HB 1115 revises North Carolina law governing advance health care planning documents, including health care powers of attorney, advance directives for a natural death (“living wills”), and advance instructions for mental health treatment. The bill is based in part on recommendations from the General Statutes Commission and the 2023 Uniform Health-Care Decisions Act. It clarifies how these documents relate to one another, expressly allows them to be combined into a single instrument, and requires combined documents to be clearly labeled with each component separately titled.
The bill also simplifies execution requirements for these documents. For health care powers of attorney and living wills, it changes the law to allow execution either before two qualified witnesses or before a notary public, rather than requiring both in all cases. For advance instructions for mental health treatment, it similarly updates the form and execution rules and clarifies that these instructions may be combined with other advance planning documents. The bill makes conforming changes throughout the General Statutes to align definitions, cross-references, and form language, and it repeals one existing statute related to health care powers of attorney.
A major substantive change is the expansion of who may consent to treatment when a patient lacks capacity and has no applicable directive. The bill adds several categories of surrogate decision-makers, including certain long-term household members, supported decision-making assistants, and stepchildren with ongoing relationships, in addition to the existing hierarchy of guardians, spouses, parents, children, siblings, grandparents, and others. It also updates provisions on when physicians may rely on advance directives, when they may decline to honor them for conscience-based reasons, and how out-of-state documents are treated.
The bill’s impact on state law is broad but targeted: it modernizes and harmonizes three separate statutory frameworks in Chapters 32A, 90, and 122C, while preserving the validity of documents executed before the effective date. It also adds protections for health care agents and providers acting in good faith, and it clarifies that these documents do not authorize actions intended to end life other than allowing the natural dying process. The bill is scheduled to take effect January 1, 2027, unless the related House Bill 349 becomes law, in which case Part II of this bill is repealed.
No committee transcript or recorded vote information was provided, so the overall sentiment cannot be measured from debate or roll call history. Based on the bill text, the measure appears largely technical and consensus-oriented, aimed at simplifying estate and end-of-life planning and reducing formal barriers to execution. The main likely points of contention are the expansion of surrogate decision-makers, the ability to combine multiple directives into one document, and the conscience-based refusal provisions for physicians and facilities.
HB 1115 would amend multiple North Carolina statutes governing advance health care planning, including Chapter 32A (health care powers of attorney), Chapter 90 (living wills/advance directives), Chapter 122C (advance instructions for mental health treatment), and related informed-consent provisions. It would allow these documents to be combined, simplify witnessing/notarization requirements, expand surrogate consent authority when no directive exists, and update statutory forms and definitions. The bill also repeals one existing statute and makes conforming changes to cross-references and liability protections for agents and providers.
No votes or committee discussion were provided, so there is no recorded legislative sentiment to summarize from the available history. From the bill text itself, the measure reads as a technical modernization effort with a generally practical, noncontroversial purpose: making advance care documents easier to execute and more consistent across statutes. The inclusion of contingency language tied to House Bill 349 suggests the sponsor and drafters were trying to ensure the full set of recommendations could be enacted regardless of the fate of a related bill.
The most likely points of contention are the policy choices embedded in the bill rather than its technical drafting. These include expanding the list of people who may make health care decisions for incapacitated patients without a directive, allowing combined documents that may be easier to execute but more complex to interpret, and preserving conscience-based refusals by physicians and facilities. Stakeholders most likely to focus on these issues include health care providers, hospitals, elder-law and estate-planning practitioners, disability advocates, and families dealing with end-of-life or mental health treatment decisions.