Advance Medical Directives in Washington: Why Every Adult Should Have Them

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• ADVANCE MEDICAL DIRECTIVES IN WASHINGTON
• Why Every Adult Should Make Them

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What Is an
Advance Medical Directive?
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Advance directives, also called medical
directives or advance medical directives, are
legal documents that state your medical care
preferences.
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They are designed to be used when you are
INCAPACITATED and are either ABOUT TO RECEIVE
MEDICAL CARE, or are CURRENTLY HOSPITALIZED.
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What Kind of
Directives are Available
in Washington?
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There are two main types of directives you can
make, each of which has a specific purpose.
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These directives detail your medical choices so
your doctors will know what you want if you
cannot communicate.
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Your living will states what kind of medical
treatment you want to receive,
as well as the kind of treatments you refuse to
receive.
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Living wills are typically used when you are in a
terminal condition or permanent unconscious
condition and do not want to receive
life-sustaining care or artificial means of
nutrition and hydration.
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They are sometimes known as medical directives,
medical declarations, or directives to
physicians.
You must be an adult and be of sound mind in
order to make one.
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HEALTHCARE POWER OF ATTORNEY
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These documents select someone to represent you
and make choices for you when you are incapable
of doing so.
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Through a power of attorney you choose someone
who will communicate medical decisions to your
doctors on your behalf.
Only mentally capable adults can make these
documents.
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AGENT
Your health care agent will tell your doctors and
healthcare providers the kind of medical care you
should or should not receive. Your doctors will
follow your agents directions as if you made
them yourself.
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• INCAPACITY
• Your agent will get to act if your doctors
  determine that you are incapacitated. Until that
  point you make your own decisions.

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How Do I Make a
Living Will?
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You will have to create a living will in writing.
Washington law imposes several requirements on
these documents.
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SIGNATURE
You must sign your living will or direct someone
else to sign it if you are physically incapable.
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TWO WITNESSES
Two competent witnesses must also sign the
document.
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UNINTERESTED
The witnesses cannot be related to you or stand
to inherit anything from you should you die.
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What Kind of
Medical Treatment
Can I Choose?
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Living Wills are designed to address your medical
needs primarily in end-of-life situations. You
can state your preference for either accepting
such treatments or refusing them.
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CPR
Kidney Dialysis
Ventilation
Artificial Nutrition and Hydration
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How Do I Make a
Durable Power of Attorney
for Healthcare?
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Like your living will, you can only make a
durable power of attorney for health care in
writing.
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Competent Adult

• Your choice of agent must be at least 18 years
  old and be of sound mind.
• You can choose alternate agents if the first
  refuses to serve or is unable to do so.
• You can limit the kinds of choices your agent can
  make, as well as direct when the agent can make
  choices for you.

Alternates
Limitations
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What Can
My Agent Do?
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After selecting a health care agent, that person
has the legal authority to make medical decisions
for you after you are incapacitated.
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Consent

• If doctors need to obtain consents to perform any
  procedure, your health care agent can grant it.
• Your agent can also refuse to allow your doctors
  to perform any type of procedure.
• If you are being given treatments, medications,
  or procedures, your agent can order your doctors
  to cease such activities.

Refusal
Stop
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Which Advance Directive
Is Better?
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Both types of advance directives recognized in
Washington serve different purposes. Anyone
making a directive SHOULD ALWAYS MAKE BOTH.
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COMPLEMENTARY Your living will can direct the
actions of your agent by informing your agent
what kind of medical treatment you want to
receive.
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PRECAUTIONS If your doctors cannot reach your
health care agent they can rely on your living
will until your agent becomes available.
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Are Those The Only
Directives I Need?
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While the two main advance directives in
Washington state should be made by every
competent adult, there are additional provisions
you will likely need to include.
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DO NOT RESUSCITATE A do-not-resuscitate order
states whether you want to receive CPR or other
resuscitative measures should your heart and
lungs stop. This kind of order is usually
included in a living will when someone has a
chronic or terminal disease.
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HIPAA Release

• You should also include a HIPAA release with any
  directive. This allows your agent to view your
  medical records and share information with your
  doctors.

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Other Considerations
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FAMILY DISCUSSIONS Whenever you make a medical
directive its a good idea to discuss your
choices with your family ahead of time so there
are no surprises or conflicts.
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Single Agent
Choose one person to act as your agent. You can
select backups, but only one person should have
decision-making authority at any time.
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Withdrawal of Life Support If you know you want
life-sustaining treatments withdrawn in some
circumstances, make sure your family is aware of
your choice and your agent is willing to tell
your doctors to stop treatment.
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Disposition of Remains You can also include
directions about how you want your remains
treated in your directives, including your
choices about organ donation, burial, or
cremation.
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EMERGENCY TREATMENT
In emergency situations it may not be possible
for your doctors to access your advance
directives.
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Alert card or Bracelet
You can keep a medical alert card or bracelet
with you at all times so your doctors will have a
way of finding out if you have made a medical
directive.
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• Copies
• You should provide your agent, family members,
  and physicians with copies of any directives you
  make.

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Other Considerations
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YOU CAN ALWAYS CHANGE YOUR MIND
Medical directives are not written in stone.
You always retain the right to change your mind
at any time.
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UPDATES AND REWRITES If you want to make
simple changes you can amend your advance
directive. More significant changes will
probably require rewriting them completely.
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NOTIFICATION If you dont have time to change
your medical directive you can tell your
physician what your choices are and he or she
must follow them as long as you are mentally
sound.
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NOT CREATING ANY DIRECTIVE CAN BE A
DISASTER You are never required to make any
kind of advanced medical directive, but making
one is always in your best interests.
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Conflict
If you cannot make your own choices your doctors
will ask your spouse or family members to do so
for you. If they cannot come to an agreement this
will likely cause strife. In the worst-case
scenario a court will have to step in and appoint
someone to make decisions for you. The low cost
of creating a directive is far outweighed by the
high cost of a potential court battle.
Courts
Costs
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Consider Preparing Your
Will On Your Own?
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