How Do I Create an Advance Directive?

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

Creating an advance directive in Washington is more straightforward than most people expect, but the details of how you sign and witness it are what make it legally valid. Getting those details right is the difference between a document that works and one that fails when your family needs it.

The Short Answer

To create an advance healthcare directive in Washington, you must be an adult, put your wishes in writing, and then sign the document in one of two approved ways: either have your signature acknowledged before a notary public, or sign it in front of two qualified witnesses. This is set out in Washington's Natural Death Act, specifically RCW 70.122.030. Once it is properly signed, the directive becomes a legally effective statement of your wishes about life-sustaining treatment.

Step One: Confirm You Are Eligible

The eligibility bar is low, and that is intentional. Under RCW 70.122.030, any adult person may execute a directive directing the withholding or withdrawal of life-sustaining treatment in a terminal condition or permanent unconscious condition. The statute wants adults to be able to plan ahead. You do not need to be diagnosed with anything, and you do not need to be in poor health. The ideal time to create your directive is while you are healthy and able to think through your choices without pressure.

Step Two: Decide What You Want to Say

The directive lets you state whether you want life-sustaining treatment withheld or withdrawn if you reach a terminal condition or a permanent unconscious condition and that treatment would only prolong the process of dying. RCW 70.122.030 even includes a suggested form you can follow, and it lets you make a separate, specific choice about whether you want artificially provided nutrition and hydration. You are also free to add your own directions or change the wording, as long as the changes remain consistent with Washington law. This is your document, and it should reflect your values.

Step Three: Sign It the Right Way

Here is where care matters most. Under RCW 70.122.030, the directive must be signed by you, the declarer, and then validated in one of two ways. The first option is to have your signature acknowledged before a notary public or another individual authorized by law to take acknowledgments. The second option is to sign the directive in the presence of two witnesses. Either path works, but the document is only valid if you follow one of them exactly.

If you choose the witness route, you cannot use just anyone. The statute lays out clear disqualifications, and they exist to prevent conflicts of interest.

Four Steps to a Valid Directive

The signing details are what make it enforceable (RCW 70.122.030).

1

Confirm eligibility: any adult may execute one, no diagnosis required. Best done while healthy.

2

Decide your wishes about life-sustaining treatment, including a separate choice on artificial nutrition and hydration.

3

Sign it the right way: acknowledged before a notary, or signed before two qualified witnesses.

4

Get copies to your physician, your agent, and close family so it can actually be found.

Who Cannot Serve as a Witness

Under RCW 70.122.030, a witness to your directive may not be a person related to you by blood or marriage. A witness also may not be someone who would inherit any part of your estate, whether under your existing will or codicil or by operation of law. In addition, a witness cannot be your attending physician, an employee of your attending physician, or an employee of a health facility where you are a patient. Finally, no one who has a claim against any portion of your estate at the time you sign may serve as a witness.

The reasoning is common sense. The law does not want anyone who stands to gain from your death, or anyone responsible for your care, vouching for a document about ending life-sustaining treatment. Choosing neutral witnesses protects the integrity of your directive and helps it hold up when it matters.

Step Four: Make Sure the Right People Have It

A directive only helps if the people who need it can find it. Under RCW 70.122.030, when withholding or withdrawing life-sustaining treatment is being considered, the directive becomes part of your medical records kept by your attending physician, and a copy is forwarded to the health facility. Practically, that means you should give copies to your physician, to any healthcare agent you have named, and to close family members who may be involved in your care. A perfectly drafted directive locked in a safe deposit box does no good in an emergency. If you travel or move, check how your advance directive will work across state lines.

Coordinating With Your Other Documents

An advance directive works best as part of a larger plan. Many people pair it with a healthcare power of attorney, which names a trusted agent to make medical decisions the directive cannot anticipate. In Washington, an agent's authority over health care comes from RCW 11.125.400. If you later become seriously ill, your provider may also prepare a POLST, a portable medical order that translates your wishes into immediate instructions for emergency responders. The directive is the foundation; the other documents build on it.

A Note on Out-of-State Directives

If you signed a directive in another state and later moved to Washington, do not assume it automatically works here. Under RCW 70.122.030, a directive executed in another jurisdiction is valid only to the extent Washington law and federal constitutional law permit. If you have relocated to Snohomish County from elsewhere, it is worth having your existing documents reviewed so you know they will actually be honored.

Why This Matters Locally

For families throughout Snohomish County, a valid directive prevents painful uncertainty. When the signing formalities are done correctly, no one has to wonder whether the document counts. When they are done carelessly, a directive can be challenged at the worst possible moment, especially in families navigating separation, remarriage, or strained relationships. Taking the time to execute your directive properly is a gift to the people you love.

Getting It Right

Creating an advance directive is not complicated, but the signing and witnessing rules leave no room for guesswork. A small mistake can undo the whole document. If you want to be certain your directive is valid and coordinated with the rest of your estate plan, the Law Office of Chad Foster helps Snohomish County families put these documents in place with confidence. Reach out to start the conversation.