How to Fill Out the North Carolina Living Will (Advance Directive)

To fill out a North Carolina living will, you use the statutory Advance Directive for a Natural Death printed in NCGS § 90-321, initial your choices in each numbered section, and then sign it in the physical presence of two qualified witnesses and a notary public.¹ The form itself is short. Getting the initialing right, and getting the signing ceremony right, is what makes it legally binding.

Before You Sit Down With the Form

You have to be at least 18 and of sound mind, meaning you understand what the document does and the consequences of your choices. No one can pressure you into signing.² You do not need a lawyer; the state prints the form in the statute itself.

Use a current version. The statutory language lives in NCGS § 90-321(d1), and you can download it from the North Carolina General Assembly’s website or the Secretary of State’s Advance Health Care Directive Registry page. Hospitals, hospice organizations, and attorneys’ offices usually keep blank copies as well.³ Forms printed before 2007 may be missing sections the current law requires, so check that whatever you pick matches the statutory text.

Read the general instructions printed at the top of the form before you initial anything. And do not sign at the bottom until your witnesses and notary are actually with you.

Working Through the Form Section by Section

Section 1: When Your Directives Apply

Section 1 defines the medical situations in which the rest of the document takes effect. You can initial any combination of the three conditions, or all of them. The directive only activates when your attending physician determines you can no longer make or communicate healthcare decisions and at least one of the conditions you initialed exists:¹

An incurable or irreversible condition that will result in your death within a relatively short period of time.
Permanent unconsciousness, where providers determine to a high degree of medical certainty that you will never regain consciousness.
Advanced dementia or substantial cognitive loss that providers determine, to a high degree of medical certainty, is not reversible.

If you initial only one, the form stays silent on the other two, and providers would have to look elsewhere for guidance in those situations. Most people initial all three to close that gap.

Section 2: Your Instructions About Life-Prolonging Measures

Section 2 tells providers what to do once a Section 1 condition applies. Initial exactly one of two options:¹

Providers may withhold or withdraw life-prolonging measures. This gives permission but leaves room for clinical judgment.
Providers shall withhold or withdraw life-prolonging measures. This is a mandatory directive.

The distinction is real. “May” leaves your medical team discretion; “shall” does not. If you want treatment stopped once a qualifying condition is confirmed, “shall” is the clearer instruction.

Section 3: An Exception for Feeding Tubes and IV Fluids

Section 3 is optional. Even if Section 2 tells providers to withhold life-prolonging measures, you can carve out an exception for artificial nutrition, artificial hydration, or both. If you want an exception, initial only one of these three blocks:¹

Both artificial hydration and artificial nutrition should continue.
Only artificial hydration should continue.
Only artificial nutrition should continue.

If you initial nothing here, your Section 2 instruction covers nutrition and hydration along with everything else. The form warns in capital letters not to initial more than one option in this section, because that creates conflicting instructions.

Section 4: Comfort Care

Section 4 is pre-printed and applies automatically. It directs providers to take reasonable steps to keep you clean, comfortable, and free of pain, even if that care happens to hasten death.¹ Nothing to initial. Pain management continues regardless of your other choices.

Section 6: What Happens If Your Healthcare Agent Disagrees

If you have signed a separate healthcare power of attorney naming someone to make medical decisions for you, Section 6 decides which document wins when they conflict. Initial one:¹

Follow this Advance Directive. Your written instructions override your agent’s contrary decisions.
Follow my Healthcare Agent. Your agent has authority to override this document.

If you initial neither, the statutory default is that the living will controls and your agent’s conflicting instructions are ignored.³ Giving your agent override authority adds flexibility for scenarios your form cannot anticipate, but it also means your written wishes can be set aside.

Signing With Witnesses and a Notary

Everyone signs at the same event. Do not put pen to the signature line until two qualified witnesses and a notary public (or a clerk or assistant clerk of superior court) are in the room with you.²

Who Can Serve as a Witness

Both witnesses must believe you are of sound mind, and each must meet every one of the following:¹

Not related to you or your spouse within the third degree. That excludes parents, grandparents, great-grandparents, children, grandchildren, siblings, aunts, uncles, nieces, and nephews.
Not someone who knows or reasonably expects they would inherit from you under your will or North Carolina’s intestacy rules.
Not someone holding a financial claim against your estate at the time you sign.
Not your attending physician, a paid employee of your physician, or a paid employee of the hospital, nursing home, or adult care home where you are a patient or resident.

Friends, neighbors, coworkers, and members of your faith community usually qualify. If even one witness is disqualified, the whole document can be challenged.

Notarization

After you and both witnesses sign, the notary certifies the signatures and applies the official seal. A North Carolina notary may charge up to $10 per signature for an in-person acknowledgment.⁴ Banks, UPS stores, and public libraries commonly offer notary services. A clerk or assistant clerk of superior court can perform the same function.

One thing you cannot do: notarize this form remotely. North Carolina explicitly prohibits remote online notarization for an Advance Directive for a Natural Death.⁵ Everyone has to be in the same physical room.

After You Sign: Registry and Copies

Your living will is legally valid the moment it is executed, but it only helps if the right people can find it. The Secretary of State’s office runs the North Carolina Advance Health Care Directive Registry, where you can file the document and receive a wallet card alerting emergency personnel that a directive is on file and allowing providers to retrieve it electronically.³

Also hand copies to:

Your primary care physician, with a request to add it to your permanent medical record.
Your healthcare agent, if you have one, along with the location of the original.
Close family members likely to be at your bedside or speaking with medical staff.
Any hospital or facility you are being admitted to, for scanning into their system.

Keep the original somewhere safe but reachable at home. A fireproof document box works. A safe-deposit box usually does not, because family members often cannot get in fast enough during an emergency.

Changing or Revoking It Later

You can revoke a living will at any time, regardless of your mental or physical condition. North Carolina recognizes two methods:¹

A signed written statement revoking the directive.
Communicating your intent to your attending physician in any clear and consistent manner, including verbal statements or gestures, so long as the intent is unambiguous.

If you revoke, try to destroy all copies, including any on file with the Secretary of State’s registry and any copies given to your physician or family. To change your choices rather than cancel them, the cleanest approach is to revoke the old form and sign a new one, running through the same witness and notary process.

How It Fits With Other Advance Directives

A living will handles the narrow question of life-prolonging treatment in the three statutory scenarios. A healthcare power of attorney is a separate document that names a person to make your other medical decisions, from approving surgery to choosing a rehab facility. Section 6 of the living will controls what happens when the two conflict.³

A living will is not the same as a DNR (do-not-resuscitate) order or a MOST (Medical Orders for Scope of Treatment) form. Those are medical orders written by a physician and placed in your chart. A living will is your directive to your physician. In fast-moving events like cardiac arrest, staff look for a physician order rather than a multi-page legal document, so ask your doctor to enter a DNR if that is what you want in a hospital setting.

If You Spend Time in Another State

Not every state handles out-of-state directives the same way. Many will honor a living will validly executed under the law of the state where it was signed, but hospitals unfamiliar with another state’s form sometimes hesitate, and terminology differences do not help; some states use “healthcare proxy” or “healthcare surrogate designation” for related concepts. If you spend significant time in another state, consider signing a second directive that complies with that state’s requirements so there is nothing to argue about at the bedside.

1
North Carolina General Assembly. North Carolina Code 90-321 – Right to a Natural Death
2
North Carolina General Assembly. North Carolina Code 90-321 – Right to a Natural Death
3
North Carolina Bar Association. Living Wills and Health Care Powers of Attorney
4
North Carolina General Assembly. North Carolina Code 10B-31 – Fees for Notarial Acts
5
North Carolina General Assembly. North Carolina Senate Bill 680 – Remote Notarization Act