Honoring Choices North Dakota: What It Offers and What It Doesn't Cover

If you've searched for advance directive help in North Dakota, you've probably landed on Honoring Choices North Dakota. It's one of the most visible advance care planning programs in the state, backed by the American College of Physicians North Dakota Chapter and supported by local health systems. Their resources are free, clinically sound, and a reasonable starting point.

But "starting point" is the operative phrase. Honoring Choices focuses on the medical conversation. If your planning needs extend to asset protection, mineral rights, or making sure the document is actually enforceable under North Dakota's strict execution rules, you'll need more than what the program provides.

What Honoring Choices North Dakota Does Well

Honoring Choices distributes both short-form and long-form versions of the North Dakota Health Care Directive. Their materials walk you through the basics of naming a healthcare agent and expressing preferences about life-sustaining treatment. Local facilitators — often trained volunteers at hospitals and faith communities — can sit with you and guide the conversation about what matters to you at end of life.

The program also connects to the POLST (Provider Orders for Life-Sustaining Treatment) framework, helping seriously ill patients translate their wishes into actionable medical orders that travel with them between care settings. For someone who primarily needs to document their CPR preferences and comfort care instructions, Honoring Choices covers that ground capably.

Where the Gaps Show Up

The program is built around clinical advance care planning. That means it addresses what happens in a hospital bed, not what happens to your farm, your mineral leases, or your family's finances when a medical crisis hits.

No witness compliance guidance. North Dakota's execution requirements under NDCC § 23-06.5-05 are among the most detailed in the country. Your witnesses cannot be your spouse, any blood or adoptive relative, your named agent, anyone who inherits from your estate, or anyone with a financial claim against it. If you use witnesses instead of a notary, one must not be a healthcare provider currently treating you. Honoring Choices provides the form but doesn't include a systematic qualification checklist to prevent signing errors.

No asset coordination. For families with agricultural land, energy leases, or Bakken mineral rights, a health care directive is the first domino. Without a designated agent, energy companies freeze royalty payments immediately upon learning of an owner's incapacity. Farm operations stall. The family gets pushed toward an expensive, public court guardianship instead of a private, pre-planned transition. Honoring Choices doesn't address how your directive coordinates with Transfer-on-Death deeds, living trusts, or Medicaid estate recovery protections.

No registry walkthrough. North Dakota operates a Health Care Directive Registry through the NDHIN (North Dakota Health Information Network). Registering your directive means any participating hospital can access your wishes electronically. Honoring Choices mentions the registry but doesn't provide step-by-step registration instructions.

No POLST-vs-directive clarity. Many families confuse the POLST with an advance directive. A POLST is a medical order for people with serious illness — signed by a physician, active immediately, and focused on emergency interventions. A health care directive is a legal planning document for any competent adult — activated only when capacity is lost, and covering agent appointment plus broad care instructions. Mixing them up can mean your family holds one document when they need the other.

When the Free Form Is Enough (and When It Isn't)

If you're a healthy adult with straightforward wishes, no complex assets, and a family structure where the default surrogate hierarchy under NDCC § 23-12-13 would produce the result you want anyway, the Honoring Choices form paired with careful attention to the witness rules may be sufficient.

But if any of these apply to you, the free form alone creates risk:

• You own agricultural land, mineral rights, or cooperative equity
• You have blended family dynamics where the default hierarchy could produce conflict
• You want to understand how your directive interacts with financial powers of attorney and TOD deeds
• You need to register your directive with the NDHIN and want a walkthrough
• You want a signing-day checklist that prevents witness disqualification errors

Filling the Gaps

The North Dakota Advance Directive & Living Will Kit builds on the same statutory framework Honoring Choices uses, then extends it. It includes a zero-error execution checklist for witness and notary compliance, a signing-day script, step-by-step NDHIN registry instructions, and dedicated sections on farm succession coordination, mineral rights protection, and Medicaid estate recovery. For families whose planning needs go beyond the clinical conversation, it bridges the gap between a free hospital form and a $1,500 elder law attorney consultation.

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