What is an advance directive?
You are encouraged to make instructions for your mental health, substance use or intellectual/developmental disability treatment in advance to use if you become incapable of making such decisions.
The forms used to do this are called advance directives. The N.C. Secretary of State provides forms you can use to create advance directives that meet the requirements of state law.
However, you are not required to use these forms, and N.C. law allows the use of other forms that meet certain requirements. If you prepare your own advance directive, you should be very careful to make sure it is consistent with N.C. law. If you want to use any of the N.C. Secretary of State forms, you must complete the form, sign it and have your signature witnessed by two qualified witnesses and a notary public.
Follow the instructions about which choices you can initial very carefully. Do not sign the form until two witnesses and a notary public are present to watch you sign it.
All of the documents mentioned in this section must be written and signed by you while you still have capacity, understand your condition and your treatment choices and are able to make your wishes known. Keep a copy in a safe place and give copies to your healthcare agent, any alternates, your family, treatment team, doctor and the hospital where you are likely to receive treatment.
You can also arrange to have any of these advance directives filed in the N.C. Advance Health Care Directive Registry maintained by the Secretary of State. There is a $10 fee to register an advance directive. This includes registration, a revocation form, registration card and password.
You have the right to file a grievance with the N.C. Division of Health Service Regulation or with Vaya Health if you think the laws governing the advance directives have not been followed correctly. Even if you do not wish to file these forms as legal documents, the questions on these forms will help you plan for a crisis and think about what kind of treatment you would want.
Our Member Services Department can provide assistance with questions related to advance directives. Call 1-800-849-6127 to ask for help.
There are three types of advance directives in North Carolina that allow you to make your wishes known in case you are unable to make decisions for yourself: (1) Healthcare Power of Attorney, (2) Psychiatric Advance Directives (also known as the Advance Directive for Mental Health Care) and (3) advance directive for a natural death (also known as a living will).
This document gives the person you designate as your healthcare agent broad powers to make healthcare decisions for you when you cannot make the decision yourself or cannot communicate your decision to other people. You should discuss your wishes concerning life-prolonging measures, mental health treatment and other healthcare decisions with your healthcare agent.
Except to the extent that you express specific limitations or restrictions in this form, your healthcare agent may make any healthcare decision you could make yourself.
The Psychiatric Advance Directive (PAD), also called an Advance Directive for Mental Healthcare, is a legal document that records your instructions for your mental health treatment if you cannot communicate or make voluntary decisions for yourself.
The instructions may include statements about:
- What you think calms you down
- How you feel about seclusion or electroconvulsive therapy
- Whom to contact in the event of a mental health crisis
- What medicines you do not want to take
- Which doctor you want to be in charge of your treatment
These are decisions you can make in advance of any situation in which you are unable to communicate your wishes about your care and provide specific instructions to be followed by a physician or psychologist. The instructions you include in the PAD will be followed if a physician or eligible psychologist determines that you are incapable of making and communicating treatment decisions.
Your instructions may be overridden if you are being held in accordance with civil commitment law.
A living will is a notarized document that tells others that you want to die a natural death if you are incurably sick and cannot receive nutrition or breathe on your own. You can use the living will form to give instructions for the future if you want your healthcare providers to withhold or withdraw life-prolonging measures in certain situations.
A living will goes into effect when you are unable to share what you want to happen regarding your care or when you are in a persistent vegetative state. You should talk to your doctor about what these terms mean. The living will states what choices you would have made for yourself if you were able to communicate. Talk to your family members, friends and others you trust about your choices.
Yes. You may cancel or change your advance directives at any time if you have not been determined to be incapable. It is important to know that you may not revoke advance directives after you are found incapable by a physician or other authorized mental health treatment provider.
If you revoke your advance directive, you must inform anyone who has copies of the document about the change. A revocation is effective when it is communicated to your attending physician or other provider. There is a revocation form available on the N.C. Secretary of State website that you can use.