What Happens If I Don't Have an Advance Directive?

If you are ever too sick or injured to make your own medical decisions and you have no advance directive, Washington law does not leave a blank. It automatically hands the decision to someone else, and it may not be the someone you would have chosen. This topic is part of Washington advance healthcare directives.

The Law Fills the Gap for You

Many people assume that if they never sign any documents, their spouse or their oldest child simply steps in and everyone agrees. Sometimes it works out that way. But when it does not, Washington already has a rule in place. Under RCW 7.70.065, when a patient lacks the capacity to make a health care decision, informed consent can be obtained from a person authorized to consent on the patient's behalf, and the statute sets a strict order of priority for who that person is. This is the default surrogate hierarchy, and it controls when you have made no arrangements of your own. Related guides cover What Happens If My Advance Directive Conflicts With Family Wishes? and What Is an Advance Healthcare Directive?.

Who Gets to Decide, and in What Order

The priority list in RCW 7.70.065 for an adult who cannot decide runs, in order, as follows. First is a court-appointed guardian, if one exists. Next is the person holding a durable power of attorney that includes authority over health care, which is exactly the health care agent an advance directive would name. After that comes your spouse or state registered domestic partner, then your adult children who are at least eighteen, then your parents, then your adult siblings. The list continues from there to adult grandchildren, then adult nieces and nephews, then adult aunts and uncles who are familiar with you, and finally, under specific conditions, a close adult friend who signs a sworn declaration.

Notice where the health care agent sits. Once you get past a court-appointed guardian, the person you would have named yourself sits at the very top. That is not an accident. The statute treats your own chosen decision maker as taking priority over even your spouse, which tells you how much weight the law gives to a documented choice. Without that document, the law simply moves down the list to the next available class of relatives.

The Problems the Default Rule Cannot Solve

The hierarchy sounds tidy on paper, but real families are not always tidy. RCW 7.70.065 adds two rules that create genuine difficulty. First, no one in a lower class may act if a person in a higher class has refused to authorize the care. Second, and this is the one that stops families cold, when there are two or more people in the same class, the decision must be unanimous among all available members of that class.

Picture a patient with three adult children and no spouse. All three sit in the same priority class, and the law requires them to agree. If two want to continue aggressive treatment and one does not, there is no tiebreaker in the statute. The disagreement can stall care, strain relationships, and in serious cases push the family toward court to sort out who decides. The default rule was designed for the common case, not for the divided one, and it offers no mechanism for choosing among equals.

There is also the matter of who the law picks. The statute follows blood and legal relationship, not closeness or trust. The relative who ends up authorized may be someone you rarely speak to, while the person who actually knows your wishes sits lower on the list or is left off entirely because they are not related to you in the way the statute requires. The law does its best with a formula, but a formula cannot know your relationships.

Why a Directive and an Agent Are Better

An advance directive solves both problems at their root. By naming a health care agent through a power of attorney, you place the person you trust at the top of the priority order, above the guessing and above the potential for a stalemate among siblings or other relatives. You choose one decision maker, which removes the unanimity trap entirely. And by pairing that appointment with a health care directive under Washington's Natural Death Act, chapter 70.122 RCW, you give that agent, and your family, written guidance about your wishes for life-sustaining treatment in a terminal or permanently unconscious condition.

The difference is control. The default hierarchy is what happens to you when you have not decided. An advance directive is what happens because you decided. One is a formula applied by strangers under stress; the other is your own plan, followed by a person you selected precisely because you trust their judgment.

Putting Your Plan in Place

For families throughout Snohomish County, from Everett to Edmonds to the smaller communities in between, the takeaway is simple. Doing nothing is still a choice, and it is a choice to let a statute rank your relatives and demand their unanimity at the hardest possible moment. A modest amount of planning replaces that with clarity. This is often the same conversation families have about guardianship of children and the handling of an estate, because the person you trust with your medical decisions is frequently the same person you trust with everything else.

If you would like to make sure the right person is empowered to speak for you and that your wishes are on record, the Law Office of Chad Foster helps Snohomish County families put advance directives in place. We are glad to help whenever you are ready to start the conversation.