7. How can you revoke this health care power of attorney? If you are competent, you may revoke this
health care power of attorney in any way that makes clear your desire to revoke it. For example, you
may destroy this document, write “void” across this document, tell your doctor that you are revoking the
document, or complete a new health care power of attorney.
8. Who makes health care decisions for me if I don’t name a health care agent and I am not able to
make my own decisions? If you do not have a health care agent, NC law requires health care providers
to look to the following individuals, in the order listed below: legal guardian; an attorney-in-fact under a
general power of attorney (POA) if that POA includes the right to make health care decisions; a husband
or wife; a majority of your parents and adult children; a majority of your adult brothers and sisters; or an
individual who has an established relationship with you, who is acting in good faith and who can convey
your wishes. If there is no one, the law allows your doctor to make decisions for you as long as another
doctor agrees with those decisions.
Part B: Living Will
1. What is a living will? In North Carolina, a living will lets you state your desire not to receive life-
prolonging measures in any or all of the following situations:
▪ You have a condition that is incurable that will result in your death within a short period of time.
▪ You are unconscious, and your doctors are confident that you cannot regain consciousness.
▪ You have advanced dementia or other substantial and irreversible loss of mental function.
2. What are life-prolonging measures? Life-prolonging measures are medical treatments that would
only serve to postpone death, including breathing machines, kidney dialysis, antibiotics, tube feeding
(artificial nutrition and hydration), and similar forms of treatment.
3. Can life-prolonging measures be withheld or stopped without a living will? Yes, in certain
circumstances. If you are able to express your wishes, you may refuse life-prolonging measures. If you
are not able to express your wishes, then permission must be obtained from those individuals who are
making decisions on your behalf.
4. What if you want to receive tube feeding (artificial nutrition and hydration)? You may express
your wish to receive tube feeding in all circumstances. To do this, you must initial the statement in
Section 2 of Part B.
5. How can you revoke this living will? You may revoke this living will by clearly stating or writing in
any clear manner that you wish to do so. For example, you may destroy the document, write “void”
across the document, tell your doctor that you are revoking the document, or complete a new living will.
Part C: Completing this Document
To make this advance directive legally effective, all three sections of Part C of the document must be
1. Wait until two witnesses and a notary public are present, then sign and date the document.
2. Two witnesses must sign and date the document in Section 2 of Part C. These witnesses cannot be:
▪ related to you by blood or marriage,
▪ your heir, or a person named to receive a portion of your estate in your will,
▪ someone who has a claim against you or against your estate, or
▪ your doctor, other health care provider, or an employee of a hospital in which you are a patient, or an
employee of the nursing home or adult care home where you live.
3. A notary public must witness these signatures and notarize the document in Section 3 of Part C.
801632 Page 2 of 5 Revised March 13, 2014