What Is an Advance Healthcare Directive?

If you could not speak for yourself in a medical crisis, who would know what you would want, and would anyone be legally bound to follow it? An advance healthcare directive is the document that answers that question before the crisis arrives. This topic is part of Washington advance healthcare directives.

The Short Answer

An advance healthcare directive, often called a living will, is a written statement of your wishes about life-sustaining treatment if you reach the end of life and cannot communicate. In Washington, this document is governed by the Natural Death Act, chapter 70.122 RCW. The law lets you put your instructions in writing now so that your family and your physicians know what you would choose if you could no longer tell them yourself. Related guides cover What Is a Healthcare Power of Attorney? and How Do I Create an Advance Directive?.

The Natural Death Act defines a "directive" as a written document that you voluntarily execute, generally consistent with the guidelines set out in the statute, and it defines the key terms that make the document work. See RCW 70.122.020. The statute then spells out what the directive actually does and what it must contain. See RCW 70.122.030.

What the Directive Covers

A Washington healthcare directive speaks to a narrow but important moment: when you have a terminal condition or a permanent unconscious condition and life-sustaining treatment would only prolong the process of dying. Under RCW 70.122.020, a "terminal condition" is an incurable and irreversible condition that, within reasonable medical judgment, will cause death within a reasonable period of time, and where life-sustaining treatment serves only to prolong dying. A "permanent unconscious condition" is an irreversible coma or persistent vegetative state with no reasonable probability of recovery.

In those situations, the directive lets you say whether you want life-sustaining treatment withheld or withdrawn so that you can die naturally. The statute even provides a suggested form you can follow, and it allows you to make a separate choice about whether you want artificially provided nutrition and hydration. See RCW 70.122.030. This is your voice, preserved in writing, for a time when you may not be able to use it.

Who Can Create One

The Natural Death Act keeps the door wide open. Any adult person may execute a directive directing the withholding or withdrawal of life-sustaining treatment in a terminal condition or permanent unconscious condition. See RCW 70.122.030. An "adult person" under RCW 70.122.020 is someone who has reached the age of majority and has the capacity to make health care decisions. You do not need to be sick to sign one. In fact, the best time to create a directive is while you are healthy and thinking clearly.

How It Differs From a POLST

People often confuse a healthcare directive with a POLST, and the difference matters. A POLST, which stands for Portable Orders for Life-Sustaining Treatment, is not a document you write on your own and it is not part of the Natural Death Act. It is a medical order signed by your treating provider, administered in Washington through the Department of Health and the Washington State Medical Association. A POLST is designed for people who are already seriously ill or frail, and it travels with the patient across care settings so that emergency responders and hospital staff can act on it immediately.

Think of it this way: your healthcare directive states your wishes, and a POLST turns treatment decisions into a doctor's standing medical order once you are already facing serious illness. The directive is the planning document you sign in advance; the POLST is the medical order your provider signs when you are in the thick of a serious condition. Both can exist together, and a POLST often draws on the wishes you already expressed in your directive.

How It Differs From a Healthcare Power of Attorney

A healthcare directive is not the same as naming a healthcare agent. A directive states your wishes directly, but it does not appoint a person to make decisions for you. A healthcare power of attorney does the opposite: it names a trusted person, your agent, to make medical decisions on your behalf when you cannot. In Washington, an agent's authority over health care comes from chapter 11.125 RCW, specifically RCW 11.125.400, which allows the agent to give informed consent for your care and to access your medical records as your personal representative under federal privacy law.

The two documents work best as a pair. Your directive tells everyone what you want, and your healthcare agent stands ready to make the many decisions your directive cannot anticipate. One is a written wish; the other is a living decision-maker. Together they cover both the situations you can predict and the ones you cannot.

Why This Matters in Snohomish County

For families across Snohomish County, from Everett to Marysville to Lake Stevens, the absence of a directive can turn a heartbreaking moment into a legal and emotional tangle. When no one knows your wishes, loved ones are left guessing, and disagreements among family members can surface at the worst possible time. In family law situations, such as blended families or a recent separation, the question of who speaks for you and what you would have wanted becomes even more pressing. A clear, valid directive removes that uncertainty and spares the people you love from having to guess.

Putting It All Together

An advance healthcare directive is one piece of a complete plan. Paired with a healthcare power of attorney, and coordinated with a POLST if you become seriously ill, it gives you a voice when you need it most and gives your family peace of mind. Getting the documents right, and making sure they are executed the way Washington law requires, is where careful drafting pays off.

If you are ready to put your wishes in writing or simply want to understand your options, the Law Office of Chad Foster helps Snohomish County families create clear, valid estate planning documents. Reach out to start the conversation.