Medical Aid in Dying in Washington: Eligibility, Process, and What Families Need to Know

Washington legalized medical aid in dying in 2008 through Initiative 1000, codified as the Death with Dignity Act under RCW 70.245. The law allows terminally ill adults to request and self-administer life-ending medication — but the requirements are strict, the process is deliberate, and there are critical limitations that most planning guides don't explain clearly.

Who Qualifies

Every requirement must be met. There are no exceptions:

• Adult — 18 years or older
• Washington resident — must be domiciled in the state
• Mentally competent — capable of making and communicating an informed healthcare decision at the time of each request
• Terminal diagnosis — a physician has determined a life expectancy of six months or less
• Self-administration — the patient must be physically capable of ingesting the medication themselves

That last requirement is the one that catches most families off guard. A patient who cannot swallow, who is too weak to lift a cup, or who has lost the physical ability to self-administer is not eligible — even if they meet every other criterion.

The Request Process (Updated 2023)

The 2023 legislative amendments streamlined the process and expanded provider eligibility:

Two oral requests — the patient must verbally request aid in dying from their attending provider on two separate occasions, with at least seven days between the first and second oral request.

One written request — signed and dated by the patient, witnessed by at least two independent individuals. At least one witness must be:

• Not related to the patient by blood or law
• Not entitled to any portion of the patient's estate
• Not an owner, operator, or employee of the patient's healthcare facility

The patient's attending provider cannot serve as a witness.

Waiting period — at least seven days must pass between the initial oral request and the writing of the prescription. The previous 48-hour waiting period between the written request and the prescription was repealed in 2023.

Consulting provider — a second provider must confirm the terminal diagnosis and the patient's mental competence. If either the attending or consulting provider has concerns about the patient's judgment, they must refer the patient for psychological or psychiatric evaluation.

The 2023 Provider Expansion

Before 2023, only physicians could serve as attending and consulting providers. The law now allows advanced practice registered nurses (APRNs) and physician assistants (PAs) to serve in these roles — with one constraint:

If the attending provider is a non-physician (ARNP or PA), the consulting provider must be a licensed physician, and vice versa. The attending and consulting providers cannot have a direct supervisory relationship.

This expansion matters in rural Washington, where access to multiple physicians can be limited.

What Healthcare Agents Cannot Do

This is the most important limitation: a healthcare proxy, agent, or guardian has absolutely no legal authority to request or consent to medical aid in dying on behalf of an incapacitated patient.

The request must be:

• Personally made by the patient
• Voluntary — no coercion from family, providers, or institutions
• Self-administered — the patient must physically ingest the medication

An advance directive cannot authorize aid in dying. A DPOA-HC cannot authorize it. A court-appointed guardian cannot authorize it. If the patient loses competency before completing the process, the process stops.

This is why timing matters. Patients with progressive conditions — some cancers, ALS, certain neurological diseases — sometimes begin the request process earlier than they might otherwise need to, because they're aware that their window of competence and physical ability may close.

Facility and Provider Participation

Healthcare providers and facilities are not legally required to participate in the Death with Dignity Act. A physician can refuse to write the prescription. A hospital can prohibit the medication from being ingested on its premises.

However, Washington law creates one important protection: long-term care facilities cannot prohibit residents from ingesting legally prescribed aid-in-dying medications in their private rooms. Forcing a resident to leave the facility to exercise this right would violate their statutory protections.

If a provider or facility declines to participate, they must inform the patient. They are not required to refer the patient to a willing provider, though many do.

How This Connects to Advance Directives

Medical aid in dying and advance directives serve different purposes but overlap in one critical way: both require planning while you still have capacity.

An advance directive covers what happens when you can't make decisions — it instructs physicians about life-sustaining treatment and names a decision-maker. Medical aid in dying is something you do while you can still make decisions — it requires competence, physical ability, and personal volition at every step.

But because many terminally ill patients are simultaneously planning for both scenarios — what happens if they lose competence before completing the aid-in-dying process, and what treatment they want during the decline — both documents should be prepared together.

Washington's advance directive kit covers the healthcare directive, DPOA-HC, body disposition instructions, and POLST preparation — the foundational documents that every Washington adult needs, whether or not they pursue medical aid in dying.

See more Washington guides →