Washington Living Will Requirements

Introduction

Key Things to Know

1. 1

   Washington calls this document a directive, not a living will, and treats it as its own freestanding instrument under the Natural Death Act (RCW 70.122). It states what treatment you want or refuse, and those elections are binding on their own, with no agent named anywhere in it.

2. 2

   A living will is not a last will and testament. One covers medical care while you are alive but unable to communicate; the other covers who inherits your property after you die. Many people end up preparing both.

3. 3

   Your directive is complete and enforceable under RCW 70.122 whether or not you ever execute a health care power of attorney. Naming an agent is entirely optional and falls under a different chapter of law, chapter 11.125 RCW, with its own separate execution rule and witness list.

4. 4

   The directive recognizes only two conditions that can trigger it: a terminal condition, diagnosed by your attending physician, or a permanent unconsciousness condition, which needs a diagnosis from two physicians.

5. 5

   Artificial nutrition and hydration gets its own separate checkbox on Washington's form, apart from your general treatment instruction. Leaving it blank leaves your wishes on that specific point unstated.

6. 6

   Nothing in Washington's Natural Death Act changes, pauses, or cancels your directive because you are pregnant. The chapter contains no such clause at all.

7. 7

   You can sign before a notary public, or before two qualifying witnesses instead. Both are equally valid ways to execute the directive; neither is a fallback for the other.

8. 8

   Washington does not require an extra advocate or ombudsman witness for residents of skilled nursing or long term care facilities, a requirement some other states do impose.

9. 9

   You can revoke the directive at any time, no matter your mental state, by destroying it, telling your physician, writing a signed revocation, or, if it is stored in Washington's registry, revoking it online through the Department of Health.

Washington Requirements for Living Will

• Declaration of Intent (Washington Revised Code Section 70.122.030)

  Washington's statute calls this document a directive, created under the Natural Death Act. The directive is a written, signed statement of your wishes about withholding or withdrawing life sustaining treatment if you are later diagnosed with a terminal condition or a permanent unconscious condition. The phrase living will does not appear in the statute itself; it is a common nickname, not the statutory term.

• Capacity and Age Requirement (Washington Revised Code Sections 70.122.020, 26.28.010, 26.28.015)

  Only an adult person may execute a directive, meaning someone who has reached the age of majority, 18, under RCW 26.28.010 and 26.28.015, and who has the capacity to make health care decisions.

• Terminal Condition Trigger (Washington Revised Code Sections 70.122.020, 70.122.030)

  A terminal condition must be diagnosed in writing by your single attending physician, not multiple physicians. It is defined as an incurable and irreversible condition that will, within reasonable medical judgment, cause death within a reasonable period, where life sustaining treatment would only prolong the process of dying.

• Permanent Unconscious Condition Trigger (Washington Revised Code Sections 70.122.020, 70.122.030)

  Washington's second and only other trigger condition is a permanent unconscious condition, defined as an incurable, irreversible state with no reasonable probability of recovery from an irreversible coma or a persistent vegetative state. Unlike the terminal condition trigger, this diagnosis takes two physicians, one of whom must be your attending physician, both of whom must personally examine you.

• Life Sustaining Treatment Definition (Washington Revised Code Section 70.122.020)

  Washington defines life sustaining treatment broadly as any medical or surgical intervention using mechanical or other artificial means, including artificially provided nutrition and hydration, to sustain, restore, or replace a vital function that would otherwise only prolong dying. The statute does not itemize specific modalities like ventilation, dialysis, or antibiotics by name, and expressly excludes medication or intervention given solely to relieve pain.

• Witness Requirements (Washington Revised Code Section 70.122.030)

  If you use witnesses instead of a notary, Washington requires two witnesses who are not related to you by blood or marriage, not entitled to any portion of your estate, not your attending physician, not an employee of your attending physician or of the health facility where you are a patient, and not anyone with a claim against your estate.

• Notarization Alternative (Washington Revised Code Section 70.122.030)

  Acknowledging your directive before a notary public or other official authorized to take acknowledgments is not just an extra verification step, it is a fully independent, equally valid way to execute the directive, standing on equal footing with signing before two witnesses. You need one or the other, not both.

• Revocation Procedures (Washington Revised Code Section 70.122.040)

  You may revoke your directive at any time, regardless of your mental state, by destroying it, by a signed and dated written revocation, or by telling your attending physician. If your directive is stored in Washington's health care declarations registry, you may also revoke it through an online method the Department of Health establishes.

• Healthcare Provider Immunity (Washington Revised Code Section 70.122.051)

  A physician, advanced practice registered nurse, or health facility that participates in good faith in withholding or withdrawing life sustaining treatment consistent with your directive is immune from civil, criminal, and professional discipline liability, unless otherwise negligent.

• Organ Donation Directive (Washington Revised Code Chapter 68.64)

  Washington's Uniform Anatomical Gift Act, chapter 68.64 RCW, lets you make, amend, or revoke an anatomical gift.

• Out-of-State Recognition (Washington Revised Code Section 70.122.030(3))

  Under RCW 70.122.030(3), a directive executed in another jurisdiction is valid in Washington to the extent allowed by state law and federal constitutional law.

• Mental Health Advance Directive (Washington Revised Code Chapter 71.32)

  Chapter 71.32 RCW governs Washington's voluntary mental health advance directives, which are distinct from the directive under RCW 70.122 and from involuntary commitment proceedings. It is its own document with its own execution and witness rules, not a section of the RCW 70.122 directive covered on this page, so completing this page's directive alone does not give you mental health advance directive coverage.

• Healthcare Agent Designation (Washington Revised Code Section 11.125.400)

  A durable power of attorney for health care, authorized under chapter 11.125 RCW, lets you name an agent with authority over health care decisions, including HIPAA access and informed consent. That is a separate function from the treatment wishes directive covered on this page. For agent designation guidance specifically, see Washington Healthcare Power of Attorney.

• Patient Self-Determination Act Compliance (42 U.S.C. Section 1395cc(f))

  Federal law requires Medicare and Medicaid participating hospitals, nursing homes, and other facilities to inform patients in writing of their right under Washington law to make an advance directive, including stating their own treatment wishes.

• Medical Records and Facility Notice (Washington Revised Code Section 70.122.030)

  The directive, or a copy, must be made part of the patient's medical records. The records custodian must also forward a copy to the health facility when withholding or withdrawal of treatment is being considered.

• Separate Artificial Nutrition and Hydration Election (Washington Revised Code Section 70.122.030(1)(c))

  Washington's statutory directive form requires a second, separately initialed choice for artificial nutrition and hydration, apart from the general life sustaining treatment instruction. Marking the general instruction alone does not state your wishes on nutrition and hydration specifically.

• Directive and Health Care Power of Attorney Kept as Separate Documents (Washington Revised Code Chapter 70.122; Chapter 11.125 RCW)

  Washington does not combine the treatment wishes directive with agent designation into one instrument. The directive (chapter 70.122 RCW) and the durable power of attorney for health care (chapter 11.125 RCW) are governed by different statutes with different execution rules.

• Pain Relief During Withholding or Withdrawal of Treatment (Washington Revised Code Sections 70.122.010, 70.122.020(5))

  Washington's legislative findings state that physicians and nurses should not withhold or unreasonably diminish pain medication for a patient in a terminal condition where the medication's primary purpose is comfort, and the statutory definition of life sustaining treatment expressly excludes medication or intervention given solely to relieve pain.