What Happens If My Healthcare Agent Disagrees With My Wishes?

You named someone you trust to make medical decisions if you cannot, but what if, in the moment, that person leans toward something other than what you would have chosen? Understanding the role your agent plays helps you see why your known wishes still carry real weight. This topic is part of Washington advance healthcare directives.

What a Health Care Agent Is and Is Not

When you sign a durable power of attorney that grants authority over health care, you appoint an agent to make medical decisions for you if you lose the ability to make them yourself. In Washington, the scope of that authority is set out in RCW 11.125.400. Where the power of attorney grants general authority over health care matters, the agent is authorized to provide informed consent for health care decisions on your behalf and to access your health information under federal privacy law. Related guides cover What Happens If My Advance Directive Conflicts With Family Wishes? and How Do I Choose a Healthcare Agent?.

The important thing to understand is what that authority is for. Your agent is not appointed to substitute their own preferences for yours. The agent is a stand-in for your voice, empowered to speak your decisions when you cannot. RCW 11.125.400 grants the agent the power to consent to care on your behalf, and that power exists to carry out your wishes, not to override them. In legal terms, an agent acting under a power of attorney is a fiduciary, someone who owes you a duty of loyalty and is expected to act for your benefit and in line with what you have made known.

Your Written Directive Is Strong Evidence of Your Wishes

This is where a written advance directive becomes so valuable. If you have executed a directive under Washington's Natural Death Act, chapter 70.122 RCW, you have created a clear, documented record of what you want regarding life-sustaining treatment in a terminal or permanent unconscious condition. When your agent's instinct pulls in a different direction, that written directive is powerful evidence of your actual wishes, and it gives everyone involved, including your physician, a concrete reference point rather than a guess.

Washington's directive form itself anticipates the interplay between a directive and an agent. Under RCW 70.122.030, the standard directive language provides that if another person is appointed to make decisions for you, whether through a durable power of attorney or otherwise, you request that the person be guided by the directive and by your other clear expressions of your desires. So the law contemplates that your agent should follow your directive, not depart from it. When a directive and an agent's preference diverge, the directive stands as your documented voice, and that carries real force.

How a Disagreement Actually Plays Out

If your agent disagrees with your wishes, the resolution starts with the recognition that the agent's job is to honor those wishes, not their own. A conscientious agent, reminded of your written directive and your prior conversations, is expected to set aside personal preference and follow what you decided. Physicians and hospitals are attentive to this too. Under RCW 70.122.060, before withholding or withdrawing life-sustaining treatment, the attending physician must make a reasonable effort to confirm the directive complies with the law, and the same statute treats a valid, unrevoked directive as conclusively presumed to be your directions. That framework helps keep the focus on your documented choices rather than on an agent's contrary impulse.

Where an agent cannot or will not act in keeping with your known wishes, there are avenues to address it, including the involvement of the treating physician and, in serious cases, the courts. The clearer your documentation, the easier these situations are to resolve, because there is little room to argue about what you wanted when you have written it down and executed it properly.

Where the Surrogate Hierarchy Fits

It helps to understand how your agent relates to Washington's broader decision-making structure. RCW 7.70.065 sets out an order of priority for who may give informed consent when a patient lacks capacity and no one is already authorized to decide. An agent under a durable power of attorney for health care sits near the top of that list, just below a court-appointed guardian and above the spouse, adult children, and other relatives. That priority is one reason naming an agent is valuable: it places a person you chose ahead of the default chain of relatives.

Even that hierarchy points back to your wishes. RCW 7.70.065 requires a surrogate to first determine in good faith what you would have chosen if you could decide, and only to fall back on your best interests when your wishes cannot be determined. Your written directive is exactly the kind of clear evidence that answers that question, which is why having both a well-chosen agent and a written directive works better than relying on either one alone.

Choose Well and Document Clearly

The best protection is on the front end. Choose an agent who understands your values and has shown they will honor them even when it is hard, and talk with that person openly about what you want. Back the appointment with a written directive so your agent has a clear map to follow. For families in Snohomish County navigating these decisions, especially after a divorce or remarriage when it may be time to change who holds this role, reviewing your power of attorney and your directive together keeps them consistent and keeps the right person in charge.

If you would like help choosing an agent, drafting a durable power of attorney, and pairing it with a clear advance directive, the Law Office of Chad Foster is here to help you build a plan that speaks with your voice.