Health care directive in North Dakota: form, signing and who decides

The form, who can witness, who can be your agent and who decides if you have no directive in North Dakota.

Checked against official sources: October 31, 2026.

Short answer

Health care directive

Official form
Health Care Directive - optional form
How to sign
Notarized or signed by two adult witnesses
Who decides without a directive
Yes

The document and its form

Document
Health care directive
Official form
Health Care Directive - optional form (N.D.C.C. 23-06.5-17)Published by North Dakota Legislative BranchVersion: Statutory optional form, N.D.C.C. 23-06.5-17 (current Century Code)

You do not have to use it.

Living will

Health care instructions (in the health care directive)

Part of the directive.

Your treatment instructions, for example about life-prolonging treatment or artificially administered nutrition and hydration, go in the health care directive, with or without naming an agent. The same signing rule applies.

Law: N.D.C.C. §§ 23-06.5-16, 23-06.5-17; N.D.C.C. §§ 23-06.5-03, 23-06.5-05.1

Signing rules

How to sign

Sign and date the health care directive and have the signature verified either by a notary public or by two qualified adult witnesses. It must include a health care instruction, a power of attorney for health care, or both.

Who signs

In writing, dated, stating your name, and signed by you (or by another person in your presence at your express direction if you cannot sign).

Notary
A notary or witnesses (your choice)
Witnesses
2 (instead of a notary)
Who cannot witness

Your signature must be verified by a notary public or by at least two witnesses age 18 or older. At least one witness must not be a health care or long-term care provider giving you direct care, or such a provider's employee, on the day you sign. The notary or any witness cannot be your agent, your spouse or heir, a relative by blood, marriage or adoption, someone entitled to part of your estate, someone with a claim against your estate, a person directly financially responsible for your medical care, or your attending physician. A notary may be an employee of a health care or long-term care provider giving you direct care.

Law: N.D.C.C. § 23-06.5-05

Who can be your agent and what the agent can do

Who cannot be your agent

These people cannot act as your health care agent while serving in that role: your health care provider, a nonrelative employee of your health care provider, your long-term care services provider, or a nonrelative employee of your long-term care services provider.

Law: N.D.C.C. 23-06.5-04

When the agent starts

The directive and the agent's authority are in effect only when your attending physician, psychiatrist or psychologist certifies in writing in your medical record that you lack capacity, and stop when you recover capacity. You can choose to let your agent decide even while you have capacity.

Law: N.D.C.C. 23-06.5-03(3), (4)

Decisions an agent cannot make

An agent cannot consent to admission to a mental health facility or state institution for more than 45 days without a mental health proceeding or court order, or to psychosurgery, abortion or sterilization unless first approved by a court. Directives that withhold care do not apply to emergency treatment before reaching a hospital.

Law: N.D.C.C. 23-06.5-03(6); N.D.C.C. 23-06.5-13(13)

Revoking and conflicting documents

Revoking your agent

A health care directive is revoked when you tell your agent or a health care or long-term care provider, orally or in writing, or by any other act showing a specific intent to revoke, or when you sign a later health care directive.

Law: N.D.C.C. 23-06.5-07(1)

Revoking your instructions

The same rule covers the whole directive.

Law: N.D.C.C. 23-06.5-07(1)

Telling others

A provider who learns of a revocation must immediately record it in your medical record and notify your agent, attending physician and care staff.

Law: N.D.C.C. 23-06.5-07(2)

Divorce ends a spouse's authority
Yes · Divorce rules in North Dakota (Divorce Law Map)
Conflicting documents

If health care directives conflict, the one signed later controls. Unless a court decides otherwise, your health care agent's appointment takes precedence over a guardian's medical decision authority.

Law: N.D.C.C. 23-06.5-13(2); N.D.C.C. 23-06.5-13(1), 30.1-28-04(6)

Law: N.D.C.C. § 23-06.5-07

If you have no directive

Who decides without a directive

Unless a court decides otherwise, people in these classes, in this order, can give informed consent for an incapacitated adult whose attending physician, psychiatrist or psychologist has certified incapacity. The provider must try to reach the highest class first; a lower class cannot consent if a higher-priority person refused. The person must first decide in good faith whether you would consent, and otherwise decide based on your best interests.

  1. A health care agent under a health care directive (or similar out-of-state instrument)
  2. A court-appointed guardian or custodian
  3. Your spouse who has maintained significant contact with you
  4. An adult child who has maintained significant contact with you
  5. A parent, including a stepparent who has maintained significant contact with you
  6. An adult sibling who has maintained significant contact with you
  7. A grandparent who has maintained significant contact with you
  8. An adult grandchild who has maintained significant contact with you
  9. An adult close relative or friend who has maintained significant contact with you
  10. An interdisciplinary team of at least three health care professionals

Law: N.D.C.C. § 23-12-13

Other states, registry and medical orders

Signed in another state

Chapter 23-06.5 does not limit the enforceability of a health care directive or similar instrument made in another state under that state's law.

Law: N.D.C.C. 23-06.5-11

Free notice: revoke or change a health care directive

Names and addresses of people and facilities that should know. They go into your letter only.

Other formats

Sign the letter and keep a copy. This tool does not check whether your document is valid, and it is not legal advice.

Free help in North Dakota

Report abuse or exploitation

North Dakota Health and Human Services - Vulnerable Adult Protective Services · 1-855-462-5465

Questions about powers of attorney in North Dakota

How do I sign a health care directive in North Dakota?

Sign and date the health care directive and have the signature verified either by a notary public or by two qualified adult witnesses. It must include a health care instruction, a power of attorney for health care, or both.

Who decides my health care if I have no directive in North Dakota?

Unless a court decides otherwise, people in these classes, in this order, can give informed consent for an incapacitated adult whose attending physician, psychiatrist or psychologist has certified incapacity. The provider must try to reach the highest class first; a lower class cannot consent if a higher-priority person refused.

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