**WASHINGTON STATE
LIVING WILL / ADVANCE HEALTH-CARE DIRECTIVE
(Draft Template for Attorney Customization)
[// GUIDANCE: This template is designed to comply with Washington’s Natural Death Act, Wash. Rev. Code ch. 70.122, and the Durable Power of Attorney Act, Wash. Rev. Code ch. 11.125. Customize bracketed items, remove guidance comments, and review all defined terms for consistency before finalizing.]
TABLE OF CONTENTS
- Document Header
- Definitions
- Appointment of Health-Care Agent
- Statement of Treatment Preferences
- Organ & Tissue Donation (Optional)
- Indemnification & Good-Faith Reliance
- Revocation & Amendment
- Statutory Construction & Miscellaneous
- Execution Block (Signature, Witnesses / Notary)
1. DOCUMENT HEADER
1.1 Title.
Living Will / Advance Health-Care Directive of [PRINCIPAL FULL LEGAL NAME] (“Principal”).
1.2 Effective Date.
This Directive is effective on the date executed below (“Effective Date”) and shall remain in effect until revoked pursuant to Section 7.
1.3 Governing Law.
This Directive shall be construed under the laws of the State of Washington, including but not limited to Wash. Rev. Code §§ 70.122 & 11.125 (“State Health-Care Law”).
2. DEFINITIONS
For purposes of this Directive, capitalized terms have the meanings set forth below:
“Adult” – An individual 18 years of age or older.
“Agent” – The person designated in Section 3.1 to make health-care decisions for the Principal.
“Artificial Nutrition & Hydration” – Invasive provision of nutrients or fluids through medical technology (e.g., IV or feeding tube).
“Comfort Care” – Measures to alleviate pain and maintain dignity without intent to cure.
“Life-Sustaining Treatment” – Any medical intervention that serves only to prolong the process of dying, including but not limited to mechanical ventilation, CPR, dialysis, and Artificial Nutrition & Hydration.
“Principal” – The individual executing this Directive.
“Qualified Physician” – A licensed physician authorized to practice in Washington who has primary responsibility for the Principal’s care.
[// GUIDANCE: Add or delete definitions to suit client-specific terminology.]
3. APPOINTMENT OF HEALTH-CARE AGENT
3.1 Designation.
The Principal designates [AGENT FULL LEGAL NAME], whose address is [ADDRESS] and telephone [PHONE], as Agent to make health-care decisions on the Principal’s behalf when the Principal lacks capacity, subject to the limitations in this Directive and State Health-Care Law.
3.2 Successor Agent(s).
If the Agent is unwilling or unable to act, the Principal designates, in order of priority:
(a) [SUCCESSOR AGENT 1 NAME, CONTACT];
(b) [SUCCESSOR AGENT 2 NAME, CONTACT].
3.3 Scope of Authority.
The Agent’s authority includes, without limitation, the power to:
a. Consent to, refuse, or withdraw medical treatment, including Life-Sustaining Treatment;
b. Access medical records and information under HIPAA;
c. Authorize admissions to or discharges from health-care facilities;
d. Sign documents necessary to carry out health-care decisions; and
e. Seek injunctive relief to enforce this Directive.
3.4 Limitations.
The Agent’s authority is expressly limited by the Principal’s instructions in Sections 4 and 5 and by any applicable statutory restrictions.
4. STATEMENT OF TREATMENT PREFERENCES
4.1 Terminal Condition.
If I am diagnosed by two Qualified Physicians as having an incurable, irreversible condition that will result in death within a reasonable period, and I lack capacity:
☐ I DIRECT that Life-Sustaining Treatment be withheld or withdrawn.
☐ I DIRECT that Life-Sustaining Treatment continue.
4.2 Permanent Unconscious Condition.
If I am in a persistent vegetative state or irreversible coma with no reasonable likelihood of regaining awareness:
☐ Withhold/withdraw Life-Sustaining Treatment.
☐ Continue Life-Sustaining Treatment.
4.3 Artificial Nutrition & Hydration.
☐ WITHHOLD if it only prolongs the dying process.
☐ PROVIDE under all circumstances.
☐ AGENT DECIDES after consultation with medical professionals.
4.4 Pain Management.
I direct that adequate medication for pain or discomfort be provided even if it hastens death in accordance with medical standards of comfort care.
4.5 Additional Instructions.
[PLACEHOLDER for religious, cultural, or other instructions.]
[// GUIDANCE: Under Wash. Rev. Code § 70.122.030, the Principal may modify statutory form language. Ensure clarity and consistency.]
5. ORGAN & TISSUE DONATION (OPTIONAL)
☐ I DONATE any needed organs/tissues for transplantation, therapy, research, or education.
☐ I DONATE only the following: [SPECIFY].
☐ I DECLINE to make an anatomical gift.
6. INDEMNIFICATION & GOOD-FAITH RELIANCE
6.1 Provider Protection.
Any health-care provider or institution that in good faith and in accordance with State Health-Care Law relies on this Directive or on the Agent’s decisions shall not incur civil or criminal liability and is hereby indemnified by my estate to the fullest extent permitted by law.
6.2 Liability Cap.
No Agent, provider, or facility acting in good faith shall be liable for more than actual damages proven to have resulted from gross negligence or willful misconduct.
[// GUIDANCE: Good-faith liability caps align with meta-data “good_faith_standard.” Confirm alignment with professional liability policies.]
7. REVOCATION & AMENDMENT
7.1 Revocation Methods.
This Directive may be revoked at any time by:
a. A signed and dated written revocation;
b. Physical destruction of the original Directive by the Principal or at the Principal’s direction; or
c. An oral expression of intent to revoke in the presence of an Adult witness, followed by a written confirmation signed and dated by that witness.
(See Wash. Rev. Code § 70.122.040.)
7.2 Automatic Revocation of Agent’s Authority.
If the Agent is the Principal’s spouse or domestic partner, the Agent’s authority terminates upon the dissolution or legal termination of that relationship, unless otherwise expressly provided herein.
7.3 Amendment.
The Principal may amend this Directive in writing at any time; amendments become effective upon proper execution with the same formalities as this Directive.
8. STATUTORY CONSTRUCTION & MISCELLANEOUS
8.1 Conflict with Other Instruments.
If a Durable Power of Attorney for health care executed by the Principal conflicts with this Directive, the most recently executed instrument controls unless expressly stated otherwise.
8.2 Copies.
A photocopy or electronically transmitted copy of this Directive has the same effect as an original.
8.3 Severability.
If any provision is held invalid, the remaining provisions shall remain in full force.
8.4 Integration.
This Directive constitutes the Principal’s entire advance directive and supersedes prior inconsistent instructions.
9. EXECUTION BLOCK
[// GUIDANCE: Washington allows EITHER two qualified witnesses OR a notary. Use one option only and remove the other.]
9.1 Principal’s Signature
I, [PRINCIPAL FULL LEGAL NAME], being of sound mind, voluntarily execute this Advance Directive on [DATE].
Signature: _______
Address: ________
Telephone: ______
OPTION A – TWO WITNESSES
We declare that the Principal is personally known to us, appears to be of sound mind, and signed this Directive in our presence. We are not (i) related to the Principal by blood, marriage, or state-registered domestic partnership; (ii) entitled to any portion of the Principal’s estate; (iii) directly financially responsible for the Principal’s medical care; nor (iv) the attending physician or an employee of the health-care facility in which the Principal is a patient.
(See Wash. Rev. Code § 70.122.030.)
Witness #1: _____ Date: __
Print Name & Address: _____
Witness #2: _____ Date: __
Print Name & Address: _____
OPTION B – NOTARY PUBLIC
State of Washington )
County of ____ )
On this ___ day of ____, 20__, before me, [NOTARY NAME], a Notary Public in and for said State, personally appeared [PRINCIPAL NAME], personally known to me or proved on the basis of satisfactory evidence to be the person whose name is subscribed to this instrument, and acknowledged that he/she/they executed it.
IN WITNESS WHEREOF I have hereunto set my hand and affixed my official seal.
Signature: ____
Notary Public for the State of Washington
Commission Expires: _______
[// GUIDANCE: After execution, distribute copies to the Agent, successors, primary physician, and any relevant health-care facility. Consider filing with the Washington State Advance Directive Registry if desired.]