Advance Directives

Learn more about advance care planning below. For help with advance care planning, please contact your health care team. 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 your completed documents and 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 physician, health care team, 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 Washington State Medical Association advance directive is a durable power of attorney for health care, or 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. This form 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 health care directive is based on Washington state law (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. Visit the Northwest Justice Project at www.washingtonlawhelp.org for more information on the health care directive or talk with your physician or health care team.

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 team, 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. 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 apply for health care insurance benefits on your behalf.
• Choose the health care professionals 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.

Standard care in Washington state is to provide CPR to people if their heart and 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 physician or other member of the health care team about completing a Portable Orders for Life-Sustaining Treatment, or 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. Some examples of life-support treatments are CPR, breathing machines, feeding tubes, blood transfusions, and kidney dialysis.

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 team will follow Washington state law to determine who can act as your medical decision-maker (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.

Although a primary goal of this form is to name a health care agent, you have the option not to name one. If you complete the other sections of this form, it will be considered a personal values statement and not an advance directive. You may also consider completing a health care directive at www.washingtonlawhelp.org or by talking with your physician or health care team.

What should I do with this advance directive?

Once you complete this advance directive, give copies to your health care agent, loved ones, health care team, clinic, hospital, and any nursing home or assisted living facility you use. It is important that everyone has a copy.

What if I change my mind?

You can revoke or void your advance directive at any time. Tell everyone who has a copy. You will need to tell your physician or other member of the health care team that you want to revoke it either by writing them a letter (make sure to sign and date it) or by verbally telling them. Be sure to complete a new advance directive and give copies to everyone who matters to you.

What about organ and tissue donation?

Indicate your decisions regarding organ, tissue, and eye donation at www.donatelifetoday.com, then inform your health care agent, family, and health care team of your choice. Registering to be a donor is a legally binding decision.

What about decisions for after death?

The authority of those named in a DPOA-HC ends at time of death. For more information, visit www.washingtonfuneral.org or speak to a local funeral home or hospice agency.

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

If you need support with advance care planning contact your health care team.