What to Do If a Hospital Refuses Your Advance Directive in Washington

You did everything right — executed the documents, had them witnessed, distributed copies to your physician, filed them with the hospital. And now a doctor is refusing to follow them.

This happens more often than most people expect. Washington law addresses it directly, but the rules aren't as simple as "the hospital must comply, period."

When Refusal Is Legal

Under RCW 70.122, healthcare providers receive broad immunity when they follow a valid advance directive in good faith. But they also have the legal right to refuse — under specific conditions.

A provider or health facility can decline to participate in withholding or withdrawing life-sustaining treatment if they have a religious, moral, or professional objection to doing so. This is commonly called conscientious objection.

Washington-based faith-affiliated hospital systems — several of which operate across the state — may have institutional policies that restrict certain end-of-life interventions, even when a patient's directive specifically requests them.

What the Law Requires from a Refusing Provider

An objecting provider cannot simply refuse and walk away. Under Washington law, they must:

1. Immediately inform the patient or their surrogate that they will not comply with the directive
2. Facilitate a prompt, safe transfer of the patient's care to a willing provider or facility that will honor the directive

The obligation isn't just to suggest a transfer — it's to actively facilitate one. That means coordinating with another provider, arranging the transfer logistics, and ensuring continuity of care during the transition.

Practical Steps When You Hit a Refusal

If a hospital or physician refuses to follow your advance directive (or your loved one's), take these steps:

1. Ask for the refusal in writing. Request that the provider document their objection and the specific provisions they're declining to follow. This creates a record.

2. Contact the hospital's patient advocate. Every Washington hospital is required to have a patient advocacy or patient relations office. They mediate disputes between patients (or their surrogates) and clinical staff. Ask to speak with them immediately.

3. Request an ethics committee review. Most hospitals have a clinical ethics committee that can convene to review disputes about advance directive compliance. This is a formal process that weighs the patient's documented wishes against the provider's objection.

4. Demand transfer facilitation. If the provider maintains their objection, invoke their legal obligation to facilitate a transfer. Ask for specific names and contact information of willing providers or facilities. Don't accept vague promises — get the transfer coordinated before the situation becomes more urgent.

5. Contact the Washington State Department of Health. If the provider refuses to facilitate a transfer, or if you believe the refusal doesn't meet the statutory standard for conscientious objection, you can file a complaint. The Department of Health oversees provider licensing and can investigate whether the provider met their legal obligations.

Common Reasons Directives Are Challenged (Not Refused)

Sometimes the issue isn't a moral objection — it's a technical challenge to the directive's validity. Common reasons:

• Witness defects — a witness was related to the patient or was an employee of the facility, violating RCW 70.122.030 or RCW 11.125.050
• Outdated documents — the named healthcare agent is divorced from the patient (RCW 11.125.085 automatically revokes the authority) or is deceased
• Ambiguous instructions — the directive uses vague language that the medical team interprets differently than the surrogate
• Conflicting documents — multiple versions exist with different dates and conflicting instructions

These aren't refusals — they're validity disputes. They can usually be resolved by producing the most recent executed version, clarifying the patient's intent through the healthcare agent, or having the agent make a contemporaneous decision.

Provider Immunity

Washington provides broad immunity to healthcare providers who follow a valid directive in good faith (RCW 70.122.051). This immunity covers civil liability, criminal liability, and professional disciplinary action.

The immunity also extends to providers who refuse to follow a directive based on a good-faith moral, religious, or professional objection — as long as they promptly inform the patient and facilitate transfer.

This creates a balanced system: providers aren't forced to act against their conscience, but they can't abandon the patient either. The patient's wishes are ultimately honored — either by the original provider or by the one they're transferred to.

Prevention Is the Best Strategy

Most directive refusals can be avoided by:

• Discussing your wishes with your physician before an emergency — confirm they will follow your directive
• Choosing a hospital system whose policies align with your values
• Executing documents properly — correct witnesses, notarization, current dates, clear language
• Keeping copies current and accessible — filed with every provider who might treat you

Washington's advance directive kit includes a hospital integration guide and witness validation checklist to help ensure your documents will be accepted and followed when they're needed.

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