Starting January 1, 2026, Utah adopted the Uniform Health-Care Decisions Act (Utah Code § 75A-9-101 et seq.), replacing the previous advance directive framework that had been in place for years. The new law introduces a significantly more detailed optional form that gives you more control over your future health-care decisions than the old one ever did.
If you already have an advance directive, here’s the most important thing to know up front: your existing directive is still valid. The new law explicitly says so in its saving provision (§ 75A-9-128). An advance directive created before January 1, 2026 remains valid as long as it complied with the law at the time it was created. So this is not a “drop everything and redo your paperwork” situation.
That said, there are some very good reasons to consider updating to the new form, and I’ll walk you through them below.
Why Update If My Old One Still Works?
Your old directive will continue to be honored. But the new form lets you express your wishes with a level of detail that simply wasn’t available before. Think of it this way: the old form was like telling someone your general preferences for dinner. The new form lets you hand them the recipe.
On top of that, as the new form becomes the standard in Utah, health-care providers will become increasingly familiar with its format and structure. Having your wishes documented in the form they’re trained on can only help ensure those wishes are followed when it matters most.
What’s New in the Form
The new optional form (§ 75A-9-110) is organized into several parts. Let me walk through the key sections and what they mean for you in practical terms.
Part A: Naming an Agent (and an Alternate)
This part is similar to the old form — you designate someone to make health-care decisions for you if you can’t make them yourself. The new form also provides a clear space to name an alternate agent in case your first choice isn’t available or able to serve.
The big question here isn’t a legal one — it’s a personal one. Who do you trust to carry out your wishes, even under pressure, even when family members might disagree? If you haven’t had that conversation with the person you’re considering, now is the time. Naming someone as your agent without telling them is a bit like volunteering someone to run a marathon without checking if they own running shoes.
Part B: Health-Care Instructions
This is where the new form really shines compared to the old one. Instead of a single general section about your preferences, the new form breaks your end-of-life treatment wishes into three distinct categories, each with specific scenarios to consider. This is worth spending some time on, so let me explain what each one means.
Treatment (Life-Sustaining Medical Treatment)
This covers the medical interventions that keep you alive but aren’t being provided for your comfort — things like mechanical ventilation (a breathing machine), CPR, dialysis, vasopressors (medications to keep your blood pressure up), and similar measures. These are treatments that sustain or restore vital functions when your body can no longer do so on its own.
The form asks you to consider whether you’d want these treatments under different circumstances: if you have a terminal condition expected to cause death soon even with treatment, if you’re permanently unconscious, or if you have an irreversible condition that prevents you from communicating, caring for yourself, or recognizing loved ones. You can also write in your own conditions. The key point is that you’re not making a single blanket decision — you’re telling your agent how you feel about life-sustaining treatment under several different scenarios, which gives them much better guidance when the moment comes.
Food and Liquids (Artificial Nutrition and Hydration)
This section addresses what happens if you can no longer swallow and the only way to receive nutrition and hydration is through a feeding tube or IV — not just for recovery, but for the remainder of your life. This is separate from the treatment section because many people feel differently about artificial nutrition and hydration than they do about other life-sustaining measures. Some people view tube feeding as basic care that should always be provided, while others view prolonged artificial feeding as an intervention they would not want under certain circumstances.
The form presents the same set of scenarios as the treatment section — terminal illness, permanent unconsciousness, and irreversible loss of function — and lets you indicate your preferences for each. Separating this from other medical treatment allows you to be precise. For example, you might decide you wouldn’t want to be on a ventilator if you’re permanently unconscious, but you would want to continue receiving nutrition. Or vice versa. The old form didn’t give you that level of specificity.
Pain Relief
This section asks a question that many people haven’t considered: if you’re in significant pain, would you want care that keeps you comfortable but is likely to shorten your life? This is sometimes called palliative sedation or comfort-focused care.
This isn’t about standard pain management — most pain medications given at normal doses don’t meaningfully shorten life. This section is about situations where the level of pain relief needed to keep you comfortable may, as a side effect, hasten death. It’s a deeply personal question, and the form lets you indicate your preferences under the same set of scenarios: terminal illness, permanent unconsciousness, and irreversible loss of function.
Again, separating this from the other categories matters. Someone might want aggressive comfort care even if it shortens their life when they’re terminally ill, but might feel differently in other situations. The new form respects that these decisions aren’t one-size-fits-all.
The Priorities Section (New)
This is entirely new and, in my opinion, a great addition. The old form didn’t have anything like this.
The priorities section asks you to rank how important certain values are to you — things like staying alive as long as possible (even with substantial physical or mental limitations), being free from significant pain, and being independent. It also asks whether you’d want your agent to consult with your family or friends before making decisions.
Why does this matter? Because advance directives can’t anticipate every possible medical scenario. When your agent faces a decision that your specific instructions don’t directly address, your priorities give them a framework to work from. If they know that independence is very important to you but longevity with significant limitations is not, that guides their decision-making in situations you never specifically contemplated. It’s like giving your agent a compass, not just a map.
Mental Health-Care Directive (New)
The new law allows you to create an advance directive that specifically addresses mental health care (§ 75A-9-108). This is a significant addition that the old form didn’t include at all.
So what does this actually mean? An advance mental health-care directive lets you document your preferences for psychiatric and psychological treatment in case you’re ever unable to make those decisions yourself — for example, during a severe mental health crisis. You can express preferences about specific medications you do or don’t want, specific types of therapy or treatment programs, preferences about mental health facilities and providers, and your wishes regarding crisis intervention.
One of the most notable provisions is the optional special power that allows your agent to admit you to a mental health facility as a voluntary patient. This power does not exist unless you specifically grant it in your directive, and you get to set the maximum number of days. Without this explicit authorization, your agent simply cannot consent to voluntary psychiatric admission on your behalf.
This matters because mental health crises can impair decision-making capacity, and having your preferences documented in advance ensures that your treatment aligns with your values even when you’re unable to advocate for yourself. If you have a history of mental health conditions, or if this is something you want to plan for proactively, this section gives you a way to do that.
It’s also worth noting that a mental health-care directive can be created as a standalone document or combined with your general advance health-care directive. And if you already have an agent for general health-care decisions, appointing a separate agent for mental health-care decisions doesn’t revoke the earlier appointment — the two can coexist, each handling their respective area (§ 75A-9-109).
Optional Special Powers (New)
The new form includes a section for special powers that your agent does not have unless you specifically grant them. This is an opt-in system, which means your agent’s authority is limited by default. The special powers include:
- Voluntary mental health facility admission (as discussed above), with a maximum number of days that you choose
- Extended nursing home placement — your agent can place you in a nursing home for more than 100 days even if your needs could be met elsewhere, you object, or you’re not terminally ill. Without this authorization, your agent cannot do this.
- Access to your health information at any time — by default, your agent can access your health information only when you lack capacity. This option lets them do so whenever they think it will help you, even while you still have capacity.
- Flexibility for your agent — this allows your agent to deviate from your written instructions if they believe doing so is in your best interest. Without this, your agent must follow your instructions exactly, even if circumstances suggest a different approach would be better for you.
Each of these is worth thinking about carefully. The flexibility option, in particular, is a judgment call. Some people want their instructions followed to the letter, no exceptions. Others trust their agent enough to say, “Use your best judgment if the situation calls for it.” There’s no wrong answer — it depends on your relationship with your agent and your comfort level.
Organ Donation (New)
The old form didn’t address organ donation at all. The new form builds it right in, which is convenient since it’s a decision closely related to your end-of-life wishes.
The form lets you indicate whether you want to donate your organs, tissues, and body parts after death, and whether there are specific parts you do not want donated. It also lets you specify the purpose of your donation. The options are transplant, therapy, research, education, or all of the above.
Most people are familiar with transplant — that’s when your organ is placed into another person’s body to replace a failing organ, like a kidney transplant or a heart transplant. But the other categories are worth understanding:
- Therapy refers to using donated tissues to treat medical conditions, rather than replacing an entire organ. The most common example is donated skin used as temporary grafts for severe burn victims, which helps prevent infection, reduce pain, and promote healing while the patient’s own skin recovers. Donated bone, tendons, ligaments, and heart valves are also used therapeutically — a donated tendon might help reconstruct a knee, or donated bone might be used in a spinal fusion surgery.
- Research means your donated tissues or organs are used in medical studies to advance scientific understanding of diseases and develop new treatments.
- Education means your donation is used to train medical students, surgeons, and other health-care professionals.
If you don’t mark any specific purpose, your donation can be used for all of them. If organ donation is something you feel strongly about — either for or against — having it documented in your advance directive provides clear legal authority and removes any ambiguity for your family at a difficult time.
Witness Requirements
One practical change worth mentioning: the new law still requires a witness when you’re appointing an agent, but it now expressly allows remote witnessing. A witness can be “present” via real-time audio and video communication, or even audio-only if the witness personally knows you or can verify your identity (§ 75A-9-107(5)). This makes executing the document more accessible, especially for people in rural areas or those with mobility limitations.
Disqualifying a Default Surrogate (New)
Under both the old and new law, if you don’t have an agent or your agent isn’t available, Utah has a priority list of people who can make health-care decisions for you — your spouse, adult children, parents, siblings, and so on. The new law adds an important tool: you can disqualify specific people from serving as your default surrogate (§ 75A-9-113). If there’s someone on that statutory list you don’t want making decisions for you, you can say so in writing, verbally, or even nonverbally, and that disqualification is effective even if you later lose capacity.
What Should You Do Now?
If you already have an advance directive, you don’t need to panic. Your existing document is still legally valid. But I’d encourage you to consider updating to the new form, especially if any of the following apply to you:
- Your current directive is more than a few years old and your circumstances or wishes may have changed
- You want more granular control over your end-of-life care decisions
- You’d like to address mental health care preferences
- You want to document your organ donation wishes in the same document
- You’d like to grant (or specifically withhold) the new optional special powers
Download the Free Companion Guide
I’ve created a free guide that walks you through the key questions to consider before filling out Utah’s new advance health-care directive form. It covers choosing an agent, life-sustaining treatment preferences, the new priorities section, mental health care directives, special powers, organ donation, and more.
