Advance Directive vs. Medical Power of Attorney in Washington: Which Do You Need?
Advance Directive vs. Medical Power of Attorney in Washington: Which Do You Need?
These two documents get confused constantly, even by people who've already signed one. In Washington, they're governed by entirely different statutes, cover different situations, and leave different gaps if you only have one.
Short answer: you need both. Here's why.
What Each Document Does
Health Care Directive (Living Will) — governed by RCW 70.122
This is your written instruction to physicians about life-sustaining treatment. It tells doctors what to do (or not do) when you can no longer speak for yourself and you've been diagnosed with a terminal condition or permanent unconsciousness.
It's a set of pre-recorded instructions. It doesn't give anyone authority to make decisions on your behalf — it just tells the medical team what your wishes are for a specific, narrow scenario.
Durable Power of Attorney for Health Care (DPOA-HC) — governed by Chapter 11.125 RCW
This designates a specific person — your healthcare agent — to make medical decisions when you lack capacity. Unlike the living will, it covers all medical situations where you can't communicate, not just terminal or permanently unconscious scenarios.
Your agent can consent to surgery, choose a care facility, refuse treatments, access your medical records, and handle organ donation decisions. They adapt to whatever situation arises, rather than following a fixed script.
When Each Document Activates
| Health Care Directive | DPOA-HC | |
|---|---|---|
| Trigger | Terminal diagnosis or permanent unconsciousness, confirmed by physicians | Loss of decision-making capacity (any cause) |
| Scope | Life-sustaining treatment only | All medical decisions |
| Flexibility | Fixed instructions — can't adapt to unforeseen scenarios | Agent makes real-time decisions based on your values |
| Duration | Until you die, revoke it, or regain capacity | Until you die, revoke it, or regain capacity |
The Gap If You Only Have a Living Will
A living will handles the endgame. But most medical crises don't start as terminal diagnoses.
A stroke. A severe car accident. A complicated surgery. Post-operative delirium. A sudden cardiac event where you survive but can't communicate for days or weeks. In all of these situations, decisions need to be made — and a living will that only activates upon terminal diagnosis or permanent unconsciousness is silent.
Without a DPOA-HC, those decisions fall to Washington's default surrogate hierarchy under RCW 7.70.065. Your spouse gets priority, but adult children must agree unanimously. One holdout sibling can paralyze your care.
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The Gap If You Only Have a DPOA-HC
Your agent has authority to act, but they may not know what you want. When a physician asks "would the patient want us to continue mechanical ventilation?" or "should we attempt CPR?", your agent is guessing unless you've documented your preferences somewhere.
A living will provides that documentation. It gives your agent — and your medical team — clear guidance on your values around life-sustaining treatment, artificial nutrition, and end-of-life care. Even if the directive doesn't technically activate (because the situation isn't terminal or permanently unconscious), its documented preferences help your agent make decisions that align with your values.
Execution Differences
Both documents must be signed and dated. Both can be validated by notary acknowledgment or two qualified witnesses. But the witness disqualification rules differ:
Living will witnesses can't be: relatives, heirs, your healthcare agent, your attending physician or their employees, employees of your current healthcare facility, or anyone with a claim against your estate.
DPOA-HC witnesses can't be: relatives, your healthcare agent, paid home care providers, or care providers at your adult family home or long-term care facility.
The living will restrictions are broader (they include heirs and estate claimants). If you're signing both documents at once, either use a notary for both or choose witnesses who satisfy all restrictions from both statutes.
One Situation Neither Document Covers
Washington's Death with Dignity Act (RCW 70.245) allows terminally ill residents to request and self-administer life-ending medication. But a healthcare agent has absolutely no legal authority to make this request on an incapacitated patient's behalf. Medical aid in dying must be a personal, voluntary, self-administered decision — no proxy can authorize it.
The Bottom Line
A living will without a DPOA-HC leaves you without a decision-maker during most medical crises. A DPOA-HC without a living will leaves your agent without documented guidance on your end-of-life values. You need both, executed properly, distributed to the right people, and reviewed after any major life change.
Washington's advance directive kit integrates both documents with a body disposition directive and witness eligibility checklist, so every piece works together and nothing falls through the gaps.
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