End-of-Life Planning Checklist for North Carolina: Every Document You Need

End-of-life planning in North Carolina involves more legal steps than most people realize. A Living Will alone doesn't cover it. An HCPOA alone doesn't cover it. Even both together leave gaps if you haven't addressed clinical orders, organ donation, estate protections, and document distribution. This checklist walks through everything — in the order you should tackle it.

Part 1: Healthcare Planning Documents

Living Will (Advance Directive for a Natural Death)

The Living Will under N.C.G.S. § 90-321 lets you direct the withholding or withdrawal of life-prolonging treatments when you have a terminal condition, persistent vegetative state, or advanced dementia (the dementia clause is optional — you must affirmatively select it).

• [ ] Draft your Living Will specifying which treatments to refuse (ventilation, CPR, dialysis, feeding tubes, antibiotics, artificial hydration)
• [ ] Select or decline the optional dementia trigger clause
• [ ] Sign before two qualified witnesses AND a notary public — the Living Will requires both (unlike the HCPOA)
• [ ] Confirm witnesses are not related to you by blood or marriage within the third degree, not heirs to your estate, not creditors, and not paid employees of your healthcare facility

Health Care Power of Attorney (HCPOA)

The HCPOA under N.C.G.S. Chapter 32A names your health care agent — the person authorized to make medical decisions when you cannot.

• [ ] Choose a primary agent and at least one successor agent
• [ ] Decide whether to include mental health treatment authority (required for psychiatric care decisions, ECT consent)
• [ ] Decide whether to include anatomical gift authority under § 32A-25.1
• [ ] Decide whether to delegate authority over disposition of remains
• [ ] Sign before either two qualified witnesses OR a notary public (House Bill 1115 allows either method for the HCPOA)

Clinical Orders (If Currently Ill)

If you have a terminal or serious illness, these physician-signed orders translate your advance directives into immediate clinical instructions:

• [ ] Portable DNR order — must be printed on Goldenrod paper and signed by your physician, PA, or NP; prevents unwanted resuscitation by EMS
• [ ] MOST form (Medical Orders for Scope of Treatment) — must be printed on Astrobrights Pulsar Pink paper; covers CPR status, medical interventions, antibiotics, artificial nutrition, and other treatment preferences
• [ ] Store originals where EMS can find them — on the refrigerator, above the bed, or on the bedroom door

Part 2: Document Distribution

Completing the documents is half the job. Getting them to the right people is the other half.

• [ ] Give copies to your health care agent and successor agents
• [ ] Provide copies to your primary care physician
• [ ] Upload to your hospital system's electronic medical records (MyChart, FollowMyHealth, or equivalent)
• [ ] Give copies to any specialists managing chronic conditions
• [ ] File with the NC Secretary of State Advance Health Care Directive Registry ($10 per document) — this creates a searchable backup that emergency providers can access
• [ ] Keep wallet card from the Secretary of State registry in your wallet or purse
• [ ] Store originals in a known, accessible location — not a safe deposit box (banks close at 5 p.m.; emergencies don't)

Part 3: Conversations

Documents are legal instruments. Conversations are what make them work.

• [ ] Tell your health care agent your specific preferences — ventilators, feeding tubes, comfort vs. alertness trade-offs, organ donation, facility preferences
• [ ] Discuss your wishes with your spouse or partner (especially if they are not your designated agent)
• [ ] Inform adult children about the existence and location of your documents
• [ ] Talk to your physician about the circumstances under which a MOST form or portable DNR would be appropriate
• [ ] If you have strong feelings about palliative sedation or VSED (voluntarily stopping eating and drinking), discuss these with your agent

Part 4: Organ Donation and Anatomical Gifts

• [ ] Decide whether you want to donate organs, tissues, or your whole body
• [ ] Update your NC driver's license organ donor designation if appropriate
• [ ] Include anatomical gift authority in your HCPOA if you want your agent to make donation decisions
• [ ] Consider filing a separate declaration of anatomical gift with the Secretary of State registry
• [ ] If interested in whole-body donation, contact a NC medical school program directly (UNC, Duke, ECU, Wake Forest each have pre-registration requirements)

Part 5: Estate Planning Integration

End-of-life healthcare planning doesn't exist in a vacuum. These estate planning steps connect directly to your advance directives:

• [ ] Execute a financial Power of Attorney (separate from the HCPOA) — covers bank accounts, bills, and property management during incapacity
• [ ] Review beneficiary designations on life insurance, retirement accounts, and bank accounts — these transfer outside probate regardless of your will
• [ ] Understand the Spousal Year's Allowance ($60,000 under N.C.G.S. § 30-15) — your surviving spouse should know about this immediate post-death entitlement
• [ ] Confirm whether a will is current and reflects your wishes — without one, North Carolina's intestate succession laws determine who inherits
• [ ] Consider whether non-probate transfers (Lady Bird deeds, joint tenancy with right of survivorship, transfer-on-death accounts) should be part of your plan

Part 6: Review and Maintenance

Advance directives aren't one-and-done documents.

• [ ] Review all documents after any major life event: marriage, divorce, new diagnosis, death of your agent, move to or from North Carolina
• [ ] Note that divorce automatically revokes a spousal agent appointment (but the rest of the HCPOA remains valid, including successor agents)
• [ ] Update the Secretary of State registry if you execute revised documents
• [ ] Redistribute updated copies to all providers and agents
• [ ] Confirm your MOST form and DNR orders still reflect your current preferences (clinical situations change)

Getting Started

The hardest part is starting. Most people get stuck not because the process is complicated, but because they don't have a clear sequence. This checklist gives you the sequence — work through it section by section, and you'll have comprehensive end-of-life planning in place.

The North Carolina Advance Directive & Living Will Kit includes the statutory forms, witness screening tools, and step-by-step worksheets that turn this checklist into a completed set of legally valid documents.

See more North Carolina guides →