Committee considers adopting Uniform Health Care Decisions Act to clarify advance directives and surrogates

Assemblymembers David Orentlicher (Assembly District 20) and Shay Backus (Assembly District 37) presented Assembly Bill 461 to the Assembly Committee on Health and Human Services as a vehicle to adopt the 2023 Uniform Health Care Decisions Act, a model law produced by the Uniform Law Commission. Orentlicher told the committee that most sections are “designed to enact the 2023 version of the Uniform Health Care Decisions Act,” and that the bill updates the state’s approach to advance health care directives, surrogate decision making and capacity assessments.

The bill text would add definitions and procedures to determine when a patient lacks capacity, set a presumption that people have capacity unless found otherwise, recognize appointment of an agent (a surrogate) and specify the surrogate’s duties to follow the patient’s instructions, goals and preferences or, when unavailable, the patient’s best interests. The measure includes separate recognition of advance directives for mental health care and so‑called ‘‘Ulysses clauses’’ that allow people to direct care during episodic mental‑health crises. Sponsors said the act also includes good‑faith immunity for health care professionals who follow or reasonably rely on valid documents and that it explicitly does not authorize assisted suicide or euthanasia.

Professor Nina Cohn, a drafter of the Uniform Act, told the committee the law’s goal is to reduce confusion by clarifying what “capacity” means for specific health decisions and by providing a single, accessible form to replace multiple older forms in state law. Cohn said the statute spells out a presumption of capacity and the specific understanding required to make decisions, which she said will reduce ad hoc determinations in hospitals and clinics.

Supporters included AARP Nevada, the Alzheimer’s Association, students and family members who described personal experiences making medical decisions for relatives. Matilda Miller, government relations director at Native Voters Alliance, recounted making life‑and‑death decisions at 18 and urged a public awareness campaign and simpler forms. The Alzheimer’s Association urged the committee to approve AB 461 as part of efforts to improve advanced care planning for people with dementia.

Sponsors said a conceptual amendment would eliminate older, narrower forms from statute and replace them with the single uniform form adopted under the act. Committee members asked about which licensed professionals can assess capacity; sponsors and Professor Cohn replied that the bill uses a broad definition of health care professional that includes physicians and other licensed practitioners and that section 29 lists the types of practitioners and evaluators appropriate to capacity assessments. Members asked about language access and cultural relevance for forms and outreach; sponsors said the public awareness campaign would address accessibility and plain‑language concerns and agreed to work with members on clarifying language in a conceptual amendment. There was no opposition testimony recorded and the committee did not take a final vote during the hearing.