## Healthcare directives in North Carolina Healthcare directives let you make decisions NOW about medical care you want — or don't want — in case you become unable to communicate them later. North Carolina recognizes Advance Directive for Natural Death . ### North Carolina framework Advance Directive for Natural Death + Healthcare Power of Attorney + MOST. ## Two main types of healthcare directives **1. Living Will / Healthcare Directive.** Written statement of what medical treatments you want or refuse if terminally ill or permanently unconscious. Common topics: - Resuscitation (CPR) - Mechanical ventilation - Artificial nutrition and hydration - Tube feeding - Pain management - Specific treatments to refuse (dialysis, blood transfusion, antibiotics) - Comfort care preferences - Organ donation **2. Healthcare Power of Attorney / Healthcare Proxy / Healthcare Surrogate.** Designates an **agent** to make medical decisions when you can't. The agent can: - Speak with doctors - Consent to or refuse treatments - Choose facilities and providers - Receive HIPAA-protected medical info - Make end-of-life decisions - Authorize pain management Most modern statutes allow these to be combined in a single "Advance Directive" document. ## POLST / MOLST / MOST / POST **POLST** (Physician Orders for Life-Sustaining Treatment) and similar variations (MOLST in NY/MA, MOST in NC/NM, POST in TN/IN/WV) are MEDICAL ORDERS — signed by both patient and physician — covering specific end-of-life treatments. Different from Living Will / Healthcare POA: - **Living Will** = patient's wishes; advisory; for use when incapacitated - **POLST** = doctor's orders; binding; for medical professionals to follow immediately POLST is most common for seriously ill patients and elderly people in nursing facilities. ## Execution requirements Most state directives require: - Written form - Signed by the patient - Witnessed (typically 2 witnesses, often barred from being agent / healthcare provider / heir) - Sometimes notarized - Specific statutory language for some elements Failing to follow execution requirements can void the directive entirely. ## Choosing a healthcare agent **Pick someone who:** - You trust completely - Will be available in a crisis - Lives close enough to come quickly - Can make hard decisions under pressure - Will respect your wishes (not impose their own values) - Can advocate against family pressure - Has the time and emotional capacity **Pick a backup** — agents die, get sick, become unavailable. **Talk to your agent** — share your values, fears, religious beliefs, treatment preferences. The directive is a starting point; the conversation makes it work. ## What healthcare agents can typically NOT do - Override a fully-conscious patient's decisions - Make decisions about civil commitment - Authorize sterilization (in some states) - Authorize psychosurgery - Withhold mechanical ventilation in some states unless explicitly authorized - Authorize abortion (in some states) - Override specific provisions of the directive ## When a directive takes effect Healthcare directives generally activate when: - Your physician determines you lack capacity to make medical decisions, OR - The specific triggering condition (terminal illness, permanent unconsciousness) is met Two physicians often must agree before life-sustaining treatment can be withdrawn. ## Recognition between states Most states honor advance directives executed in other states (sometimes only if they meet that state's requirements). Travel-heavy people should consider: - Executing directives in multiple states where they spend time - Carrying digital copies - Registering with state databases (where available) - Keeping copies with primary doctor, family, agent ## HIPAA authorization Don't forget — your agent needs **HIPAA authorization** to access your medical records. Many advance-directive forms include this; if not, file a separate HIPAA release. ## Mental health directives Some states have separate mental-health directives addressing: - Psychiatric treatment preferences - Medication choices - Hospitalization preferences - ECT consent - Trusted advocate for mental-health treatment These are separate from general healthcare directives and have their own execution requirements. ## What you should do Every adult in North Carolina should have BOTH a Living Will (or equivalent) AND Healthcare POA — even teenagers about to turn 18. Most North Carolina estate-planning attorneys offer flat-fee "basic estate planning packages" that include healthcare directives + financial POA + simple will + HIPAA release. Many state hospitals and senior services offer free templates. Don't wait for an emergency. --- *This guide is general information about North Carolina law as of early 2026 and is not legal advice. Healthcare-directive law varies by state. Talk to a licensed North Carolina estate-planning attorney about your specific situation.*