NORTH CAROLINA ADVANCE DIRECTIVE FOR A NATURAL DEATH
(“Living Will”)
[// GUIDANCE: This template is drafted to comply with N.C. Gen. Stat. § 90-321 (the North Carolina Right to a Natural Death Act) and incorporates industry-standard defensive drafting. Bracketed items must be completed or revised by counsel prior to execution. Remove all guidance comments before finalizing.]
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
- Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Risk Allocation
- Dispute Resolution
- General Provisions
- Execution Block (Signature, Witness, Notary)
- Attachments & Schedules
1. DOCUMENT HEADER
1.1 Title and Declarant Identification
This Advance Directive for a Natural Death (this “Directive”) is made by [DECLARANT FULL LEGAL NAME], born [MM/DD/YYYY], currently residing at [STREET ADDRESS, CITY, NC ZIP] (the “Declarant”).
1.2 Effective Date
This Directive shall become effective on the later of (a) the date of execution set forth in Section 10 below or (b) the date on which the Declarant’s attending physician determines, in writing and in accordance with N.C. Gen. Stat. § 90-321(c1), that the Declarant lacks decisional capacity and the conditions selected in Section 3.2 apply (the “Effective Date”).
1.3 Governing Law
This Directive is governed by and shall be construed in accordance with the laws of the State of North Carolina, without regard to its conflict-of-laws principles.
2. DEFINITIONS
For purposes of this Directive (capitalized terms used herein but not defined have the meanings assigned by applicable North Carolina law):
“Artificial Nutrition or Hydration” means the provision of nutrients or fluids by tube or intravenous line when, in the medical judgment of the attending physician, the same are necessary to sustain life.
“Attending Physician” means the physician who has primary responsibility for the Declarant’s care and treatment.
“Decisional Capacity” means the ability to understand and appreciate the nature and consequences of a health-care decision and to communicate such a decision.
“Health Care Agent” means the individual designated under a separate Health Care Power of Attorney, if any, to make health-care decisions on behalf of the Declarant.
“Life-Prolonging Measures” means medical procedures or interventions that would serve only to postpone the moment of death or maintain the Declarant in a condition of permanent unconsciousness, as defined in § 90-321(a)(4).
“Permanent Unconscious Condition” means a medical condition that, to a high degree of medical certainty as determined by the attending physician, will last permanently without hope of recovery of any cognitive function.
3. OPERATIVE PROVISIONS
3.1 Statement of Intent
The Declarant executes this Directive to express personal desires regarding the withholding or withdrawal of Life-Prolonging Measures under the circumstances set forth herein.
3.2 Conditions Triggering Directive
The Declarant directs that Life-Prolonging Measures (check applicable options):
a. ☐ be withheld or withdrawn if the Declarant is determined to have an incurable or irreversible condition that will result in death within a relatively short period of time (“Terminal Condition”).
b. ☐ be withheld or withdrawn if the Declarant is in a Permanent Unconscious Condition.
c. ☐ be withheld or withdrawn if the Declarant suffers from advanced dementia or other condition of significant cognitive loss that is irreversible and such condition renders the Declarant unable to recognize or interact with others (“Advanced Cognitive Decline”).
[// GUIDANCE: Most clients choose (a) and (b); (c) is optional and more subjective. Delete any unselected options.]
3.3 Artificial Nutrition or Hydration
If Life-Prolonging Measures are to be withheld or withdrawn pursuant to Section 3.2, the Declarant further directs that (check one):
- ☐ Artificial Nutrition or Hydration shall also be withheld or withdrawn.
- ☐ Artificial Nutrition or Hydration shall continue unless specifically determined by the attending physician to be medically contraindicated or to prolong suffering.
3.4 Coordination with Health Care Agent
In the event this Directive conflicts with any decision made by the Declarant’s Health Care Agent, this Directive (check one):
- ☐ Shall Control.
- ☐ May be overridden by the Health Care Agent after consultation with the attending physician.
3.5 Additional Preferences (Optional)
The Declarant expresses the following non-binding preferences:
• [PREFERRED PLACE OF CARE (e.g., at home, hospice facility, hospital)]
• [PREFERENCES REGARDING PAIN MANAGEMENT, SPIRITUAL CARE, FAMILY VISITATION, ETC.]
4. REPRESENTATIONS & WARRANTIES
4.1 Declarant represents and warrants that:
a. Declarant is at least eighteen (18) years of age, of sound mind, and executing this Directive voluntarily and without undue influence.
b. Declarant has reviewed and understands the provisions of N.C. Gen. Stat. § 90-321 and intends that this Directive be interpreted consistently therewith.
c. Declarant is not currently a patient in or a resident of a health-care facility where any witness is employed or has a financial interest, nor is any witness a relative or heir entitled to any portion of the Declarant’s estate.
4.2 Each witness identified in Section 10.2 warrants that the witness:
a. Is competent and at least eighteen (18) years of age; and
b. Is not (i) related within the third degree, (ii) an heir or beneficiary of the Declarant, (iii) the Declarant’s attending physician or a person under the control of the attending physician, or (iv) a paid employee of a health-care facility in which the Declarant is a patient or resident, other than a certified notary public.
5. COVENANTS & RESTRICTIONS
5.1 Declarant covenants to:
a. Provide copies of this fully executed Directive to the Declarant’s primary care physician, attending physician, Health Care Agent, and such family members or trusted persons as the Declarant deems appropriate.
b. Record any revocation, amendment, or replacement of this Directive with the Declarant’s health-care providers promptly.
5.2 Restriction on Modification by Others
No person other than the Declarant may modify, alter, or revoke this Directive except as expressly permitted by North Carolina law.
6. DEFAULT & REMEDIES
[// GUIDANCE: Although traditional “default” concepts are less typical in personal directives, this section reinforces enforceability.]
6.1 Failure to Honor Directive
Any health-care provider who, with knowledge of this Directive, fails to comply in good faith with its terms shall, upon written notice from the Health Care Agent or family member, promptly transfer the Declarant to a provider willing to honor the Directive.
6.2 Enforcement
The Declarant’s Health Care Agent, next of kin, or any person designated by the Declarant may petition a court of competent jurisdiction for injunctive relief compelling compliance with this Directive.
6.3 Attorneys’ Fees
In any action to enforce this Directive, the substantially prevailing party shall be entitled to recover reasonable attorneys’ fees and costs.
7. RISK ALLOCATION
7.1 Indemnification of Health-Care Providers
The Declarant agrees to indemnify and hold harmless any health-care provider who, in good faith reliance on this Directive, withholds or withdraws Life-Prolonging Measures, from any civil or criminal liability, except for acts of gross negligence or intentional misconduct.
7.2 Limitation of Liability
No health-care provider acting in good faith pursuant to this Directive shall be liable for damages or subject to disciplinary proceedings for honoring or declining to honor the Directive, as provided in N.C. Gen. Stat. § 90-322.
8. DISPUTE RESOLUTION
8.1 Governing Law
This Directive is governed by the internal laws of the State of North Carolina.
8.2 Venue
Any proceeding arising under or relating to this Directive shall be brought exclusively in the General Court of Justice of the State of North Carolina sitting in [COUNTY] County.
8.3 Injunctive Relief
Nothing in this Section shall limit any party’s right to seek emergency injunctive relief to enforce compliance with this Directive.
9. GENERAL PROVISIONS
9.1 Amendment & Revocation
a. This Directive may be revoked by the Declarant at any time and in any manner consistent with N.C. Gen. Stat. § 90-321(f), including, without limitation, by (i) burning, tearing, or otherwise destroying the document; (ii) executing a subsequent written revocation; or (iii) executing a new advance directive.
b. Any amendment must (i) be in writing, (ii) be executed with the same formalities as this Directive, and (iii) expressly state the intent to amend.
9.2 Severability
If any provision of this Directive is found invalid or unenforceable, the remaining provisions shall remain in full force and effect.
9.3 Integration
This Directive constitutes the entire statement of the Declarant’s wishes with respect to the matters addressed herein and supersedes all prior oral or written statements regarding the same subject matter.
9.4 Counterparts & Electronic Signatures
This Directive may be executed in counterparts, each of which shall be deemed an original. Electronic, facsimile, or PDF signatures shall be deemed to have the same legal effect as original signatures.
10. EXECUTION BLOCK
10.1 Declarant Signature
I, [DECLARANT FULL LEGAL NAME], being of sound mind, hereby sign my name to this Advance Directive for a Natural Death on this [DAY] day of [MONTH, YEAR].
Signature of Declarant
10.2 Witness Attestation
We declare that the Declarant is personally known to us, appears to be of sound mind, and signed or acknowledged this Directive in our presence without undue influence, and that we meet the qualifications of Section 4.2 above.
| Witness Name & Address | Signature | Date |
|---|---|---|
| 1. [NAME] [ADDRESS] |
________ | ____ |
| 2. [NAME] [ADDRESS] |
________ | ____ |
10.3 Notary Acknowledgment
State of North Carolina
County of [COUNTY]
On this ___ day of __, 20__, before me, the undersigned Notary Public, personally appeared [DECLARANT FULL LEGAL NAME], who is personally known to me or has produced satisfactory evidence of identity, and acknowledged that he or she executed the foregoing Directive voluntarily for the purposes therein contained.
Notary Public
My Commission Expires: _____
[Seal]
11. ATTACHMENTS & SCHEDULES
• Schedule A – Optional Supplemental Instructions (if any)
• Schedule B – Contact Information for Health Care Agent(s)
[// GUIDANCE: Attach schedules only if needed. Remove this section if no schedules will be included.]
[// GUIDANCE: North Carolina maintains a voluntary Advance Health-Care Directive Registry. Practitioners should advise clients regarding registration, and, if requested, insert registry language here.]
© [YEAR] [LAW FIRM NAME]. All rights reserved. This template is provided solely for use by licensed attorneys. No legal advice is given to non-lawyers.