What Medical Decisions Can Be Included in an Advance Directive?

If you have ever wondered exactly how much control a health care directive gives you over your own care, the honest answer surprises most people: a Washington living will is powerful, but it is also narrower than many assume. The Law Office of Chad Foster helps Snohomish County clients with advance health-care planning.

The Core Purpose of a Washington Health Care Directive

In Washington, the document most people call a "living will" is a health care directive created under the state's Natural Death Act, chapter 70.122 RCW. Its job is specific. A directive lets you say, in advance, that you do not want your dying artificially prolonged when you reach a point of no return. Under RCW 70.122.030, any adult may sign a directive that instructs doctors to withhold or withdraw life-sustaining treatment if you are ever in a terminal condition or a permanent unconscious condition, and where that treatment would only prolong the process of dying rather than help you recover.

That is the heart of it. The directive speaks for you when you can no longer speak for yourself, but only in those two triggering situations. A terminal condition means an incurable, irreversible condition that, in reasonable medical judgment, will cause death within a reasonable period. A permanent unconscious condition means an irreversible coma or persistent vegetative state with no reasonable probability of recovery, and it must be confirmed by two physicians. Outside of those circumstances, the directive is not the document doing the work. For related guidance, see Can I Change My Advance Directive.

The One Decision the Statute Singles Out: Nutrition and Hydration

One of the most important choices a directive lets you make explicitly is whether you want artificially provided nutrition and hydration, meaning food and fluids delivered through a tube or IV. The statutory form in RCW 70.122.030 gives you a specific checkbox: you may state that you DO want artificially provided nutrition and hydration, or that you DO NOT. This matters because families often disagree about feeding tubes at the end of life, and the law treats that decision as significant enough to call it out separately. By addressing it in writing, you take that painful question off your family's shoulders and answer it yourself. For related guidance, see What Is an Advance Healthcare Directive.

You are also not locked into the exact language on the state form. The statute expressly allows you to add your own specific directions, and to change the wording before you sign, so long as your additions stay consistent with Washington law. So if you have particular wishes about the circumstances in which you would or would not want intervention, a well-drafted directive can capture them.

Where the Living Will Stops and a Health Care Agent Begins

Here is the part that trips people up. A health care directive under chapter 70.122 RCW is not a general "make all my medical decisions" document. It is focused on end-of-life care in terminal or permanently unconscious conditions. It does not appoint anyone to decide whether you should have surgery after a car accident, which medication to try, whether to move you to a different facility, or how to handle a serious but survivable illness.

Those broader, day-to-day medical decisions are handled by a different tool: a health care agent named in a durable power of attorney. Under RCW 11.125.400, when a power of attorney grants general authority over health care matters, the agent you name is authorized to give informed consent for health care decisions on your behalf and to access your medical records under federal privacy law. That is a much wider grant of authority. Your agent can weigh options in real time, ask questions, and respond to situations no document could have predicted in advance.

In practice, most people need both. The directive states your firm wishes about life support at the end of life so no one has to guess. The power of attorney names a trusted person to handle everything else while you are unable to. The directive even anticipates this pairing: the statutory form says that if someone is appointed to make decisions for you, that person should be guided by your directive. The two documents work together, with the directive setting the guardrails and the agent steering within them.

What a Directive Cannot Do

It is worth being clear about the limits. A health care directive is not a tool for physician-assisted death, which is governed separately under Washington's Death with Dignity Act. It does not control your finances, which requires a separate financial power of attorney. And it does not appoint a guardian for your minor children. A directive is a focused instrument, and trying to stretch it to cover everything is how families end up confused at the worst possible moment.

Putting It Together for Snohomish County Families

For families in Everett, Marysville, Lynnwood, and across Snohomish County, the practical takeaway is that a single form rarely does everything you need. Estate planning and family planning overlap here more than people expect. If you are a parent thinking about who would raise your children if something happened to you, you are often the same person who should be thinking about who would make your medical decisions and what those decisions should be. Building the directive and the health care power of attorney together, as part of one coordinated plan, is what turns a good intention into a document that actually protects you.

The value of getting this right is not abstract. When these documents are clear and properly executed, your loved ones are spared the anguish of guessing what you would have wanted, and your care follows your own considered choices rather than a default no one chose.

If you would like help deciding which decisions belong in your directive and which belong with a health care agent, the Law Office of Chad Foster is here to walk through it with you and build a plan that fits your life. Reach out whenever you are ready to start the conversation.

This article is general information about Washington law and is not legal or medical advice. For guidance about your specific situation, please consult a qualified attorney or your physician.