How Do Doctors Use Advance Directives?

By Chad Foster, Family Law Attorney · Updated September 11, 2026

You signed a health care directive, filed it away, and hoped you would never need it. But have you ever wondered what a physician is actually required to do with that document when the moment arrives? Washington law is surprisingly specific, and understanding it can give you real confidence that your wishes will be honored. The Law Office of Chad Foster helps Snohomish County families with advance-directive planning.

How instructions become part of care

Clinical condition

Does the directive apply?

The treating team evaluates the conditions addressed by the document.

Communication

Clarify wishes and authority

The directive and any authorized agent have different roles.

Facility policy

Address conflicts early

Washington requires disclosure and a written plan in specified circumstances.

The Directive Is Presumed To Be Your Voice

The most reassuring part of Washington law is a legal presumption that works in your favor. Under RCW 70.122.060, your directive is conclusively presumed, unless you have revoked it, to be your directions about the withholding or withdrawal of life-sustaining treatment. In plain terms, the law treats the document as your true voice. A physician does not get to second-guess whether the directive really reflects what you wanted, so long as it is valid and you have not taken it back. That presumption is the backbone of the whole system, because it means your written choices carry weight even when you can no longer speak for yourself.

What the Attending Physician Must Confirm First

That presumption does not turn the directive into an automatic switch. Before life-sustaining treatment is withheld or withdrawn, the attending physician has duties to perform. RCW 70.122.060 requires the attending physician to make a reasonable effort to determine that your directive complies with the statute that governs it, RCW 70.122.030. If you are still able to make health care decisions, the physician must also confirm that the directive and every step the physician proposes are currently in line with your wishes. This is a sensible safeguard. It ensures that a document you signed years ago still matches what you would choose today, and it keeps a capable patient in the driver's seat.

There is also a threshold that has to be crossed before a health care directive operates at all. The directive addresses a terminal condition or a permanent unconscious condition, and RCW 70.122.030 requires those to be diagnosed in writing, with a terminal condition diagnosed by the attending physician and a permanent unconscious condition diagnosed by two physicians. RCW 70.122.030 also requires that those diagnoses be entered in writing and made a permanent part of your medical record before life-sustaining treatment is withheld or withdrawn. A physician therefore does not act on a directive lightly or prematurely. The medical condition has to be documented, and only then does the directive tell the doctor how to proceed. A separate issue arises when family wishes conflict with an advance directive.

When a Provider Has a Conflicting Policy

RCW 70.122.060(2) requires the physician or facility to disclose any policy or practice that would prevent honoring your directive when it becomes aware of the document. If you choose to remain after that disclosure, the provider and you or your representative must prepare a written plan describing what the provider intends to do if the directive becomes operative. That plan is filed with the directive.

The statute does not impose a simple honor-or-transfer rule. A provider that complies with subsection (2), including the written plan, has no obligation under that subsection to honor a conflicting directive. Subsection (4) also protects practitioners who object to participating in withholding or withdrawing treatment. Ask about those policies while you can still choose your care arrangements, and discuss alternatives with the medical team if the policy does not fit your wishes.

Protection for Providers Who Follow Your Wishes

One reason directives work is that Washington gives good-faith providers legal protection for honoring them. RCW 70.122.060 provides that a physician, health facility, or health personnel acting in good faith with the directive, or in accordance with the written plan the statute describes, receives the protections described in that statute, including protection for good-faith conduct under the written plan. That protection matters more than it might seem. It removes the fear of being sued for doing exactly what you asked, which makes providers far more willing to respect your choices rather than defaulting to maximum intervention out of caution.

Your Named Agent Works Alongside the Directive

A directive states your wishes, but a person can advocate for them in real time. If you named a health care agent through a power of attorney, that agent can be at the table when decisions are made. RCW 11.125.400 authorizes an agent with general health care authority to give informed consent for health care decisions on your behalf and to access your health information. RCW 70.122.030 also anticipates this pairing, asking that anyone appointed to make decisions for you, whether through a durable power of attorney or otherwise, be guided by your directive. Together, the document and the person reinforce each other, so the medical team has both a written statement of your wishes and a human being who can answer the questions a form cannot. Distinguish written treatment instructions from a healthcare agent's authority.

Planning Ahead in Snohomish County

For families in Snohomish County, the takeaway is that a directive is not a passive piece of paper. It triggers concrete duties for the physicians and facilities who care for you, it is presumed to speak with your voice, and it is strongest when paired with a trusted agent who can stand up for it. Getting the document drafted correctly, and making sure it meets the statutory requirements so a physician can rely on it, is what allows all of these protections to work as intended.

If you want to be sure your health care directive is drafted so your doctors can honor it without hesitation, the Law Office of Chad Foster helps families throughout Snohomish County put those documents in place. We would be glad to help you plan.