What Happens If I Become Incapacitated Without Directives?
If an illness or accident left you unable to make your own medical decisions tomorrow, and you had signed no advance directive and named no health care agent, someone would still have to decide for you. Washington law fills that vacuum with a fixed priority list, and it may not put the person you would have chosen at the top.
Washington's Default Decision-Maker List
When a patient lacks the capacity to make a health care decision and has not appointed anyone, providers turn to RCW 7.70.065. This statute sets out an order of priority for who may give informed consent on your behalf. The list begins with any court-appointed guardian, then the person to whom you gave a durable power of attorney for health care, then your spouse or state registered domestic partner, then your adult children, then your parents, then your adult brothers and sisters. If none of those are available, the law continues on to adult grandchildren, adult nieces and nephews, and adult aunts and uncles who are familiar with you, and finally to a close friend who meets specific requirements and signs a declaration under penalty of perjury.
The key thing to notice is that without your own planning, the decision defaults to whoever sits highest on this list, in the order the legislature chose. That is fine if the ordering happens to match your wishes. It is a serious problem if it does not.
Why the Default Order Can Go Wrong
Consider a few common situations. Suppose you are unmarried but have a partner you have lived with for years and would trust with your life. Under RCW 7.70.065, an unmarried partner is not a spouse or state registered domestic partner, so that person is not high on the list, and your adult children or parents would outrank them. Or suppose you have three adult children who do not agree with one another. The statute requires that when there are two or more people in the same priority class, the decision must be unanimous among all available members of that class. If your children split, care can stall while everyone tries to reach agreement.
There is another limit worth knowing. A surrogate under this statute is not permitted to exercise rights under Washington's Death with Dignity Act on your behalf. That decision, by law, can only be made by a competent patient personally. So the default framework covers ordinary medical consent, but it does not let a substitute step into every possible choice.
The Standard a Surrogate Must Follow
Even the right person on the list is bound by a standard. Before acting, a surrogate must determine in good faith what you would have decided if you had capacity. Only if that cannot be determined may they act in your best interests instead. This is meant to keep the focus on your wishes. But if you never wrote those wishes down, your surrogate is left guessing, and family members can honestly disagree about what you "would have wanted." That uncertainty is exactly what advance planning is designed to prevent.
When No Surrogate Is Available: Guardianship
Sometimes there is no one on the priority list who is available and willing to serve, or the people who are available cannot agree. In that situation, the path forward is guardianship under chapter 11.130 RCW, Washington's guardianship and conservatorship law. A court can appoint a guardian to make decisions for an adult who cannot make or communicate them safely, including decisions about health care and living arrangements.
Guardianship works, but it comes at a cost. It requires a court petition, notice, a hearing, and often the appointment of professionals to evaluate the situation. It takes time you may not have in a medical crisis, it can be expensive, and it puts a judge, rather than you, in charge of choosing who speaks for you. Notice, too, that a court-appointed guardian sits at the very top of the RCW 7.70.065 priority list. The law would rather you name your own decision-maker in advance than have a court do it after the fact.
How Planning Ahead Changes the Picture
You can take almost all of this uncertainty off the table with two documents. A durable power of attorney for health care lets you name the specific person you trust to make your medical decisions, moving them to the top of the list ahead of the default order and avoiding the deadlock and guesswork that can otherwise follow. A health care directive, or living will, lets you state your own wishes about life-sustaining treatment so your chosen agent and your family are following your instructions rather than debating them. Together, these documents replace a rigid statutory default and a possible courtroom with your own clear choices.
A Note for Snohomish County Families
These issues hit close to home for families across Snohomish County. Blended families, unmarried partners, adult children spread across different cities, and aging parents are all common here, and each of those situations is one where the statutory default may not match what you would actually want. Family law and estate planning intersect at precisely this point. The same care you would put into planning for your children's future deserves to go into planning for the moment you cannot speak for yourself.
If you would rather choose your own decision-maker than leave it to a list or a judge, the Law Office of Chad Foster can help you put those protections in place. We are here in Snohomish County and glad to help you plan ahead whenever you are ready.
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.