Can I Include Preferences for Specific Treatments?

When you plan for a serious illness, you may have firm views about particular treatments, and Washington law lets you record many of those preferences so your care follows your wishes rather than a stranger's guess.

Two Documents, Two Different Reaches

People often assume a single form covers every possible medical decision. In reality, Washington gives you two complementary tools, and understanding what each one reaches is the key to including your preferences for specific treatments. The first is a health care directive under the Washington Natural Death Act, chapter 70.122 RCW. The second is the appointment of a health care agent through a durable power of attorney under RCW 11.125.400. The directive speaks directly for you in the situations it names, while the agent can decide across the far broader range of medical choices a directive cannot anticipate.

What a Directive Addresses

A health care directive focuses on a specific and serious question: if you reach a terminal condition or a permanent unconscious condition, do you want life-sustaining treatment used when it would serve only to prolong the process of dying? RCW 70.122.030 sets out the directive and provides a form. In it, you declare that under those circumstances you want such treatment withheld or withdrawn so you can die naturally.

The directive also reaches one specific treatment that often weighs on people's minds. RCW 70.122.030 includes an express election about artificially provided nutrition and hydration, letting you check whether you do or do not want it if you are in a terminal or permanent unconscious condition. That is a concrete, treatment-specific preference the statute allows you to record in the document itself.

Just as important, the same statute makes clear the wording is not fixed. Before signing, you may add to, delete from, or otherwise change the directive, and may include other specific directions, so long as your changes stay consistent with Washington law. So if you have particular wishes about the kinds of interventions you would or would not want as your dying progresses, there is room to write them down rather than leave them unsaid.

One reassurance built into the framework: the directive is about declining treatment that only prolongs dying, not about declining comfort. RCW 70.122.020 defines life-sustaining treatment and expressly excludes medication or interventions meant solely to alleviate pain. Choosing to forgo life-sustaining measures never means forgoing pain relief.

Where a Health Care Agent Covers the Rest

A directive is powerful, but it operates within the specific conditions it describes, and it cannot foresee every treatment decision a real illness produces. That is exactly the gap a health care agent fills. Under RCW 11.125.400, when a power of attorney grants general authority over health care matters, your agent is authorized to provide informed consent for health care decisions on your behalf and to access your health information under federal privacy law.

That authority is broad by design. It reaches the many day-to-day and situation-specific choices that come up in the course of treatment, from surgeries and medications to whether to pursue or decline a particular intervention when your directive does not squarely address it. An agent can respond to new information in real time, ask questions of the medical team, and apply your known values to a situation no form could have predicted.

The two documents are meant to work together. RCW 70.122.030 asks that anyone appointed to make decisions for you, whether through a durable power of attorney or otherwise, be guided by your directive and your other clear expressions of your wishes. In practice, your directive sets the anchor for the most serious end-of-life questions, and your agent carries your values into everything else. The clearer you are with your agent about your preferences on specific treatments, the better they can honor them when it counts.

Choosing the Right Agent

Because an agent's reach is so broad, whom you choose matters. RCW 11.125.400 places a limit worth knowing: unless the person is your spouse, registered domestic partner, parent, adult child, or sibling, your physicians, their employees, and the owners or staff of the facility where you live or receive care generally cannot serve as your agent. The rule guards against conflicts of interest and usually steers you toward a trusted family member or close friend who understands your wishes.

Put Your Preferences in Writing and in Conversation

The most effective plans combine written specificity with an honest conversation. A directive that records your wishes about life-sustaining treatment and artificial nutrition and hydration, paired with an agent who knows your views on the treatments a form cannot list, gives your care team a clear picture. When your preferences live only in your head, families are left guessing at a painful moment, and that is where conflict tends to arise.

A Snohomish County Perspective

For families here, thorough documents do more than direct medical care. They protect relationships. When your directive states your specific wishes and your agent is empowered to decide the rest, relatives are far less likely to end up at odds over what you would have wanted. Estate planning and family peace are tightly connected, because the same clarity that guides your treatment also spares your loved ones from a preventable dispute.

You can include preferences for specific treatments in your Washington health care planning. Use the directive for the serious end-of-life questions it is built to answer, including artificial nutrition and hydration, and use a health care agent to cover the broad range of decisions the directive cannot reach. If you would like help building a plan that reflects your specific wishes, the Law Office of Chad Foster would be glad to guide you through each piece.