How Do I Ensure My Advance Directive Is Followed?

By Chad Foster, Family Law Attorney · Updated July 16, 2026

Signing an advance directive is only the first step. Making sure it actually guides your care when the moment comes takes a few deliberate actions that many people overlook.

Start With Proper Execution

A directive only carries legal weight if it is executed correctly, so this is where everything begins. Under Washington's Natural Death Act, specifically RCW 70.122.030, any adult may execute a directive directing the withholding or withdrawal of life-sustaining treatment in a terminal condition or permanent unconscious condition. To be valid, the directive must be signed by you and either acknowledged before a notary public or signed in the presence of two witnesses.

The witness requirements are strict for good reason. Under RCW 70.122.030, your two witnesses cannot be related to you by blood or marriage, and they cannot be anyone who would inherit from your estate under a will or by operation of law. They also cannot be your attending physician, an employee of that physician, or an employee of the health facility where you are a patient. If you choose the witness route, line up people who clearly meet these rules. If that is difficult, using a notary public is a clean alternative the statute expressly allows. Getting execution right is what turns a heartfelt wish into an enforceable document.

Making Sure It Is Actually Followed

A valid directive still needs to be found and honored.

1

Execute it correctly: signed, and either notarized or witnessed by two qualified people (RCW 70.122.030).

2

Distribute copies: your physician's chart, your health care agent, close family, and the state registry.

3

Confirm your provider will honor it, and ask up front if their policy would prevent it (RCW 70.122.060).

4

Talk it through with your people, and keep it consistent with your other documents.

Put the Document Where It Will Be Found

A perfectly valid directive helps no one if it sits in a safe deposit box that no one can open. RCW 70.122.030 contemplates that the directive, or a copy, will be made part of your medical records retained by your attending physician, and that the custodian of those records forwards a copy to the health facility when withholding or withdrawing treatment is being considered. In practice, that means you should give a copy to your regular physician so it lives in your chart before any emergency arises.

Beyond your doctor, give copies to the people most likely to be present or contacted in a crisis. If you have named a health care agent under a power of attorney, that person should have a copy and should know exactly where the original is kept. Close family members who might be at the hospital should also know the directive exists and what it says. Washington also maintains a health care declarations registry through the Department of Health, and registering your directive there gives providers another way to locate it. The goal is redundancy: several trusted people and your medical file should all have the current version.

Know What the Law Asks of Providers

Washington law does not leave your physician guessing. Under RCW 70.122.060, before withholding or withdrawing life-sustaining treatment, the attending physician must make a reasonable effort to confirm that the directive complies with RCW 70.122.030, and, if you are still able to make health care decisions, that the proposed steps line up with your current wishes. The same statute states that a directive is conclusively presumed, unless revoked, to be your directions regarding life-sustaining treatment. That presumption is powerful, because it means a valid, unrevoked directive is treated as your genuine voice.

RCW 70.122.060 also handles the situation where a physician or facility has a policy that would prevent honoring your directive. In that case, the provider must inform you or your representative of that policy when they become aware of the directive. If you choose to stay with that provider anyway, the statute requires a written plan, filed with your directive, setting out what the provider intends to do if your medical status changes so that the directive would apply. Understanding this rule matters, because it tells you to ask providers up front whether they will honor your directive rather than assuming they will.

Talk to the People Who Will Speak for You

Documents are important, but conversation is what makes them work. The people who may be asked to act on your directive should hear directly from you about what you want and why. When your family and your health care agent already understand your values, they are far less likely to hesitate or second-guess at a painful moment. RCW 70.122.030 itself anticipates this: the standard directive language asks that anyone appointed to make decisions for you be guided by the directive and your other clear expressions of your wishes.

These conversations are rarely easy, but they spare your loved ones from having to guess. A directive that is backed by a clear, remembered discussion is much harder to dispute than a document that surprises everyone.

Keep It Current and Consistent

Make sure your directive does not contradict your other planning documents. If you also have a durable power of attorney naming a health care agent, the instructions should point in the same direction. Review your directive after major life changes, and when you update it, replace every outstanding copy so no one is working from an old version. For families in Snohomish County who are already organizing wills, powers of attorney, and family law matters, folding an advance directive review into that process keeps the whole plan aligned.

Doing these things well is not complicated, but each step matters, and a small gap can create a large problem at exactly the wrong time. If you want to be confident your directive is properly executed, correctly distributed, and consistent with the rest of your plan, the Law Office of Chad Foster can help you put it all in order.