's life if, as specified in the declaration as to 37
any or all in the event of one or more of the following: 38
a. The declarant has an incurable or irreversible condition that will result 39
in the declarant's death within a relatively short period of time; ortime. 40
b. The declarant becomes unconscious and, to a high degree of medical 41
certainty, will never regain consciousness; orconsciousness. 42
… 43
(2) That It states that the declarant is aware that the declaration authorizes a 44
physician to withhold or discontinue the life -prolonging measures; 45
andmeasures. 46
(3) Except as provided in G.S. 90-321.1, that it has been signed by the declarant 47
in the presence of two witnesses who believe the declarant to be of sound mind 48
and who state that they (i) are not related within the third degree to the 49
declarant or to the declarant's spouse, by blood, marriage, or adoption, (ii) do 50
not know or have a reasonable expectation that they would be entitled to any 51
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portion of the estate of the declarant upon the declarant's death under any will 1
of the declarant or codicil thereto to any will then existing or under the 2
Intestate Succession Act as it then provides, Act, Chapter 29 of the General 3
Statutes, (iii) are not the attending physician, licensed health care providers 4
who are paid employees of the attending physician, paid employees of a health 5
facility in which the declarant is a patient, or paid employees of a nursing 6
home or any adult care home in which the declarant resides, and (iv) do not 7
have a claim against any portion of the estate of the declarant at the time of 8
the declaration; anddeclaration. 9
(4) That It has been proved before a clerk or assistant clerk of superior court, or a 10
notary public who certifies substantially as set out in subsection (d1) of this 11
section. A notary who takes the acknowledgement may but is not required to 12
be a paid employee of the attending physician, a paid employee of a healt h 13
facility in which the declarant is a patient, or a paid employee of a nursing 14
home or any adult care home in which the declarant resides. 15
(d) Repealed by Session Laws 2007-502, s. 11(b), effective October 1, 2007. 16
(d1) The following form is specifically determined to meet meets the requirements of 17
subsection (c) of this section: 18
19
ADVANCE DIRECTIVE FOR A NATURAL DEATH ("LIVING WILL") 20
… 21
If you want to use this form, you must complete it, sign it, and have your signature witnessed by 22
two qualified witnesses and proved by a notary public. Follow the instructions about which 23
choices you can initial very carefully. Do not sign this form unti l two witnesses and a notary 24
public are present to watch you sign it. You then should consider giving a copy to your primary 25
physician and/or and a trusted relative, and should consider filing it with the Advanced Health 26
Care Directive Registry maintained by the North Carolina Secretary of State: 27
http://www.nclifelinks.org/ahcdr/ 28
… 29
1. When My Directives Apply 30
… 31
_________ I suffer from advanced dementia or any other condition 32
(Initial) which that results in the substantial loss of my cognitive ability 33
and my health care providers determine that, to a high 34
degree of medical certainty, this loss is not reversible. 35
… 36
7. My Health Care Providers May Rely on this Directive 37
38
My health care providers shall are not be liable to me or to my family, my estate, my 39
heirs, or my personal representative for following the instructions I give in this 40
instrument. Following my directions shall not be considered suicide, or the cause of my 41
death, or malpractice or unprofessional conduct. If I have revoked this instrument but my 42
health care providers do not know that I have done so, and they follow the instructions in 43
this instrument in good faith, they shall be are entitled to the same protections to which 44
they would have been entitled if the instrument had not been revoked. 45
46
8. I Want this Directive to be Effective Anywhere 47
48
I intend that this Advance Directive be followed by any health care provider in any place. 49
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I hereby state that the declarant, ______________________, being of sound mind, signed (or 1
directed another to sign on declarant's behalf) the foregoing Advance Directive for a Natural 2
Death in my presence, and that I am not related to the declarant by blood or marriage, blood, 3
marriage, or adoption, and I would not be entitled to any portion of the estate of the declarant 4
under any existing will or codicil of the declarant or as an heir under the Intestate Succession 5
Act, Chapter 29 of the General Statutes, if the declarant died on this date without a will. I also 6
state that I am not the declarant's attending physician, nor physician or a licensed health care 7
provider who is (1) an employee of the declarant's attending physician, (2) nor an employee of 8
the health facility in which the declarant is a pa tient, or (3) an employee of a nursing home or 9
any adult care home where the declarant resides. I further state that I do not have any claim 10
against the declarant or the estate of the declarant. 11
… 12
(e) A declaration may be revoked by the declarant, in writing or in any manner by which 13
the declarant is able to communicate the declarant's intent to revoke in a clear and consistent 14
manner, without regard to the declarant's mental or physical condition. A health care provider 15
shall have has no liability for acting in accordance with a revoked declaration unless the provider 16
has actual notice of the revocation. A health care agent may not is not authorized to revoke a 17
declaration unless the health care power of attorney explicitly authorizes that revocation; 18
however, a health care agent may exercise any authority explicitly given to the health care agent 19
in a declaration. A guardian of the person of the declara nt or general guardian may not is not 20
authorized to revoke a declaration. 21
(f) The execution and consummation of declarations made in accordance with subsection 22
(c) shall of this section does not for any purpose constitute suicide for any purpose.suicide. 23
(g) No person shall be required to sign a declaration in accordance with subsection (c) of 24
this section as a condition for becoming insured under any insurance contract or for receiving 25
any medical treatment. 26
(h) The withholding or discontinuance of life pr olonging measures in accordance with 27
this section shall not be considered the cause of death for any civil or criminal purposes nor shall 28
it be considered unprofessional conduct or a lack of professional competence. Any person, 29
institution or institution, or facility against whom which criminal or civil liability is asserted 30
because of conduct in compliance with this section may interpose this section as a defense. The 31
protections of this section extend to any valid declaration, including a docume nt valid under 32
subsection (l) of this section; these section. These protections are not limited to declarations 33
prepared in accordance with the statutory form provided in subsection (d1) of this section, section 34
or to declarations filed with the Advance He alth Care Directive Registry maintained by the 35
Secretary of State. A health care provider may rely in good faith on an oral or written statement 36
by legal counsel that a document appears to meet the statutory requirements for a declaration. 37
… 38
(j) The form provided by this section may be combined with or incorporated into a health 39
care power of attorney form meeting the requirements of Article 3 of Chapter 32A of the General 40
Statutes; provided, however, that the resulting form shall be signed, witnessed, and proved in 41
accordance with the provisions of this section. 42
(k) Notwithstanding subsection (c) of this section:section, the following apply: 43
(1) An attending physician may decline to honor a declaration that expresses a 44
desire of the declarant that life -prolonging measures not be used if doing so 45
would violate that physician's conscience or the conscience -based policy of 46
the facility at which the declarant is being treated; provided, an treated. An 47
attending physician who declines to honor a declaration on these grounds must 48
shall not interfere, interfere and must shall reasonably cooperate reasonably, 49
with efforts to either substitute an attending physician whose conscience 50
would not be violated by honoring the declaration, declaration or transfer the 51
General Assembly Of North Carolina Session 2025
House Bill 1115-First Edition Page 11
declarant to a facility that does not have policies in force that prohibit honoring 1
the declaration. 2
(2) An attending physician may decline to honor a declaration if if, after 3
reasonable inquiry inquiry, there are reasonable grounds to question the 4
genuineness or validity of a declaration. The subsection This subdivision 5
imposes no duty on the attending physician to verify a declaration's 6
genuineness or validity. 7
(l) Notwithstanding subsection (c) of this section, a declaration or similar document 8
executed in a jurisdiction other than North Carolina shall be is valid in this State if it appears to 9
have been executed in accordance with the applicable requirements of that jurisdiction or this 10
State." 11
SECTION 1B.(e) G.S. 90-322 reads as rewritten: 12
"§ 90-322. Procedures for natural death in the absence of a declaration. 13
(a) If the attending physician determines, determines to a high degree of medical 14
certainty, certainty that a person lacks capacity to make or communicate health care decisions 15
and the person will never regain that capacity, and:then life-prolonging measures may be 16
withheld or discontinued in accordance with subsection (b) of this section when all of the 17
following apply: 18
(1) Repealed by Session Laws 2007-502, s. 12, effective October 1, 2007. 19
(1a) That the person: 20
a. Has Either the person has an incurable or irreversible condition that 21
will result in the person's death within a relatively short period of time; 22
or 23
b. Is time or the person is unconscious and, to a high degree of medical 24
certainty, will never regain consciousness; andconsciousness. 25
(2) There is confirmation of the person's present condition as set out above in this 26
subdivisions (1a) and (3) of this subsection, in writing by a physician other 27
than the attending physician; andphysician. 28
(3) A vital bodily function of the person could be restored or is being sustained 29
by life-prolonging measures;measures. 30
(4) Repealed by Session Laws 2007-502, s. 12, effective October 1, 2007. 31
then, life-prolonging measures may be withheld or discontinued in accordance with subsection 32
(b) of this section. 33
(b) If a person's patient's condition has been determined to meet the conditions set forth 34
in subsection (a) of this section and no instrument has been executed as provided in G.S. 90-321, 35
then life-prolonging measures may be withheld or discontinued upon the direction and under the 36
supervision of the attending physician with the concurrence of the following persons, with 37
priority in the order indicated: 38
(1) A guardian of the patient's person, or a general guardian with powers over the 39
patient's person, appointed by a court of competent jurisdiction pursuant to 40
Article 5 of Chapter 35A of the General Statutes; provided th at, if Statutes. 41
However, if the patient has a health care agent appointed pursuant to a valid 42
health care power of attorney, the health care agent shall have has the right to 43
exercise the authority to the extent granted in the health care power of attorney 44
and to the extent provided in G.S. 32A-19(b) G.S. 32A-19(a), unless the Clerk 45
clerk of superior court has suspended the authority of that health care agent in 46
accordance with G.S. 35A-1208(a). 47
(2) A health care agent appointed pursuant to a valid health care power of 48
attorney, to the extent of the authority granted. 49
(3) An agent, with powers to make health care decisions for the patient, appointed 50
by the patient, to the extent of the authority granted. 51
General Assembly Of North Carolina Session 2025
Page 12 House Bill 1115-First Edition
(4) The patient's spouse. 1
(5) A majority of the patient's reasonably available parents and children who are 2
at least 18 years of age. 3
(5a) An individual who has an established relationship with the patient, who is 4
acting in good faith on behalf of the patient, who can reliably convey the 5
patient's wishes, and who has been living with the patient for at least one year. 6
(6) A majority of the patient's reasonably available siblings who are at least 18 7
years of age. 8
(6a) A majority of the patient's reasonably available grandparents or grandchildren 9
who are at least 18 years of age. 10
(6b) An individual not listed in this subsection who is acting in good faith on behalf 11
of the patient and who has assisted the patient with supported decision making 12
routinely during the preceding six months. As used in this subdivision, 13
"supported decision making" means assistance that is provided by one or more 14
individuals of the patient 's choosing and that helps the patient make or 15
communicate a decision, including by helping the patient understand the 16
nature and consequences of the decision. 17
(6c) A majority of the patient 's reasonably available stepchildren who are at least 18
18 years of age, whom the patient actively parented during their minor years, 19
and with whom the patient has an ongoing relationship. 20
(7) An individual not otherwise listed in this subsection who has an established 21
relationship with the patient, who is acting in good faith on behalf of the 22
patient, and who can reliably convey the patient's wishes. 23
If none of the above is reasonably available then available, then, at the discretion of the 24
attending physician physician, the life-prolonging measures may be withheld or discontinued 25
upon the direction and under the supervision of the attending physician. 26
(c) Repealed by Session Laws 1979, c. 715, s. 2. 27
(c1) In order to establish the authority of a person listed in subsection (b) of this section, 28
the attending physician may req uest and rely upon a statement from the person affirming the 29
person's status under subsection (b) of this section. A physician may accept the concurrence of a 30
person having lower priority under subsection (b) of this section only if a person having higher 31
priority is not reasonably available. 32
(d) The withholding or discontinuance of such life-prolonging measures pursuant to this 33
section shall not be considered the cause of death for any civil or criminal purpose nor shall it be 34
considered unprofessional conduct. Any person, institution or facility against whom which 35
criminal or civil liability is asserted because of conduct in compliance with this section may 36
interpose this section as a defense." 37
38
PART I -C. SIMPLIFY E XECUTION REQUIREMENT S FOR AN ADVANCE 39
INSTRUCTION FOR MENT AL HEALTH TREATMENT AND EXPLAIN ITS 40
RELATIONSHIP TO OTHER ADVANCE HEALTH CARE PLANNING DOCUMENTS 41
SECTION 1C.(a) G.S. 122C-71 reads as rewritten: 42
"§ 122C-71. Purpose. 43
… 44
(c) This Part is intended and shall be construed to be consistent with the provisions of 45
Article 3 (Health Care Powers of Attorney) of Chapter 32A of the General Statutes, provided that 46
in Statutes. In the event of a conflict between the provisions of this Part and Article 3 of Chapter 47
32A, 32A of the General Statutes, the provisions of this Part control." 48
SECTION 1C.(b) Part 2 of Article 3 of Chapter 122C of the General Statutes is 49
amended by adding a new section to read: 50
"§ 122C-71.1. Combining advance planning documents. 51
General Assembly Of North Carolina Session 2025
House Bill 1115-First Edition Page 13
(a) An advance instruction for mental health treatment may be combined with a general 1
power of attorney prepared pursuant to Chapter 32C of the General Statutes or any other advance 2
health care planning document, such as: 3
(1) A health care power of attorney prepared pursuant to Article 3 of Chapter 32A 4
of the General Statutes. 5
(2) An advance directive for a natural death ( "living will") prepared pursuant to 6
Article 23 of Chapter 90 of the General Statutes. 7
(b) An advance instruction for mental health treatment that is combined with other 8
advance health care planning documents shall be clearly titled as combined, and each type of 9
advance health care planning document within it shall also be individually titled." 10
SECTION 1C.(c) G.S. 122C-72 reads as rewritten: 11
"§ 122C-72. Definitions. 12
As used in this Part, unless the context clearly requires o therwise, the following terms have 13
the meanings specified: 14
(1) "Advance instruction for mental health treatment" or "advance instruction" 15
means a Advance instruction for mental health treatment or advance 16
instruction. – A written instrument, instrument that is either signed in the 17
presence of two qualified witnesses who believe the principal to be of sound 18
mind at the time of the signing, and signing or acknowledged before a notary 19
public, pursuant to which the principal makes a declaration of instructions, 20
information, and preferences regarding the principal's mental health treatment 21
and states that the principal is aware that the advance instruction authorizes a 22
mental health treatment provider to act according to the instruction. It may 23
also state the principal's instructions regarding, but not limited to, consent to 24
or refusal of mental health treatment when the principal is incapable. 25
(2) "Attending physician" means the Attending physician. – The physician who 26
has primary responsibility for the care and treatment of the principal. 27
(3) Repealed by Session Laws 1998-198, s. 2. 28
(4) "Incapable" means that, in Incapable. – In the opinion of a physician or 29
eligible psychologist, the person currently person, at the time a mental health 30
treatment decision is being made, lacks sufficient understanding or capacity 31
to make and communicate mental health treatment decisions. As used in this 32
Part, the term "eligible psychologist" has the meaning given in 33
G.S. 122C-3(13d). 34
(5) "Mental health treatment" means the Mental health treatment. – The process 35
of providing for the physical, emotional, psychological, and social needs of 36
the principal for the principal's mental illness. "Mental health treatment" The 37
term includes, but is no t limited to, electroconvulsive treatment (ECT), 38
commonly referred to as "shock treatment", treatment," treatment of mental 39
illness with psychotropic medication, and admission to and retention in a 40
facility for care or treatment of mental illness. 41
(6) "Principal" means the Principal. – The person making the advance instruction. 42
(7) "Qualified witness" means a Qualified witness. – A witness who affirms that 43
the principal is personally known to the witness, that the principal signed or 44
acknowledged the princi pal's signature on the advance instruction in the 45
presence of the witness, that the witness believes the principal to be of sound 46
mind and not to be under duress, fraud, or undue influence, and that the 47
witness is not:not any of the following: 48
a. The attending physician or physician, mental health service provider 49
provider, or an employee of the physician or mental health treatment 50
provider;service provider. 51
General Assembly Of North Carolina Session 2025
Page 14 House Bill 1115-First Edition
b. An owner, operator, or an employee of an owner or operator of a health 1
care facility in which the principal is a patient or resident; orresident. 2
c. Related within the third degree to the principal or to the principal's 3
spouse.by blood, marriage, or adoption. 4
d. A person appointed as an attorney-in-fact by this document." 5
SECTION 1C.(d) G.S. 122C-73 reads as rewritten: 6
"§ 122C-73. Scope, use, and authority of advance instruction for mental health treatment. 7
… 8
(d) A principal may nominate, by advance instruction for mental health treatment, the 9
guardian of the person of the principal if a guardianship proceeding is thereafter commenced. 10
commenced following the execution of the advance instruction for mental health treatment. The 11
court shall make its appointment in accordance with the principal's most recent nomination in an 12
unrevoked advance instruction for mental health treatment, except for good cause shown. 13
… 14
(f) An advance instruction for mental health treatment may be combined with a health 15
care power of attorney or general power of attorney that is executed in accordance with the 16
requirements of Chapter 32A or Chapter 32C of the General Statutes so long as each form shall 17
be executed in accordance with its own statute." 18
SECTION 1C.(e) G.S. 122C-77 reads as rewritten: 19
"§ 122C-77. Statutory form for advance instruction for mental health treatment. 20
(a) This Part shall not be construed to invalidate an advance instruction for mental health 21
treatment that was executed and was otherwise valid.Use of the statutory form prescribed in this 22
section is an optional and nonexclusive method for c reating an advance instruction for mental 23
health treatment and does not affect the use or validity of other forms of advance instruction for 24
mental health treatment, including previous statutory forms. 25
(b) The use of the following or similar form after the effective date of this Part in the 26
creation of an advance instruction for mental health treatment is lawful, and, when used, it shall 27
specifically meet the requirements and be construed in accordance with the provisions of this 28
Part. 29
… 30
PSYCHOACTIVE PSYCHOTROPIC MEDICATIONS 31
32
If I become incapable of giving or withholding informed consent for mental health treatment, my 33
instructions regarding psychoactive psychotropic medications are as follows: (Place initials 34
beside choice.) 35
… 36
SIGNATURE OF PRINCIPAL 37
38
Note: Do not sign this form until two witnesses or a notary public are present to watch you 39
sign it. You then should consider giving a copy to your primary physician, mental health 40
provider, and a trusted relative and should consider filing it with the Advance Health Care 41
Directive Registry maintained by the North Carolina Secretary of State. 42
43
… 44
45
Box #1 46
If you elect to have your advance instruction witnessed, have the following section completed by 47
two qualified witnesses: 48
49
NATURE AFFIRMATION OF WITNESSES 50
51
General Assembly Of North Carolina Session 2025
House Bill 1115-First Edition Page 15
I hereby state affirm that the principal is personally known to me, that the principal signed or 1
acknowledged the principal's signature on this advance instruction for mental health treatment in 2
my presence, that the principal appears to be of sound mind and not under duress, fraud, or undue 3
influence, and that I am not:not any of the following: 4
a. The attending physician or physician, mental health service provider provider, 5
or an employee of the physician or mental health treatment provider;service 6
provider. 7
b. An owner, operator, or an employee of an owner or operator of a health care 8
facility in which the principal is a patient or resident; orresident. 9
c. Related within the third degree to the principal or to the principal's spouse.by 10
blood, marriage, or adoption. 11
d. A person appointed as an attorney-in-fact by this document. 12
13
AFFIRMATION OF WITNESSES 14
15
We affirm that the principal is personally known to us, that the principal signed or acknowledged 16
the principal's signature on this advance instruction for mental health treatment in our presence, 17
that the principal appears to be of sound mind and not under duress, fraud, or undue influence, 18
and that neither of us is: 19
A person appointed as an attorney-in-fact by this document; 20
The principal's attending physician or mental health service provider or a relative of the physician 21
or provider; 22
The owner, operator, or relative of an owner or operator of a facility in which the principal is a 23
patient or resident; or 24
A person related to the principal by blood, marriage, or adoption. 25
Witnessed by: 26
Witness: ____________________________ (Signature of witness) 27
28
_________________________ (type/print name of witness) 29
30
Date: _______________________________ 31
32
Witness: ____________________________ (Signature of witness) 33
34
_________________________ (type/print name of witness) 35
36
Date: _______________________________ 37
38
STATE OF NORTH CAROLINA 39
COUNTY OF ____________________________________ 40
41
Box #2 42
If you elect to have your advance instruction notarized, have the following section completed 43
by a qualified notary public: 44
45
CERTIFICATION OF NOTARY PUBLIC 46
47
STATE OF NORTH CAROLINA 48
COUNTY OF 49
50
General Assembly Of North Carolina Session 2025
Page 16 House Bill 1115-First Edition
I, __________________________, a Notary Public for the County cited above in the State of 1
North Carolina, hereby certify that ____________________ appeared before me and swore or 2
affirmed to me and to the witnesses in my presence that this instrument is an advance instruction 3
for mental health treatment, and that he/she willingly and voluntarily made and executed it as 4
his/her free act and deed for the purposes expressed in it. 5
I further certify that _____________________and _____________________, witnesses, 6
appeared before me and swore or affirmed that they witnessed _________________________ 7
sign the attached advance instruction for mental health treatment, believing him/her to be of 8
sound mind; and also swore that at the time they witnessed the signing they were not (i) the 9
attending physician or mental health treatment provider or an employee of the physician or 10
mental health treatment provider and (ii) they were not an owner, operator, or employee of an 11
owner or operator of a health care facility in which the principal is a patient or resident, and (iii) 12
they were not related within the third degree to the principal or to the principal's spouse. I further 13
certify that I am satisfied as to the genuineness and due execution of the instrument. 14
This is the ____________ day of__________, _________________________________ 15
____________________________________ 16
Notary Public 17
My Commission expires: 18
19
________________COUNTY, _________________STATE 20
21
Sworn to (or affirmed) and subscribed before me this day by ______________________ 22
(type/print name of principal) 23
24
25
Date: ____________________ _________________________________ 26
(Official Seal) Signature of Notary Public 27
28
_____________________, Notary Public 29
Printed or typed name 30
31
My commission expires: ____________ 32
33
NOTICE TO PERSON MAKING AN INSTRUCTION FOR MENTAL HEALTH 34
TREATMENT 35
This is an important legal document. It creates an instruction for mental health treatment. Before 36
signing this document you should know these important facts: 37
This document allows you to make decisions in advance about certain types of mental health 38
treatment. The instructions you include in this declaration will be followed if a physician or 39
eligible psychologist determines that you are incapable of making and communicating treatment 40
decisions. Otherwise you will be considered capable to give or withhold consent for the 41
treatments. Your instructions may be overridden if you are being held in accordance with civil 42
commitment law. Under the Health Care Power of Attorney a health care power of attorney you 43
may also appoint a person as your health care agent to make treatment decisions for you if you 44
become incapable. You have the right to revoke this document at any time you have not been 45
determined to be incapable. YOU MAY NOT REVOKE THIS ADVANCE INSTRU CTION 46
WHEN YOU ARE FOUND INCAPABLE BY A PHYSICIAN OR OTHER AUTHORIZED 47
MENTAL HEALTH TREATMENT PROVIDER. A revocation is effective when it is 48
communicated to your attending physician or other provider. The physician or other provider 49
shall note the revocation in your medical record. To be valid, this advance instruction must be 50
signed by two qualified witnesses, personally known to you, witnesses who are present when you 51
General Assembly Of North Carolina Session 2025
House Bill 1115-First Edition Page 17
sign or acknowledge your signature. It signature, or it must also be acknowledged before a notary 1
public. 2
NOTICE TO PHYSICIAN OR OTHER MENTAL HEALTH TREATMENT PROVIDER 3
Under North Carolina law, a person may use this advance instruction to provide consent for 4
future mental health treatment if the person later becomes incapable of making those decisions. 5
Under the Health Care Power of Attorney a health care power of attorney the person may also 6
appoint a health care agent to make mental health treatment decisions for the person when 7
incapable. A person is "incapable" when in the opinion of a phy sician or eligible psychologist 8
the person currently person, at the time a mental health treatment decision is being made, lacks 9
sufficient understanding or capacity to make and communicate mental health treatment decisions. 10
This document becomes effective upon its proper execution and remains valid unless revoked. 11
Upon being presented with this advance instruction, the physic ian or other provider must make 12
it a part of the person's medical record. Upon communication that it is revoked, the physician or 13
other provider must note the revocation in the person 's medical record. The attending physician 14
or other mental health treatment provider must act in accordance with the statements expressed 15
in the advance instruction when the person is determined to be incapable, unless compliance is 16
not consistent with G.S. 122C-74(g). The physician or other mental health treatment provider 17
shall promptly notify the principal and, if applicable, the health care agent, and document 18
noncompliance with any part of an advance instruction in the principal's medical record. The 19
physician or other mental health treatment provider may rely upon the auth ority of a signed, 20
witnessed, dated, and notarized advance instruction, as provided in G.S. 122C-75." 21
22
PART I-D. ADDITIONAL CONFORMING CHANGES 23
SECTION 1D.(a) G.S. 90-21.13 reads as rewritten: 24
"§ 90-21.13. Informed consent to health care treatment or procedure. 25
(a) No recovery shall be is allowed against any health care provider upon on the grounds 26
ground that the health care treatment was rendered without the informed consent of the patient 27
or other another person authorized to give consent for the patient where:when either of the 28
following applies: 29
(1) Both of the following: 30
a. The action of the health care provider in obtaining the consent of the 31
patient or other another person authorized to give consent for the 32
patient was in accordance with the standards of practice among 33
members of the same health care profession with similar training and 34
experience situated in the same or similar communities; 35
andcommunities. 36
(2)b. A reasonable person, from the information provided by the health care 37
provider under the circumstances, would have a general understanding 38
of the procedures or treatments and of the usual and most frequent 39
risks and hazards inherent in the proposed procedures or treatments 40
which treatments, and these procedures or treatments are recognized 41
and followed by other health care providers engaged in the same field 42
of practice in the same or similar communities; orcommunities. 43
(3)(2) A reasonable person, under all the surrounding circumstances, would have 44
undergone such the treatment or procedure had he the person been advised by 45
the health care provider in accordance with the provisions of subdivisions (1) 46
and (2) subdivision (1) of this subsection. 47
(b) A consent which that is evidenced in writing and which writing, meets the foregoing 48
standards, standards of subsection (a) of this section, and which is signed by the patient who has 49
capacity to make and communicate health care decisions or other another authorized person, shall 50
be person is presumed to be a valid consent. This presumption, however, may be presumption is 51
General Assembly Of North Carolina Session 2025
Page 18 House Bill 1115-First Edition
subject to rebuttal only upon proof that such the consent was obtained by fraud, deception 1
deception, or misrepresentation of a material fact. A consent that meets the foregoing standards, 2
that is given by a patient, or other authorized person, who under all the surrounding circumstances 3
has capacity to make and communicate health care decisions, is a valid consent. 4
(c) The following persons, with priority in the order indicated, are authorized to consent 5
to medical treatment on behalf of a patient who is comatose or otherwise lacks capacity to make 6
or communicate health care decisions: 7
(1) A guardian of the patient's person, or a general guardian with powers over the 8
patient's person, appointed by a court of competent jurisdiction pursuant to 9
Article 5 of Chapter 35A of the General Statutes; provided that, Statutes. 10
However, if the patient has a health care agent appointed pursuant to a valid 11
health care power of attorney, the health care agent shall have has the right to 12
exercise the authority to the extent granted in the health care power of attorney 13
and to the extent provided in G.S. 32A-19(a) unless the Clerk clerk of superior 14
court has suspended the authority of that health care agent in accordance with 15
G.S. 35A-1208(a). 16
(2) A health care agent appointed pursuant to a valid health care power of 17
attorney, to the extent of the authority granted. 18
(3) An agent, with powers to make health care decisions for the patient, appointed 19
by the patient, to the extent of the authority granted. 20
(4) The patient's spouse. 21
(5) A majority of the patient's reasonably available parents and children who are 22
at least 18 years of age. 23
(5a) An individual who has an established relationship with the patient, who is 24
acting in good faith on behalf of the patient, who can reliably convey the 25
patient's wishes, and who has been living with the patient for at least one year. 26
(6) A majority of the patient's reasonably ava ilable siblings who are at least 18 27
years of age. 28
(6a) A majority of the patient's reasonably available grandparents or grandchildren 29
who are at least 18 years of age. 30
(6b) An individual not listed in this subsection who is acting in good faith on behalf 31
of the patient and who has assisted the patient with supported decision making 32
routinely during the preceding six months. As used in this subdivision, 33
"supported decision making" means assistance that is provided by one or more 34
individuals of the patient 's choosing and that helps the patient make or 35
communicate a decision, including by helping the patient understand the 36
nature and consequences of the decision. 37
(6c) A majority of the patient 's reasonably available stepchildren who are at least 38
18 years of age, whom the patient actively parented during their minor years, 39
and with whom the patient has an ongoing relationship. 40
(7) An individual not otherwise listed in this subsection who has an established 41
relationship with the patient, who is acting in good f aith on behalf of the 42
patient, and who can reliably convey the patient's wishes. 43
(c1) If none of the persons listed under subsection (c) of this section is reasonably 44
available, then the patient's attending physician, in the attending physician's discretion, may 45
provide health care treatment without the consent of the patient or other perso n authorized to 46
consent for the patient if there is confirmation by a physician other than the patient's attending 47
physician of the patient's condition and the necessity for treatment; provided, however, treatment. 48
However, that confirmation of the patient 's condition and the necessity for treatment are not 49
required if the delay in obtaining the confirmation would endanger the life or seriously worsen 50
the condition of the patient. 51
General Assembly Of North Carolina Session 2025
House Bill 1115-First Edition Page 19
(c2) In order to establish the authority of a person listed in subsection ( c) of this section, 1
the attending physician may request and rely upon a statement from the person affirming the 2
person's status under subsection ( c) of this section. A physician may accept the consent of a 3
person having lower priority under subsection ( c) of this section only if a person having higher 4
priority is not reasonably available. 5
(d) No action may shall be maintained against any health care provider upon any based 6
on a guarantee, warranty warranty, or assurance as to the result of any medical, surgical surgical, 7
or diagnostic procedure or treatment unless the guarantee, warranty warranty, or assurance, or 8
some note or memorandum thereof, shall be of it, is in writing and signed by the provider or by 9
some other another person authorized to act for or on behalf of such the provider. 10
(e) In the event of any a conflict between the provisions of this section and those of 11
G.S. 35A-1245, 90-21.17, and 90-322, G.S. 90-21.17, Articles 1A and 19 of Chapter 90, 90 of 12
the General S tatutes, G.S. 90-322, and Article 3 of Chapter 122C of the General Statutes, the 13
provisions of those sections and Articles shall control and continue in full force and 14
effect.control." 15
SECTION 1D.(b) G.S. 130A-466(b) is repealed. 16
17
PART II. SIMPLIFY EXECUTION REQUIREMENTS FOR A HEALTH CARE POWER 18
OF ATTORNEY AND AN ADVANCE DIRECTIVE ("LIVING WILL") 19
SECTION 2.1.(a) G.S. 32A-16(3), as amended by Section 1A(d) of this act, reads 20
as rewritten: 21
"(3) Health care power of attorney. – Except as provided in G. S. 32A-16.1, a 22
written instrument that substantially meets the requirements of this Article, 23
that is signed in the presence of two qualified witnesses, and witnesses or 24
acknowledged before a notary public, and that appoints an attorney-in-fact or 25
agent to act for the principal in matters relating to the health care of the 26
principal. The notary who takes the acknowledgement may but is not required 27
to be a paid employee of the attending physician or mental health treatment 28
provider, a paid employee of a healt h facility in which the principal is a 29
patient, or a paid employee of a nursing home or any adult care home in which 30
the principal resides." 31
SECTION 2.1.(b) G.S. 32A-25.1(a), as amended by Section 1A(f) of this act, reads 32
as rewritten: 33
"(a) The use of the following form in the creation of a health care power of attorney is 34
lawful and, when used, meets the requirements of and be construed in accordance with the 35
provisions of this Article: 36
37
HEALTH CARE POWER OF ATTORNEY 38
39
NOTE: YOU SHOULD USE THIS DOCUMENT TO NAME A PERSON AS YOUR 40
HEALTH CARE AGENT IF YOU ARE COMFORTABLE GIVING THAT PERSON 41
BROAD AND SWEEPING POWERS TO MAKE HEALTH CARE DECISIONS FOR 42
YOU. THERE IS NO LEGAL REQUIREMENT THAT ANYONE EXECUTE A 43
HEALTH CARE POWER OF ATTORNEY. 44
45
EXPLANATION: You have the right to name someone to make health care decisions for you 46
when you cannot make or communicate those decisions. This form may be used to create a health 47
care power of attorney, and meets the requirements of North Carolina law. However, you are 48
not required to use this form, and North Carolina law allows the use of other forms that meet 49
certain requirements. If you prepare your own health care power of attorney, you should be very 50
careful to make sure it is consistent with North Carolina law. 51
General Assembly Of North Carolina Session 2025
Page 20 House Bill 1115-First Edition
1
This document gives the person you designate as your health care agent broad powers to make 2
health care decisions for you when you cannot make the decision yourself or cannot communicate 3
your decision to other people. You should discuss your wishes concerning life -prolonging 4
measures, mental health treatment, and other health care decisions with your health care agent. 5
Except to the extent that you express specific limitations or restrictions in this form, your health 6
care agent may make any health care decision you could make yourself. 7
8
This form does not impose a duty on your health care agent to exercise granted powers, but when 9
a power is exercised, your health care agent will be obligated to use due care to act in your best 10
interests and in accordance with this document. 11
12
This Health Care Power of Attorney form is intended to be valid in any jurisdiction in which it 13
is presented, but places outside North Carolina may impose requirements that this form does not 14
meet. 15
16
If you want to use this form, you must complete it, sign it, and have your signature witnessed by 17
two qualified witnesses and or proved by a notary public. Follow the instructions about which 18
choices you can initial very carefully. Do not sign this form until two witnesses and or a notary 19
public are present to watch you sign it. You then should give a copy to your health care agent 20
and to any alternates you name. You should consider filing it with the Advance Health Care 21
Directive Registry maintained by the North Carolina Secretary of State: 22
http://www.nclifelinks.org/ahcdr/State. 23
… 24
By signing here, I indicate that I am mentally alert and competent, fully informed as to the 25
contents of this document, and understand the full import of this grant of powers to my health 26
care agent. 27
28
This the _____ day of ______________, 20____. 29
30
________________________(SEAL)(SIGNATURE) 31
32
I hereby state that the principal, _______________, being of sound mind, signed (or directed 33
another to sign on the principal's behalf) the foregoing health care power of attorney in my 34
presence, that I am not related to the principal by blood, marriage, or adoption, and I would not 35
be entitled to any portion of the estate of the principal under any existing will or codicil of the 36
principal or as an heir under the Intestate Succession Act, Chapter 29 of the General Statutes, if 37
the principal died on this date without a will. I also state that I am not the principal's attending 38
physician or mental health treatment provider and that I am not a licensed health care provider 39
or mental health treatment provider who is (1) an employee of the principal's attending physician 40
or mental health treatment provider, (2) an employee of the health facility in which the principal 41
is a patient, or (3) an employee of a nursing home or any adult care home wher e the principal 42
resides. I further state that I do not have any claim against the principal or the estate of the 43
principal. 44
45
Box #1 46
If you elect to have your declaration witnessed, complete the following section: 47
48
Date: _____________________________ Witness: ___________________________ 49
(Signature of witness) 50
51
General Assembly Of North Carolina Session 2025
House Bill 1115-First Edition Page 21
_________________________ 1
(type/print name of witness) 2
Date: _____________________________ Witness: ___________________________ 3
(Signature of witness) 4
5
_________________________ 6
(type/print name of witness) 7
8
Box #2 9
If you elect to have your declaration notarized, have the following section completed by a 10
qualified notary public: 11
12
________________COUNTY, _________________STATE 13
14
Sworn to (or affirmed) and subscribed before me this day by _____________________ 15
(type/print name of signer) 16
______________________ 17
(type/print name of witness) 18
19
______________________ 20
(type/print name of witness) 21
22
23
Date: ___________________________ ______________________________ 24
(Official Seal) Signature of Notary Public 25
26
__________________, Notary Public 27
Printed or typed name 28
29
My commission expires: __________" 30
31
SECTION 2.2.(a) G.S. 90-321(c)(3), as amended by Section 1B(d) of this act, reads 32
as rewritten: 33
"(3) Except as provided in G.S. 90-321.1, it either of the following: 34
a. It has been signed by the declarant in the presence of two witnesses 35
who believe the declarant to be of sound mind and who state that they 36
(i) are not related to the declarant by blood, marriage, or adoption, (ii) 37
do n ot know or have a reasonable expectation that they would be 38
entitled to any portion of the estate of the declarant upon the declarant's 39
death under any will of the declarant or codicil to any will then existing 40
or under the Intestate Succession Act, Chapte r 29 of the General 41
Statutes, (iii) are not the attending physician, licensed health care 42
providers who are paid employees of the attending physician, paid 43
employees of a health facility in which the declarant is a patient, or 44
paid employees of a nursing home or any adult care home in which the 45
declarant resides, and (iv) do not have a claim against any portion of 46
the estate of the declarant at the time of the declaration; 47
anddeclaration. 48
(4)b. It has been proved before a clerk or assistant clerk of superior court, 49
or a notary public who certifies substantially as set out in subsection 50
(d1) of this section. A notary who takes the acknowledgement may but 51
General Assembly Of North Carolina Session 2025
Page 22 House Bill 1115-First Edition
is not required to be a paid employee of the attending physician, a paid 1
employee of a health facil ity in which the declarant is a patient, or a 2
paid employee of a nursing home or any adult care home in which the 3
declarant resides." 4
SECTION 2.2.(b) G.S. 90-321(a)(1a) reads as rewritten: 5
"(1a) Declaration. – Except as provided in G.S. 90-321.1, any signed, witnessed, 6
dated, and proved signed, witnessed or proved, and dated document meeting 7
the requirements of subsection (c) of this section." 8
SECTION 2.2.(c) G.S. 90-321(d1), as amended by Section 1B(d) of this act, reads 9
as rewritten: 10
"(d1) The following meets the requirements of subsection (c) of this section: 11
12
ADVANCE DIRECTIVE FOR A NATURAL DEATH ("LIVING WILL") 13
14
NOTE: YOU SHOULD USE THIS DOCUMENT TO GIVE YOUR HEALTH CARE 15
PROVIDERS INSTRUCTIONS TO WITHHOLD OR WITHDRAW 16
LIFE-PROLONGING MEASURES IN CERTAIN SITUATIONS. THERE IS NO LEGAL 17
REQUIREMENT THAT ANYONE EXECUTE A LIVING WILL. 18
19
GENERAL INSTRUCTIONS: You can use this Advance Directive ("Living Will") form to give 20
instructions for the future if you want your health care providers to withhold or withdraw 21
life-prolonging measures in certain situations. You should talk to your doctor about what these 22
terms mean. The Living Will states what choices you would have made for yourself if you were 23
able to communicate. Talk to your family members, friends, and oth ers you trust about your 24
choices. Also, it is a good idea to talk with professionals such as your doctors, clergypersons, 25
and lawyers before you complete and sign this Living Will. 26
27
You do not have to use this form to give those instructions, but if you create your own Advance 28
Directive you need to be very careful to ensure that it is consistent with North Carolina law. 29
30
This Living Will form is intended to be valid in any jurisdiction in which it is presented, but places 31
outside North Carolina may impose requirements that this form does not meet. 32
33
If you want to use this form, you must complete it, sign it, and have your signature witnessed by 34
two qualified witnesses and or proved by a notary public. Follow the instructions about which 35
choices you can initial very carefully. Do not sign this form until two witnesses and or a notary 36
public are present to watch you sign it. You then should consider giving a copy to your primary 37
physician and a trusted relative, and should consider filing it with the Advanced Health Care 38
Directive Registry maintained by the North Carolina Secretary of State: 39
http://www.nclifelinks.org/ahcdr/State. 40
41
My Desire for a Natural Death 42
43
I, ____________________, being of sound mind, desire that, as specified below, my life not be 44
prolonged by life-prolonging measures: 45
46
… 47
48
I hereby state that the declarant, ______________________, being of sound mind, signed (or 49
directed another to sign on declarant's behal f) the foregoing Advance Directive for a Natural 50
Death in my presence, and that I am not related to the declarant by blood, marriage, or adoption, 51
General Assembly Of North Carolina Session 2025
House Bill 1115-First Edition Page 23
and I would not be entitled to any portion of the estate of the declarant under any existing will or 1
codicil of the declarant or as an heir under the Intestate Succession Act, Chapter 29 of the General 2
Statutes, if the declarant died on this date without a will. I also state that I am not the declarant's 3
attending physician or a licensed health care provider who is (1) an employee of the declarant's 4
attending physician, (2) nor an employee of the health facility in which the declarant is a patient, 5
or (3) an employee of a nursing home or any adult care home where the declarant resides. I further 6
state that I do not have any claim against the declarant or the estate of the declarant. 7
8
Box #1 9
If you elect to have your declaration witnessed, complete the following section: 10
11
Date: _____________________________ Witness: ___________________________ 12
(Signature of witness) 13
14
_________________________ 15
(type/print name of witness) 16
17
Date: _____________________________ Witness: ___________________________ 18
(Signature of witness) 19
20
_________________________ 21
(type/print name of witness) 22
23
Box #2 24
If you elect to have your declaration notarized, have the following section completed by a 25
qualified notary public: 26
27
________________COUNTY, _________________STATE 28
29
Sworn to (or affirmed) and subscribed before me this day by _____________________ 30
(type/print name of declarant) 31
32
________________________ 33
(type/print name of witness) 34
35
________________________ 36
(type/print name of witness) 37
38
Date ___________________________ ______________________________ 39
(Official Seal) Signature of Notary Public 40
41
__________________, Notary Public 42
Printed or typed name 43
44
My commission expires: _________" 45
46
PART III. CONTINGENT REPEAL AND EFFECTIVE DATE 47
SECTION 3.(a) If House Bill 349, 2025 Regular Session, becomes law, Part II of 48
this act is repealed. 49
SECTION 3.(b) This act becomes effective January 1, 2027, and applies to 50
documents executed on or after that date. This act does not affect the validity of a health care 51
General Assembly Of North Carolina Session 2025
Page 24 House Bill 1115-First Edition
power of attorney, an advance directive, or an advance instruction for mental health treatment 1
executed prior to the effective date of this act. 2