How Do Advance Directives Work in Emergencies?
Here is the honest answer many people are surprised to hear: in a true emergency, a paramedic kneeling beside you will usually start treatment first, because that is what they are trained and required to do. Your living will matters a great deal, but it is not the document that speaks fastest in the field. The Law Office of Chad Foster helps Snohomish County families with advance-directive planning. Prepare early by creating and sharing an advance directive.
Why a Living Will Is Not an Emergency Instruction
A Washington living will, which the law calls a health care directive, is governed by the Natural Death Act, chapter 70.122 RCW. It is a powerful document, but read closely it is written for a very specific moment. Under RCW 70.122.030, the directive addresses the withholding or withdrawal of life-sustaining treatment once you have been diagnosed in writing to be in a terminal condition or a permanent unconscious condition. Those diagnoses take physicians, examinations, and in the case of permanent unconsciousness, confirmation by two doctors. That process does not happen on a sidewalk or in the back of an ambulance.
The definitions in RCW 70.122.020 reinforce the point. A "qualified patient" is someone already diagnosed in writing with a terminal or permanent unconscious condition, and "life-sustaining treatment" is described as intervention that would serve only to prolong the process of dying. In a sudden collapse, a car accident, or a cardiac event, no one yet knows whether you are dying or entirely recoverable. Emergency responders therefore default to preserving life while they gather information, and your directive generally becomes actionable when the statutory medical conditions and documentation requirements are met. A known refusal, an applicable medical order, or your present ability to decide can affect the response; an emergency does not make every prior instruction irrelevant.
The Document Built for the Emergency: POLST
Washington solved this gap with a different tool called a POLST, which stands for Portable Orders for Life Sustaining Treatment. Unlike a living will, a POLST is not something you sign alone. It is a medical order signed by a qualified provider, and because it is a standing order it can direct emergency personnel at the scene.
The POLST program exists because of the Natural Death Act itself. The 1992 amendments to that Act directed the Washington State Department of Health to adopt guidelines and protocols for how emergency medical personnel respond when they are called to treat a person who has signed a directive or power of attorney asking not to receive futile emergency treatment. That directive to the Department appears in RCW 43.70.480, and the Department, working with the Washington State Medical Association, created the POLST form to carry it out. The Washington POLST program provides portable medical orders for seriously ill or frail people. Use its current form with the treating clinician, rather than relying on the sections of an older form.
That portability is the whole idea. A POLST is usually printed on brightly colored paper and kept somewhere visible, such as the refrigerator or with your medications, so that responders can find it quickly and follow the orders on it without waiting for a hospital diagnosis. Because it is a signed provider order rather than a personal declaration, EMS can act on it in the field.
Who Should Consider a POLST
A POLST is not for everyone, and that is by design. It is generally intended for people who are seriously ill or frail, where a provider and patient can have a real conversation about what treatment would and would not help. A healthy adult planning ahead for the distant future usually starts with a health care directive and a durable power of attorney, and adds a POLST later if a serious illness makes those specific emergency orders appropriate. The right sequence depends on your health, which is why the POLST is completed with a provider rather than filled out from a template.
What Fills the Gap Before a POLST Exists
Without an available applicable order or other clear basis to withhold treatment, responders generally begin emergency care. Your other documents can then guide decisions as the medical team establishes your condition and authority to consent. Your health care directive tells the treating physicians your wishes about life-sustaining treatment if you are diagnosed with a terminal or permanent unconscious condition, and RCW 70.122.030 explains that in the absence of your ability to give directions, the directive is meant to be honored by your family and physicians as the final expression of your right to refuse treatment.
Just as important, the person you named to speak for you can step in. If you granted a health care agent general authority under a power of attorney, RCW 11.125.400 authorizes that agent to give informed consent for health care decisions on your behalf and to access your health information. In the hours after an emergency, that named agent is often the single most valuable part of your plan, because a real person who knows your wishes can talk with the medical team while the paperwork is located and reviewed. Emergency planning also calls for understanding a living will versus a healthcare power of attorney.
Putting the Pieces Together in Snohomish County
For families across Snohomish County, the practical lesson is that emergency readiness usually takes more than one document. A health care directive states your wishes, a durable power of attorney names the person who can act on them, and a POLST, when your health warrants it, gives emergency responders a signed order they can follow immediately. Each does a different job, and each fills a gap the others cannot. Coordinating them, and making sure the right people know where to find them, is what turns a stack of forms into a plan that actually works when the call comes in.
If you want help deciding which of these documents fits your health and your family right now, and how to keep them coordinated, the Law Office of Chad Foster works with families throughout Snohomish County and would welcome the chance to help you plan with confidence.
Need help with a estate planning matter in King or Snohomish County? Learn about our wills, trusts, and estate planning services, or call 425.785.8679 for a consultation.