Advance directives—your questions answered
In Washington state, you have the right to make your own health care decisions. Under the principle of “informed consent,” your medical care must be explained so you understand it and can make informed decisions. Treatment without consent, however, is allowed and will generally be provided in an emergency unless you indicate otherwise.
It is important to let your physician and loved ones know your wishes for treatment should you ever be near death and unable to express them. Most health facilities assume you want all available medical treatment, including life-sustaining care, unless you direct otherwise. Advance directives can help direct these decisions.
What are advance directives?
The term 'advance directive' refers to your oral and written instructions about your future medical care in the event you are unable to express your medical wishes. There are two types of advance directives: a health care directive (also known as a living will) and a durable power of attorney for health care.
Who can make decisions for me if I’m unable?
If you lose the ability to communicate and make decisions, Washington state law enables the following people, in order of priority, to make health care decisions for you, including withdrawing or withholding care:
- A guardian with health care decision-making authority, if one has been appointed.
- The person named in the durable power of attorney with health care decision-making authority.
- Your spouse.
- Your adult children.
- Your parents.
- Your adult brothers and sisters.
When there is more than one person, such as children, parents, or brothers and sisters, all must agree on the health care decision.
Making your wishes known in an advance directive will provide your doctor and your agent the clear guidance necessary to respect your wishes. The medical decisions made by your health care agent (as named in your durable power of attorney for health care) are as meaningful and valid as your own. The wishes of other family members should not override your own clearly expressed choices or those made by your agent on your behalf.
Health care directive (living will)
If you had a terminal condition, would you want your dying artificially prolonged? The health care directive is a legal document allowing you to answer this question in writing. This directive is used only if you have a terminal condition as certified by your physician, where life-sustaining treatment would only artificially prolong the process of dying; or you are certified by two physicians to be in an irreversible coma or other permanent unconscious condition and there is no reasonable hope of recovery. In either situation, the directive allows treatment to be withheld or withdrawn so that you may die naturally.
You may also direct whether you would want artificially provided nutrition (food) and hydration (water) stopped under these circumstances. Also in the directive, you can give further instructions regarding your care. The health care directive must be signed by you and two witnesses who are not related to you and will not inherit anything from you. You can change or revoke this directive at any time.
The health care directive allows people who clearly do not want their lives artificially prolonged under the above conditions to make their wishes known.
Durable power of attorney for health care
Who would you want making your health care decisions if you were unable? The durable power of attorney for health care is a legal document allowing you to name a person as your health care agent—someone who is authorized to consent to, stop or refuse most medical treatment for you if a physician determines you cannot make these decisions yourself. The person you choose should be a trusted family member or friend with whom you have discussed your values and medical treatment choices.
Do I need an advance directive?
Advance directives are the best possible assurance that decisions regarding your future medical care will reflect your own wishes, in the event that you are unable to voice these wishes. For this reason, every person aged 18 or over should prepare a directive
Do I need both a living will and a durable power of attorney for health care?
Yes. Having both a living will and a durable power of attorney for health care will provide the best protection for your treatment wishes.
A durable power of attorney will allow for some flexibility regarding treatment decisions, since the agent that you choose to represent your wishes will be able to respond to unexpected changes in your condition and base decisions not just on your written wishes, but also on their familiarity with you and your feelings regarding your care.
A living will is necessary to provide instruction in case your agent is unable to serve, to provide evidence that the agent is acting in good faith in case the agent's decisions are challenged, or to serve as the primary record of your wishes in case you are unable to appoint a health care agent.
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 Physician Orders for Life-Sustaining Treatment (POLST) form.
What to do with these forms
Signed copies of your completed directives should be included in your medical record, given to any person to whom you give your durable power of attorney—including any alternate people you may have named—and to your personal attorney. Originals should be in a safe but accessible place (not a safe deposit box) or given to someone you trust and who can obtain them in an emergency.
Discuss your wishes
It is essential that you have honest and open discussions with your appointed health care agent, doctor(s), clergy, and family and friends about your wishes concerning medical treatment. Discuss your wishes with them often, especially if your medical condition changes.
Can I change/revoke my directive?
You can always revoke one or both of your Washington state directives. If you choose to revoke your documents, make sure you notify your health care agent, alternate agents, your family and your doctor(s). If you wish to make changes to the directives, you should complete new documents.
Where can I get both advance directives?
WSMA’s advance directive patient brochure—“Who Will Decide If You Can’t?”—has been, and remains, the most popular of our patient resources. It contains both the health care directive and durable power of attorney for health care as tear-out forms, as well as explanatory text.
Find information on WSMA’s advance directives at the WSMA’s Know Your Choices – Ask Your Doctor campaign website at www.know-your-choices.org.
For further information
You are encouraged to discuss the directives with your physician. Any legal questions you may have about the use and effect of these directives may be answered by an attorney.
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