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Advance directives

This refers to your oral and written instructions about your future medical care in the event that you are unable to express your medical wishes.

Making your wishes known in an advance directive will provide your doctor and your agent the clear guidance necessary to respect your wishes.

There are two types of advance directives:

  1. Healthcare agent (also called a durable power of attorney for healthcare).
  2. Healthcare directive (also called a living will).

Healthcare agent (durable power of attorney for healthcare)

Who can make decisions for me if I'm unable?

If you lose the ability to communicate and make decisions, Washington state law enables the following people, in order of priority, to make healthcare decisions for you, including withdrawing or withholding care:

  1. A guardian with healthcare decision-making authority, if one has been appointed.
  2. The person named in the durable power of attorney with healthcare decision-making authority.
  3. Your spouse.
  4. Your adult children.
  5. Your parents.
  6. Your adult brothers and sisters.

When there is more than one person, such as children, parents, or brothers and sisters, all must agree on the healthcare decision.

The medical decisions made by your healthcare agent (as named in your durable power of attorney for healthcare) are as meaningful and valid as your own. The wishes of other family members should not override your own clearly expressed choices or those made by your agent on your behalf.

Once the healthcare agent is in place, you continue to make your own care decisions for as long as you are able. It is only when you cannot make your wishes known that your healthcare agent can act. When you are again able to make your own decisions, your agent loses power to make decisions for you. It is very important to pick someone you trust and who knows your wishes. It is also important to choose an individual you feel can be assertive in the event that caregivers or family members challenge your wishes.

Healthcare directive (living will)

What decisions would I want made in the event that I am dying?

If you had a terminal condition, would you want your dying artificially prolonged? The healthcare directive is a legal document allowing you to answer this question in writing. This directive is used only if you have a terminal condition as certified by your physician, where life-sustaining treatment would only artificially prolong the process of dying, or you are certified by two physicians to be in an irreversible coma or other permanent unconscious condition and there is no reasonable hope of recovery. In either situation, the directive allows treatment to be withheld or withdrawn so that you may die naturally.

This is a legal form in the state of Washington. Advance directives in Washington state must be either witnessed by two different witnesses or notarized.

The witnesses to the document must be competent and must NOT be:

  • Home care providers for you.
  • Care providers at an adult family home or long-term care facility, if you live there.
  • Related to you or the designated healthcare agent by blood, marriage or state-registered domestic partnership.

You can change or revoke this directive at any time.

Will advance directives be recognized in emergencies?

No. During most emergencies, there is not enough time for emergency service personnel to consult the patient's advance directive. Once the patient is under the direct care of a physician, there will be time for the advance directive to be evaluated and/or the healthcare agent to be consulted.

For individuals with serious health conditions, Washington state has a form that can help represent your wishes in emergency medical situations called the Physician Orders for Life Sustaining Treatment (POLST) form. For more information, please ask your physician or visit our POLST patient page.

What to do with these forms

Signed copies of your completed directives should be included in your medical record; given to any person to whom you give your durable power of attorney, including any alternate people you may have named; and to your personal attorney. Originals should be in a safe but accessible place (not a safe deposit box) or given to someone you trust and who can obtain them in an emergency.

Discuss your wishes

It is essential that you have honest and open discussions with your appointed healthcare agent, doctor(s), clergy, and family and friends about your wishes concerning medical treatment. Starting a conversation about end-of-life planning can be tough, but taking that step can put you at ease for whatever may lie ahead.

Discuss your wishes with them often, especially if your medical condition changes.