North Carolina: how to sign your advance directive

What North Carolina asks

What you need to sign in North Carolina

Instruments

Health care power of attorney (ch. 32A, art. 3) · declaration of a desire for a natural death (G.S. 90-320 et seq. — not captured in this research). §32A-26 permits combining them into one document

Form

Illustrative — a statutory form is published at §32A-25.1, and §32A-24(d) states the protections are not limited to documents prepared in accordance with it

Execution

Two qualified witnesses AND a notary public (§32A-16(3))

May not witness

A qualified witness must state that he or she is not related within the third degree to the principal nor to the principal's spouse; does not know or have a reasonable expectation of being entitled to any portion of the estate under any will or codicil or under the Intestate Succession Act; is not the attending physician or mental health treatment provider, a licensed health care provider who is a paid employee of either, a paid employee of a health facility in which the principal is a patient, or a paid employee of a nursing home or adult care home in which the principal resides; and has no claim against any portion of the estate (§32A-16(6))

May not be your agent

Any competent person not engaged in providing health care to the principal for remuneration, 18 or older (§32A-18)

Copy rule

Reliance, not equivalence. A copy obtained from the Secretary of State's registry may be relied upon "to the same extent that the individual may rely upon the original document" (§32A-24(a))

Delivery

No — the directive does not wait on delivery to a clinician to operate. Revocation is the exception: it "becomes effective only upon communication by the principal to each health care agent named in the revoked" instrument and to the attending physician or eligible psychologist (§32A-20(b))

Who decides

The physician or physicians the principal designated, in writing — or an eligible psychologist for mental health treatment. If none was designated, or the designated one is unavailable or unwilling, the attending physician or eligible psychologist makes the determination (§32A-20(a))

Trigger overridable

Partly. The principal chooses who determines incapacity, and on religious or moral grounds may name a certifier who is not a physician (§32A-20(a)). Nothing found lets the document set its own clinical trigger

Registry

Yes — the Advance Health Care Directive Registry maintained by the Secretary of State under Article 21 of Chapter 130A (§32A-24(a))

Age

18 or older (§32A-17)

Reciprocity

Yes — a health care power of attorney or similar document executed in another jurisdiction "shall be valid as a health care power of attorney in this State if it appears to have been executed in accordance with the applicable requirements of that jurisdiction or of this State" (§32A-27)

Revocation

By executing and acknowledging an instrument of revocation, by executing and acknowledging a later health care power of attorney, "or in any other manner by which the principal is able to communicate an intent to revoke" (§32A-20(b)). A spouse-agent's authority is revoked upon the entry of a decree of divorce or separation — and a named successor then serves, so the instrument itself survives (§32A-20(c))

Oral instructions

The instrument must be written. Revocation may be communicated in any manner, including orally (§32A-20(b))

Uninitialled box

Two opposite traps. Leaving the form's artificial nutrition and hydration blocks uninitialled imposes no limitation — the agent keeps authority. But initialling a block without writing in a special provision strips the agent of authority entirely: "If you initial either block but do not insert any special provisions, your health care agent shall have NO AUTHORITY to withhold artificial nutrition or hydration" (§32A-25.1, Part 5.A)

Carried device

Nothing for the directive — see below

Citation

N.C. Gen. Stat. ch. 32A, art. 3

Read from the enacted statute, 2026-09-18.