Default Health-Care Surrogate Priority in Washington
At a glance
| When the default route opens | Provider reasonably finds and records decision-specific incapacity; then seeks an authorized person in priority order (RCW 7.70.065(1)). |
|---|---|
| Care or setting covered | Consent for health care; definition includes physical or mental care by a provider, with no named facility-only limit in the adult ladder (RCW 7.70.065(1), (4); 70.02.010(15)–(16)). |
| Guardian or appointed agent | Appointed guardian first; durable health-care power of attorney holder second (RCW 7.70.065(1)(a)(i)–(ii)). |
| Family and partner order | Spouse or registered partner; adult children; parents; adult siblings; familiar adult grandchildren, nieces/nephews, then aunts/uncles (RCW 7.70.065(1)(a)(iii)–(ix)). |
| Friend or other nonfamily person | Qualified close friend last; signed perjury declaration lasts up to six months, and provider may decline to rely on it (RCW 7.70.065(1)(a)(x)). |
| Decision within one class | All available people in a class must agree; a higher-priority refusal bars lower-class consent (RCW 7.70.065(1)(b)). |
| Who is available and eligible | Provider makes reasonable efforts to find a competent higher-class person; close friend must be available, familiar with values, and outside barred care-provider roles (RCW 7.70.065(1)(a)(x), (b)). |
| Decisions limited or excluded | Surrogate first seeks patient's likely consent, then best interests; cannot exercise Death with Dignity Act rights for patient (RCW 7.70.065(1)(c)–(d)). |
| No surrogate or disputed authority | Recognized emergency may imply consent if patient cannot consent and authorized person is not readily available; court may appoint a guardian after petition and findings (RCW 7.70.050(4); 11.130.265(1)). |
Requirements one by one
When the default route opens
RCW 7.70.065(1) presumes capacity at the age of consent for a particular decision. A provider must reasonably identify a cognitive impairment that prevents the person from understanding and appreciating the condition, proposed treatment, options, and consequences and reaching an informed decision, then document the basis in the medical record. The adult list itself ranks a guardian and health-care attorney-in-fact ahead of family.
Care or setting covered
RCW § 70.02.010(15) defines health care to include diagnosis, treatment, or maintenance of physical or mental conditions. The adult consent rule in RCW § 7.70.065(1)(a) does not name a hospital-only or nursing-home-only setting; the chapter's facility definition in RCW 70.02.010(16) also includes clinics, offices, and similar places.
Family and partner order
RCW 7.70.065(1)(a)(iii)–(ix) places a spouse or state registered domestic partner ahead of children who are at least eighteen, parents, and adult siblings. Familiarity with the patient is expressly required for adult grandchildren, nieces and nephews, and aunts and uncles. The statute does not impose that express familiarity phrase on the earlier family classes.
Friend or other nonfamily person
The last class in RCW 7.70.065(1)(a)(x) requires care and concern, knowledge of the patient's values, reasonable availability, and a signed declaration under penalty of perjury. The declaration must describe a close friendship and regular contact and lasts up to six months; the provider may choose whether to rely on it. A patient's physician, certain facility personnel, and paid caregivers cannot use this route.
Decision within one class
RCW 7.70.065(1)(b) requires unanimity among all available members when a class has two or more people. For example, one available adult child's objection prevents another child's affirmative consent under this section. A refusal by a person in a higher class also cannot be bypassed by seeking consent from a lower class.
Decisions limited or excluded
Under RCW 7.70.065(1)(c), a surrogate first asks whether the patient would have agreed; only if that cannot be determined may the surrogate use the patient's best interests. Subsection (1)(d) excludes exercising rights under Washington's Death with Dignity Act through a surrogate.
No surrogate or disputed authority
RCW § 7.70.050(4) implies consent to required treatment in a recognized health-care emergency when the patient cannot consent and/or an authorized person is not readily available. Outside that emergency route, RCW § 11.130.265(1) permits a court to appoint a guardian after petition, notice, hearing, and the required findings; subsection (2) limits the powers granted to the demonstrated need.
What trips people up
An unsuccessful search for a higher-class person permits moving down the ladder only after reasonable efforts under RCW 7.70.065(1)(b). A higher-class refusal is different: it bars lower-class consent under that same provision. The provision does not supply a majority vote or let a lower class break a tie.
Common questions
Can a close friend act without a formal power of attorney? Yes, if the friend meets RCW 7.70.065(1)(a)(x), signs the required declaration, and the provider relies on it. The friend comes after every listed family class.
Does a domestic partner have the same position as a spouse? RCW 7.70.065(1)(a)(iii) places a state registered domestic partner in the same class as a spouse.
Can a relative consent to aid in dying for an incapacitated adult? No. RCW 7.70.065(1)(d) expressly excludes exercise of Death with Dignity Act rights through an authorized surrogate.
Statutes and sources
- Wash. Rev. Code §§ 7.70.065, 7.70.050, 70.02.010, and 11.130.265. Verbatim official text, source links, and access dates appear in the source fields above.
Source links
Every statute quoted above, linked, with the date we checked it.
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