Washington Health Care Directive: How to Complete the Form and Make It Hospital-Ready

An advance directive sitting in a drawer does nothing. In Washington, getting your healthcare wishes followed requires completing the right forms under the right statutes — and making sure they're accessible when a hospital needs them.

Washington uses two separate documents where many states use one. The Health Care Directive (your living will, under RCW 70.122) covers end-of-life treatment instructions. The Durable Power of Attorney for Health Care (under RCW 11.125) names someone to make medical decisions when you can't. Most people need both, and they have different execution rules.

What Washington's Health Care Directive Covers

The Health Care Directive is narrowly focused. It lets you instruct physicians to withhold or withdraw life-sustaining treatment — including artificial nutrition and hydration — when:

• You've been diagnosed with a terminal condition, or
• Two physicians confirm you're in a state of permanent unconsciousness

It does not activate during temporary incapacity, recoverable illness, or general anesthesia. For those situations, only a DPOA-HC gives someone legal authority to act on your behalf.

One Washington-specific rule catches people off guard: if a female declarant is pregnant and her attending physician is aware of the pregnancy, the directive has absolutely no force or effect during the pregnancy under RCW 70.122.030.

Free vs. Paid Advance Directive Forms

Washington has several free sources for advance directive forms:

• Washington State Medical Association (WSMA) — provides a well-regarded DPOA-HC form, but it does not include a statutory living will under RCW 70.122
• Washington Law Help — offers separate templates including specialized dementia directives, but they're scattered across multiple pages with no unified workflow
• Hospital admission packets — many facilities hand out basic forms during intake, but these are often generic and incomplete

The gap with free forms is integration. You typically end up with disconnected documents that don't cross-reference each other, no body disposition directive under RCW 68.50.160, and no guidance on the witness eligibility rules that vary between the two statutes.

Washington's complete advance directive kit consolidates both statutory forms, the body disposition directive, witness checklists, and a POLST preparation guide into one coordinated system.

How to Execute the Form Correctly

Both the Health Care Directive and DPOA-HC must be signed and dated by the principal. For validity, you then choose one of two execution methods:

Notary acknowledgment — simplest path. A notary witnesses your signature, and you're done. No additional witnesses required.

Two qualified witnesses — both must watch you sign. The disqualification rules differ slightly between the two documents:

For the Health Care Directive (RCW 70.122.030), a witness cannot be:

• Related by blood, marriage, or domestic partnership
• Your designated healthcare agent
• Your attending physician or their employee
• An employee of your current healthcare facility
• Anyone with a claim against your estate

For the DPOA-HC (RCW 11.125.050), a witness cannot be:

• Related by blood, marriage, or domestic partnership
• Your designated healthcare agent
• A paid home care provider
• A care provider at your adult family home or long-term care facility

The safest approach: use the notary route for both documents, or choose witnesses who satisfy both sets of restrictions simultaneously.

Getting Your Directive Accepted at the Hospital

Completing the form is half the job. The other half is making sure it's accessible and recognized:

Distribute copies immediately. Give copies to your healthcare agent, primary care physician, any specialists you see regularly, and the admitting department of your local hospital. Washington's state Health Care Declarations Registry (RCW 70.122.130) has been suspended due to lack of funding — there is no centralized digital repository.

Don't store the original in a safe deposit box. If you're admitted to the ER on a weekend, no one can access it. Keep the original in a clearly labeled folder at home, and tell your healthcare agent where it is.

Verify acceptance. Ask your physician's office to scan the documents into your electronic health record. Some hospitals and medical groups have their own advance directive registration process — complete it.

Update after life changes. Divorce automatically revokes a former spouse's authority as healthcare agent under RCW 11.125.085, but doesn't update your living will instructions. Review both documents after divorce, remarriage, the death of your named agent, or a significant change in your health.

What Happens Without an Advance Directive

If you lose capacity without valid documents, Washington's default surrogate hierarchy kicks in under RCW 7.70.065. Medical providers must work down a strict priority list: court-appointed guardian, designated agent, spouse or domestic partner, adult children, parents, siblings, grandchildren, nieces and nephews, aunts and uncles, and finally a qualified close friend.

The critical problem: if your priority class has multiple members — say three adult children — they must reach unanimous agreement before any treatment decision can proceed. One holdout can paralyze your care, potentially forcing the family into litigation under Washington's Trust and Estate Dispute Resolution Act (TEDRA).

A properly executed advance directive bypasses this entire hierarchy and puts your documented wishes — or a single named agent — in control.

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