Senate committee substitute to the 3rd edition makes the following changes.

Removes provisions allowing parent choice in nursing service providers required under an individualized education plan. Makes conforming changes to act's titles. 

Part I.

Removes the act’s changes to GS 32A-16(3) pertaining to health care powers of attorney. Instead, amends GS 32A-16(6), pertaining to qualified witnesses, as follows. Makes organizational changes. Adds the requirement that the witness both (1) received training on recognizing  whether the declarant meets the legal requirements for competency to execute the health care power of attorney and (2) has been designated by his or her employer to serve as a witness to the execution of the health care power of attorney.

Modifies the Health Care Power of Attorney form so that a notary is required to confirm the identity of the two witnesses; removes proposed election to have it notarized instead of witnessed. Adds provisions from existing form language pertaining to designation of health care agent, effectiveness of appointment, revocation, general statements of authority granted, special provisions and limitations, organ donation, guardianship, reliance of third parties on health care agent, and miscellaneous provisions. Makes conforming change to account for changes to GS 32A-16. Makes organizational changes.

Part II.

Makes technical changes to GS 90-321(c). Makes organizational change. Requires the declaration to have been signed before two witnesses (previous edition allowed it be done before a notary public). Allows for health care provider employees of the declarant’s attending physician that have both (i) received training on recognizing whether the declarant meets the legal requirements for competency to execute the Advanced Directive for a Natural Death and (ii) been designated by his or her employer to serve as a witness to the execution of the Advanced Directive for a Natural Death to serve as a witness to advance directive for a natural death (i.e., a living will). Modifies the statutory form as follows. Requires that the two witnesses sign in front of a notary public. Adds the following provisions from existing form language: when my directives apply, directives about prolonging life, exceptions (artificial nutrition or hydration), wish to be made as comfortable as possible, acknowledgement of understanding of their advance directive, if there is an advanced health care agent, authorizing a health care provider to rely upon the directive, an option for the directive to be effective anywhere, and the right to revoke the directive at any time. Makes conforming changes to the form.

Changes the effective date to October 1, 2026.