Dec302025
Estate Planning Q&A Series

How can I choose and name an agent for my healthcare power of attorney, and what decisions can that person make? – North Carolina

Short Answer

In North Carolina, a healthcare power of attorney lets an adult name a competent person (the “health care agent”) to make healthcare decisions if the adult later cannot make or communicate those decisions. The agent can usually make the same healthcare decisions the adult could make, including decisions about treatment, facilities, and (if granted) life-prolonging measures and certain mental health treatment decisions. The document can also limit the agent’s powers and can name backups in case the first agent cannot serve.

Understanding the Problem

Under North Carolina estate planning law, can an adult name a health care agent in a healthcare power of attorney, how should that agent be identified in the document, and what healthcare decisions can the agent make if the adult later lacks capacity to make or communicate healthcare decisions?

Apply the Law

North Carolina allows an adult with capacity to sign a healthcare power of attorney that appoints a health care agent. The agent’s authority typically “turns on” when a physician determines the person lacks capacity to make or communicate healthcare decisions. Unless the document limits the authority, the agent may generally make healthcare decisions to the same extent the person could have made them while capable, including decisions about life-prolonging measures and certain mental health treatment decisions. The document can name successor agents and can include rules for resignation, removal, and substitution.

Key Requirements

  • Eligible principal: The person signing must be at least 18 and have capacity to make and communicate healthcare decisions at the time of signing.
  • Eligible agent and clear naming: The agent must be a competent adult and generally cannot be a paid healthcare provider for the principal. The document should clearly list the primary agent and at least one successor agent in order.
  • Defined scope and limits: The document should state when the agent’s authority becomes effective, what decisions the agent may make, and any limits (for example, limits on artificial nutrition/hydration, mental health treatment decisions, or end-of-life decisions).

What the Statutes Say

Analysis

Apply the Rule to the Facts: The facts describe a plan to draft a North Carolina healthcare power of attorney as part of an estate planning package. Under North Carolina law, the key drafting decisions are (1) selecting an eligible, competent adult agent and naming successor agents in order, and (2) deciding whether the agent should have broad authority or whether the document should include specific limits (for example, on life-prolonging measures, artificial nutrition/hydration, or mental health treatment decisions). The document should also address what happens if the first-choice agent cannot serve, because the healthcare power of attorney may stop being effective if no agent is available and no substitution method applies.

Process & Timing

  1. Who signs: The adult creating the healthcare power of attorney (the “principal”). Where: Typically signed in the presence of two qualified witnesses and a notary public in North Carolina. What: A North Carolina healthcare power of attorney (often based on the statutory form, with customized agent names, successor agents, and any limits). When: Signed while the principal has capacity; the agent’s authority usually becomes effective only after a physician determines the principal lacks capacity to make or communicate healthcare decisions.
  2. After signing: Provide copies to the named agent(s) and key healthcare providers so the document is available in an emergency. Many families also keep a copy with other estate planning documents and carry a wallet card noting that a healthcare power of attorney exists.
  3. When decisions arise: If the principal later lacks capacity, the agent can speak with providers, access medical information, and consent to or refuse treatment within the scope of the document. If the primary agent is unavailable or unwilling, the next named successor agent steps in.

Exceptions & Pitfalls

  • Choosing an ineligible agent: North Carolina generally does not allow a paid healthcare provider for the principal to serve as the agent. Picking someone who is not eligible can cause delays when the document is needed most.
  • No successor agent named: If the named agent dies, refuses to act, or cannot be reached, and the document has no workable substitution plan, the healthcare power of attorney can cease to be effective.
  • Unclear limits (or accidental limits): Limits must be written clearly. Some form-style options can unintentionally remove authority if a limitation is selected but not explained, which can block the agent from making a decision that later becomes urgent.
  • Mismatch with mental health instructions: If there is a separate advance instruction for mental health treatment, the agent’s mental health decisions must be consistent with it. Conflicting documents can create confusion and slow care decisions.
  • Confusing healthcare vs. financial authority: A healthcare power of attorney does not give general authority over money or property. Separate documents usually handle financial decisions, even if healthcare decisions may involve signing medical paperwork and incurring reasonable healthcare-related costs.

Conclusion

In North Carolina, a healthcare power of attorney allows an adult with capacity to name a competent adult health care agent (and backups) to make healthcare decisions if a physician determines the adult cannot make or communicate those decisions. Unless limited, the agent can generally make the same healthcare decisions the adult could make, including decisions about treatment, facilities, and certain end-of-life and mental health matters if granted. The next step is to sign the healthcare power of attorney with two qualified witnesses and a notary while capacity is intact.

Talk to a Estate Planning Attorney

If you’re dealing with choosing the right health care agent and setting clear limits on what that person can decide, our firm has experienced attorneys who can help explain options and timelines under North Carolina law. Call us today at (919) 341-7055.

Disclaimer: This article provides general information about North Carolina law based on the single question stated above. It is not legal advice for your specific situation and does not create an attorney-client relationship. Laws, procedures, and local practice can change and may vary by county. If you have a deadline, act promptly and speak with a licensed North Carolina attorney.

Category: Estate Planning Q&A Series

Author: jpierce

Attorney Jared Pierce is the founder of Pierce Law Group in Raleigh, North Carolina, a firm he established with a dedicated focus on probate administration and estate planning across North Carolina. Born and raised in the Republic of South Africa, Jared moved to Durham with his family in 2001, bringing with him a rich cultural background and a distinctive accent that often serves as a conversation starter.