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Helping ensure your wishes for future medical care are known, valued, and honored.

Advance Directives

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Honoring Choices® Pacific Northwest is your resource for advance care planning.

A joint initiative of the WSMA Foundation and the Washington State Hospital Association, Honoring Choices Pacific Northwest is inspiring adults of all ages to think about what health care you might want in the future. This type of planning includes talking about, writing down, and sharing what is important to you, as well as naming and preparing your health care agent. This helps others make health care decisions for you if you cannot make your own decisions.

Visit the Honoring Choices Pacific Northwest website to get started and access local resources in your community. It's never too soon to have the conversation and document your wishes.

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Advance Directive
Advance Directive
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Non-member orders of more than 10 Advance Directive brochures are $1.25 each.

Learn More About Advance Directives

Learn more about advance care planning below. For help with advance care planning, please contact Honoring Choices PNW at info@honoringchoicespnw.org. Any legal questions you may have about the use and effect of an advance directive may be answered by an attorney.

What is advance care planning?

Advance care planning is thinking about what health care you might want in the future. This type of planning includes talking about, writing down, and sharing what is important to you. This helps others make health care decisions for you if you cannot make your own decisions. In this situation, a person close to you would need to make decisions for you. This person is called a health care agent, also known as an attorney-in-fact, surrogate, or legal medical decision maker. It is important that you prepare your health care agent by sharing how you would want them to make health care decisions for you.

What is an advance directive?

An advance directive is a voluntary, legal way to write down your advance care planning decisions. You should share your advance directive with people who matter to you—like your health care agent and loved ones—and your health care providers, clinic, and hospital. An advance directive should be updated regularly. All adults 18 and older can complete an advance directive.

There are two types of advance directives in Washington state: 1) a durable power of attorney for health care and 2) a health care directive.

The advance directive in this booklet is a durable power of attorney for health care (DPOA-HC). The DPOA-HC is based on Washington state law (chapter 11.125 RCW). This legal form allows you to name your health care agent to make health care decisions for you if you cannot make your own decisions. The Honoring Choices PNW advance directive also helps you prepare your health care agent by sharing your goals, values, and preferences. Research shows that the best way to ensure your wishes are followed is to name and prepare a health care agent.

The advance directive in this booklet is not a health care directive (chapter 70.122 RCW). Health care directives are also known as living wills. You may consider also completing a health care directive, which is a directive to withdraw or withhold life-sustaining treatment in specific situations under Washington state law. For more information on a health care directive, visit: www.HonoringChoicesPNW.org or talk with your health care provider.

What makes a good health care agent?

Your health care agent SHOULD:

  • Understand what a health care agent does and be willing to fill this role.
  • Share your goals, values, and preferences with your health care providers, and describe what “living well” or a “good day” means to you.
  • Carry out your decisions, even if they do not agree with your decisions.
  • Be able to make decisions in difficult or stressful times.

Your health care agent CANNOT be:

  • Under 18 years old.
  • Your physician or your physician’s employee (unless they are your spouse, state registered domestic partner, parent, adult child, or adult sibling).
  • An owner, administrator, or employee of a health care facility or long-term care facility where you receive care or live (unless they are your spouse, state registered domestic partner, parent, adult child, or adult sibling).

What can a health care agent do?

If you cannot make your own health care decisions, your health care agent will be asked to make health care decisions for you. Your health care agent can use the information you share in this advance directive and in conversations to guide your care.

Consistent with state law and using their understanding of your goals, values, and preferences, your health care agent can:

  • Decide on treatments and surgeries, including whether to use cardiopulmonary resuscitation (CPR), a breathing machine, a feeding tube, and other treatments.
  • Decide whether to end life-support treatment and focus on comfort care.
  • Review and release medical records for your care and/or apply for health care insurance benefits on your behalf.
  • Choose the health care providers and organizations to provide your health care.

What is CPR?

Cardiopulmonary resuscitation or CPR is a procedure used when your heart and breathing stop. CPR works best if your body is healthy and CPR is started right away after your heart stops. CPR is less likely to be successful if you are weak, elderly, or have a serious illness.

If you survive, you might need a ventilator (breathing machine) because of weakened lungs. It is important to talk to your health care providers about whether CPR would meet your goals.

Standard care in Washington state is to provide CPR to people if their heart and breathing stop. Sharing your CPR wishes on this DPOA-HC form can guide your “code status” if you are hospitalized. Code status means the type of emergent treatment a person would or would not receive in the hospital if their heart or breathing stop.

Some people who choose not to receive CPR in a hospital also do not want CPR in other settings. In this situation you should ask your health care provider about completing a Portable Orders for Life-Sustaining Treatment (POLST). POLST is a medical order that communicates health care decisions to emergency responders and other medical professionals.

What is life support?

Life-support (also known as life-sustaining) treatments are medical treatments that keep you alive by supporting or replacing important body functions. These treatments do not cure medical conditions. They keep you alive until you either get better or you are taken off life support and are allowed to die naturally. Some examples of life-support treatments are CPR, breathing machines, feeding tubes, blood transfusions, and kidney dialysis. It is important to know that easing pain and providing comfort are part of routine care and not considered life-support treatments.

What happens if I do not name a health care agent?

If you cannot make your own health care decisions and a health care agent is not named, your health care providers will follow Washington state law to determine who can act as your medical decision maker. This means they will ask family members or friends to make health care decisions for you. If family or friends cannot be identified from the list below, health care providers may ask a court to appoint a guardian to make health care decisions on your behalf.

Health care providers will contact people in the following order until they can identify a medical decision maker for you (chapter 7.70.065 RCW).

  1. A guardian appointed by a court (if applicable)
  2. Named health care agent(s)*
  3. Spouse or registered domestic partner
  4. Adult children*
  5. Parents*
  6. Adult siblings*
  7. Adult grandchildren who are familiar with the patient*
  8. Adult nieces and nephews who are familiar with the patient*
  9. Adult aunts and uncles who are familiar with the patient*
  10. A close adult friend who meets certain criteria

* For any group that has more than one person, everyone in the group must agree to the care.

What are some situations that may apply?

Naming your spouse as your health care agent

If you choose your spouse or registered domestic partner as your health care agent, they will stop being your named health care agent if either of you file for dissolution, annulment, or legal separation (chapter 11.125.100 RCW). However, the Honoring Choices PNW advance directive allows you to choose to have them continue as your health care agent, even after divorce.

If this situation applies to you, initial next to this statement on Page 1 of the Honoring Choices PNW advance directive: “If I name my spouse or registered domestic partner as my health care agent and we later file for a dissolution, annulment, or legal separation; I want them to continue as my health care agent.”

Not naming a health care agent

Although a primary goal of the Honoring Choices PNW advance directive is to name a health care agent, you have the option not to name one. If a health care agent is not named, health care providers will follow Washington state law to determine who can act as your medical decision maker (chapter 7.70.065 RCW).

If you complete the other sections of the Honoring Choices PNW advance directive, it will be considered a personal values statement and not an advance directive. A personal values statement is a summary of your goals, values, and preferences. This information can guide your medical decision maker on how to make decisions on your behalf.

If this situation applies to you, initial next to this statement on Page 1 of the Honoring Choices PNW advance directive: “I am not naming a health care agent. By sharing my goals and values in this form, it will be considered a personal values statement and not an advance directive.”

In this situation, you may also consider completing a health care directive, also known as a living will, which is a directive to withdraw or withhold life-sustaining treatment in specific situations under Washington state law. For more information, visit www.HonoringChoicesPNW.org or talk with your health care provider.

What should I do with this advance directive?

Once you complete this advance directive, you should talk about your wishes and share copies with the people who matter to you—like your health care agent and loved ones—and your health care providers, clinic, and hospital. If it applies, consider sharing copies with your nursing home or assisted living facility too. It is important that everyone has a copy.

What if I change my mind?

If you change your mind about the decisions in your advance directive, tell everyone who has a copy, including your health care agent, loved ones, health care providers, clinic, and hospital. You can revoke or void your advance directive at any time. You will need to tell your health care provider that you want to revoke it either by writing them a letter (make sure to sign and date it) or by verbally telling them. It is important to complete a new advance directive. Be sure to give copies of the new advance directive to the people who matter to you—like your health care agent and loved ones—and your health care providers, clinic, and hospital.

What about organ, tissue, and eye donation?

If you want to be a donor, please tell your health care agent, family, and health care providers. You can also record your organ and tissue donation wishes at www.registerme.org.

Who decides how to handle my body after I die?

The Honoring Choices PNW advance directive does not direct the disposal of your remains. Consider completing a form that specifically provides instructions on how to handle your body after you die consistent with state law (chapter 68.50.160 RCW).

Who can I contact if I need help with advance care planning?

Honoring Choices PNW is here to help you. For local resources, visit: www.honoringchoicespnw.org/locations. Please contact us at info@honoringchoicespnw.org for help.

Are advance directives legal?

Yes. There are federal and state laws that govern the use of advance directives. All 50 states and the District of Columbia have laws recognizing the use of advance directives. If you travel, you may want to take copies of your documents with you, as other states may honor these forms.

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 health care agent to be consulted. For individuals with serious health conditions, there is a form in Washington state that can help represent your wishes in emergency medical situations called the Portable Orders for Life-Sustaining Treatment form. For more information on POLST, please ask your physician, or visit our POLST page.

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