By Amanda Stevens and Whitney Short
In Nevada, there are four types of documents whereby you can give instruction on the health care you would like to receive regarding a specific medical situation if you are unable to make the decision for yourself due to incapacity. Regarding these documents, the term “health care” encompasses all “care, treatment, service or procedure to maintain, monitor, diagnose or otherwise affect the physical or mental illness, injury or condition of an individual.” NRS 162A.736. This article will discuss what each of these documents does and how they relate to one another.
1. Durable power of attorney for health care (“HPOA”), also known as advance health care directive (NRS 162A.700–162A.870).
A HPOA is a document where you state your wishes as they relate to a multitude of health care decisions and appoint one or more agents to carry out your wishes. You can also designate a successor agent to act if an agent resigns, dies, becomes incapacitated, or declines to serve. A HPOA is effective upon signing, unless you state in your HPOA that it becomes effective at a future date or upon incapacity as determined in writing by an advanced practice registered nurse, physician, psychiatrist, or licensed psychologist. A HPOA terminates when you revoke it; at a termination date if your HPOA includes one; upon your death; or if your named agent dies, and your HPOA does not list a successor agent. You can update your HPOA at any time, and your new HPOA automatically revokes any previous HPOA. You must make sure your health care providers have the most updated version of your HPOA.
2. Declaration (NRS 449A.415, 449A.433-449A.481).
A declaration is a document in which you direct the withholding or withdrawal of life-sustaining treatment or designate another person to make those decisions for you. One common example is that a declaration is used to withhold life support if you are in a persistent vegetative state. You can sign a declaration at any time. This declaration can be included as part of your HPOA or as a separate document. You can revoke a declaration at any time, by any means (written or orally), without regard to your mental or physical condition. Any revocation is effective upon its communication to your attending physician or other health care provider by you or a witness to the revocation.
3. Do-Not-Resuscitate Order (“DNR”) (NRS 450B.510–450B.525).
A DNR is a written directive that emergency life-resuscitating treatment must not be administered to you. Life-resuscitating treatment means “cardiopulmonary resuscitation or a component of cardiopulmonary resuscitation, including chest compressions, defibrillation, cardioversion, assisted ventilation, airway intubation or administration of cardiotonic drugs.” NRS 450B.450. A DNR can only be issued in writing by a Nevada licensed physician or advanced practice registered nurse and to a patient who has a terminal condition. A DNR will only be effective if you (as the patient) have agreed to its terms in writing while you have capacity to make such a decision. However, if you provided authority to your agent in your HPOA and you no longer have capacity, your agent can agree to the terms of the DNR. You may revoke your DNR by removing or destroying it or requesting the removal or destruction.
4. Provider order for life-sustaining treatment (“POLST”) (NRS 449A.542), also known as a “living will.”
A POLST is a standardized form in which you state if you want to make anatomical gifts as well as your wishes regarding life-resuscitating treatment and life-sustaining treatment. The POLST directs your health care provider to adhere to your wishes. A POLST can be revoked at any time and in any manner so long as you have capacity upon communicating your desire to revoke the POLST to your health care provider. Your health care provider will make your revocation part of your medical record.
If the above four documents happen to contradict each other, your health care provider is directed to follow the document that was the most recently created so long as you had capacity when creating it. Importantly, Nevada has created a secure database where you can register your HPOA, called the Nevada Lockbox Advanced Directive Registry. This database contains a copy of each document filed by you which is kept confidentially and readily available for authorized health care providers to access in a medical emergency.
Many people think it is too early to have these types of documents prepared. However, no one can foresee when they will need them. A common misconception is that spouses, domestic partners, and parents can automatically make health-care decisions for their spouse, domestic partner, or adult child, but that is not always the case. Such decisions should not be made without the appropriate documents. Loved ones will be tasked with a variety of challenges during these heartbreaking moments, and this is one less situation they must worry about.
About the authors
Amanda L. Stevens and Whitney E. Short of Short & Stevens Law, LLC. Amanda and Whitney met during law school at Boyd School of Law and have been active members of the CCBA since graduating in 2015. Short & Stevens Law practices exclusively in the areas of estate planning, probate, business law, and real estate law.
About the article
© 2024 Clark County Bar Association (CCBA). All rights reserved. No reproduction of any portion of this issue is allowed without written permission from the publisher. Editorial policy available upon request.
This article was originally published in the Communiqué (Oct. 2024), the official publication of the Clark County Bar Association. See https://clarkcountybar.org/about/member-benefits/communique-2024/communique-oct-2024/.
The articles and advertisements appearing in Communiqué magazine do not necessarily reflect the opinion of the CCBA, the CCBA Publications Committee, the editorial board, or the other authors. All legal and other issues discussed are not for the purpose of answering specific legal questions. Attorneys and others are strongly advised to independently research all issues.