Living Will and Advance Health-Care Instruction Requirements in Washington
At a glance
| Governing law and document | Natural Death Act, RCW ch. 70.122: written 'directive' or 'health care directive' to withhold/withdraw life-sustaining treatment (§§ 70.122.020, .030). The § .030 form is optional and may include added directions; separate from a durable power of attorney and POLST. |
|---|---|
| Who may make an instruction | Any 'adult person': a person who has reached majority and has capacity to make health-care decisions (§§ 70.122.020(1), .030(1)). |
| Oral, written, and signature form | Written directive signed by the declarer (§§ 70.122.020(3), .030(1)). Chapter 70.122 provides no oral or directed-signature execution route and states no electronic-specific signing method. |
| Witness, notary, and disqualifications | Either acknowledgment before a notary/other acknowledgment officer OR two witnesses (§ 70.122.030(1)). Witnesses cannot be related by blood/marriage, inherit under the current will or intestacy, be the attending physician, the physician's or patient's facility's employee, or hold an estate claim. |
| Covered conditions and trigger | Terminal condition: attending physician's written diagnosis after personal exam. Permanent unconscious condition: written diagnosis by two physicians, one attending, both after personal exam (§§ 70.122.020(6), (8), .030(2)). The directive governs when life-sustaining treatment would only prolong dying; if the patient remains capable, proposed steps must match current desires (§ 70.122.060(1)). |
| Treatment, nutrition, hydration, and comfort | Directs withholding/withdrawal of life-sustaining treatment for a terminal or permanent unconscious condition (§ 70.122.030). Life-sustaining treatment includes artificially provided nutrition and hydration, but the model form makes provide/do-not-provide a separate election. Pain-alleviating medication/procedures are excluded from life-sustaining treatment (§ 70.122.020(5)). |
| Pregnancy and other statutory limits | No pregnancy-specific restriction appears in current ch. 70.122; the 2025 amendment removed pregnancy references from the model form. The chapter does not authorize mercy killing, lethal injection, or active euthanasia (§ 70.122.100). |
| Revocation, notice, and registry | Revoke at any time regardless of mental state/competency by directed destruction, signed dated writing, verbal expression, or registry online method (§ 70.122.040). Written/verbal revocation takes effect on communication to the attending physician, who records it. Optional state registry; nonfiling does not affect validity, and failure to update a valid revocation does not defeat it (§ 70.122.130). |
| Provider duties, recognition, and effect | Attending physician verifies compliance and current desires (§ 70.122.060). A physician/facility policy may decline to honor the directive if disclosed and a written plan is filed; individual practitioners may refuse participation. The unrevoked directive is conclusively presumed to state the patient's directions, with good-faith immunity. An out-of-jurisdiction directive is valid only to the extent Washington and federal constitutional law permit (§ 70.122.030(3)). |
Requirements one by one
Execution uses a notary or two qualified witnesses
Section 70.122.030 now gives two alternatives. The declarer may sign and acknowledge the directive before a notary or other authorized acknowledgment officer, or may sign before two witnesses. The witness route has a detailed disqualification list covering relatives, heirs, estate claimants, the attending physician, and certain physician or facility employees.
Terminal and unconscious conditions use different findings
Under § 70.122.020, a terminal condition is diagnosed in writing by the attending physician after personal examination. A permanent unconscious condition requires written diagnoses from two personally examining physicians, one of whom is the attending physician. Section 70.122.030 requires the applicable diagnosis to become a permanent part of the medical record before life-sustaining treatment is withheld or withdrawn.
Nutrition and hydration are a separate election
Section 70.122.020 includes artificially provided nutrition and hydration in "life-sustaining treatment," but the model form in § 70.122.030 asks the declarer to choose separately whether to receive them. Pain-alleviating medication and procedures are outside the life-sustaining-treatment definition.
Revocation does not require capacity
Section 70.122.040 permits revocation at any time without regard to mental state or competency. The declarer may use physical destruction, a signed dated writing, a verbal expression, or the registry's online route. Written and verbal revocations become effective on communication to the attending physician, who must make the specified medical-record entry.
A disclosed refusal policy can control provider procedure
Under § 70.122.060, a physician or facility must disclose a policy that would prevent honoring the directive when it learns of the directive. If the patient chooses to remain, the parties prepare a written plan for what the provider will do if the directive becomes operative. Compliance with that process removes the provider's obligation to honor the directive. Individual practitioners also may refuse to participate; the section does not impose a transfer duty.
What trips people up
- Terminal condition takes one physician; permanent unconsciousness takes two. The definition of qualified patient in § 70.122.020 makes that split explicit.
- Current wishes still matter. Section 70.122.060 requires reasonable effort to confirm that the directive and proposed steps remain consistent with a capable patient's present desires.
- The registry does not cure execution defects. Section 70.122.130 says filing does not replace the legal formalities or create a validity presumption.
Common questions
Is notarization mandatory?
No. Section 70.122.030 allows either an acknowledgment or two qualified witnesses.
Does Washington suspend a directive during pregnancy?
Current chapter 70.122 contains no pregnancy-specific suspension. The 2025 amendment removed pregnancy references from the model form.
Will a directive signed elsewhere work in Washington?
Section 70.122.030(3) recognizes it only to the extent permitted by Washington law and federal constitutional law.
Statutes and sources
- RCW 70.122.020 and .030 — definitions, execution, model form, medical triggers, nutrition and hydration choice, record entry, and out-of-state effect. Official § .020 and § .030 (accessed 2026-07-30).
- RCW 70.122.040, .060, and .100 — revocation, provider procedure, presumptive effect, conscience refusal, and legal limits. Official § .040, § .060, and § .100 (accessed 2026-07-30).
- RCW 70.122.130 — optional registry, current text, and the June 30, 2027 terminology update. Official section (accessed 2026-09-19).
Source links
Every statute quoted above, linked, with the date we checked it.
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