Washington Advance Health Care Directive Requirements

A Washington health care directive must be signed by the declarer and either acknowledged before a notary public or other individual authorized by law to take acknowledgments, or signed in the presence of two witnesses who meet the statute’s disqualification rules (RCW 70.122.030(1)). Washington splits the advance-directive function across two chapters: the directive under the Natural Death Act, chapter 70.122 RCW, governs withholding or withdrawing life-sustaining treatment in a terminal or permanent unconscious condition, while appointing a decision-maker runs through a durable power of attorney for health care under chapter 11.125 RCW.

This page is a practitioner reference for attorneys and paralegals handling Washington matters. It summarizes statutory requirements — it is not legal advice and does not substitute for reading the current statute or consulting Washington counsel.

The governing statute

Washington does not use the phrase “advance health care directive” in its statute. Chapter 70.122 RCW is titled the Natural Death Act (RCW 70.122.900); it calls the instrument a directive, the person executing it a declarer, and the optional statutory form is captioned “Health Care Directive.” Practitioners and clients often say living will. RCW 70.122.030 was last amended by 2025 c 56 s 1.

The agent-appointment half sits in chapter 11.125 RCW: RCW 11.125.240(1)(l) requires an express grant before an agent may make health care decisions, and RCW 11.125.400 sets the scope. The Natural Death Act acknowledges the split — RCW 70.122.010 recognizes that a person’s right to control health care “may be exercised by an authorized representative who validly holds the person’s durable power of attorney for health care” — and RCW 70.122.910 confirms the chapter is not the exclusive means of making health treatment decisions.

Citation: RCW 70.122.030 (execution); RCW 11.125.400 (agent authority) Official source: app.leg.wa.gov

Execution requirements

The witness lists for the directive and for a Washington power of attorney do not overlap cleanly. Chapter 70.122 RCW disqualifies anyone with an interest in the declarer’s estate, which the POA statute does not; chapter 11.125 RCW disqualifies relatives of the agent, which the Natural Death Act does not. A single signing ceremony for both documents needs witnesses who clear both lists. The statute does not say what happens if a disqualified person witnesses the directive.

Related rules outside the natural death act

• Default surrogate decision-makers. If an adult patient lacks capacity to make a health care decision, RCW 7.70.065 provides a separate informed-consent hierarchy. In descending order, it identifies an appointed guardian; an agent whose durable power of attorney includes health care authority; the patient’s spouse or state registered domestic partner; adult children; parents; adult siblings; qualifying adult grandchildren, nieces and nephews, and aunts and uncles; and, under specified conditions, a qualifying close friend. A provider must make reasonable efforts to locate an available person in the highest available class. A higher-priority refusal controls, and available members of the same class must agree unanimously. The surrogate must determine in good faith what the patient would have chosen or, if that cannot be determined, act in the patient’s best interests.
• HIPAA authorization for a stand-alone directive. RCW 11.125.400(1) makes a health care agent the principal’s HIPAA personal representative, and RCW 11.125.090(4) does the same for a person authorized to determine incapacity. Chapter 70.122 RCW does not itself grant a person access to protected health information merely because that person possesses the directive.
• Portable provider orders. RCW 70.122.130(2)(a)(iv) allows a form adopted under the Department of Health’s authority in RCW 43.70.480 to be submitted to the health care declarations registry. A portable medical order is distinct from a directive and should not be described as a substitute for the declarer’s execution of a directive or appointment of a health care agent.
• Electronic execution and remote notarization. Chapter 11.135 RCW expressly includes a health care directive under chapter 70.122 RCW. An electronic record may satisfy the writing requirement, and an electronic signature may satisfy the signature requirement. Witnessing and attestation may be electronic, and the statutory presence requirement may be satisfied through electronic presence. If the acknowledgment route is used, the authorized officer may sign electronically and the declarer may appear remotely as permitted by RCW 42.45.280. These rules do not eliminate the Natural Death Act’s witness-disqualification or other substantive requirements.

Scope of the directive, and what the agent can do

The directive is condition-limited. It operates only where the declarer is in a terminal condition or a permanent unconscious condition, each defined in RCW 70.122.020. The diagnostic thresholds differ, and the difference is easy to miss: a terminal condition must be diagnosed in writing by the attending physician who personally examined the patient, while a permanent unconscious condition requires two physicians, one of whom is the attending, both of whom have personally examined the patient (RCW 70.122.020(8)). Either diagnosis must be entered in writing in the medical record before treatment is withheld or withdrawn (RCW 70.122.030(2)).

Agent authority. Where health care authority has been granted in a power of attorney, RCW 11.125.400 authorizes the agent to act as the principal’s HIPAA personal representative and to provide informed consent for health care decisions. Where more than one agent has authority over mental health treatment decisions under a chapter 71.32 RCW directive, the most recently appointed agent controls any conflict. Two outer limits: no rights under Washington’s Death with Dignity Act, chapter 70.245 RCW, may be exercised through a power of attorney (RCW 11.125.420), and nothing in the Natural Death Act condones mercy killing, lethal injection, or active euthanasia (RCW 70.122.100).

Revocation is deliberately flexible. RCW 70.122.040 permits the declarer to revoke the directive at any time “without regard to the declarer’s mental state or competency.” The declarer may revoke by canceling, defacing, obliterating, burning, tearing, or otherwise destroying the directive; by a signed and dated written revocation; by a verbal expression of intent to revoke; or, for a directive stored in the health care declarations registry, through the Department of Health’s online method. A written or verbal revocation becomes effective only when communicated to the attending physician by the declarer or someone acting on the declarer’s behalf. For a written revocation, the physician records when notification was received. For a verbal revocation, the physician records the time, date, and place of the revocation and, if different, when and where notification was received.

Provider obligations. The directive is conclusively presumed, unless revoked, to be the patient’s direction (RCW 70.122.060(3)), and any person or health facility may assume it complies with the chapter and is valid (RCW 70.122.120). A provider participating in good faith is immune from civil, criminal, and professional liability unless otherwise negligent (RCW 70.122.051(2)). No practitioner may be compelled to participate over objection (RCW 70.122.060(4)) — but a facility or physician whose policy would preclude honoring the directive must tell the patient on becoming aware of it and, if the patient stays, prepare a written plan filed with the directive (RCW 70.122.060(2)).

Washington also runs a health care declarations registry at the Department of Health (RCW 70.122.130), accepting a directive, a chapter 11.125 RCW health care power of attorney, a chapter 71.32 RCW mental health advance directive, and a form adopted under RCW 43.70.480. Filing is legally neutral: it does not affect validity, substitute for any legal requirement, or create a presumption of validity.

Directives executed in another state

RCW 70.122.030(3) provides that “a directive executed in another political jurisdiction is valid to the extent permitted by Washington state law and federal constitutional law.” That is a qualified recognition rather than a full-faith rule — the statute does not say a foreign directive is valid as executed, and it gives no test for measuring the extent.

The provision does not specify how every difference between Washington law and the law of the place of execution should be resolved. A foreign directive that addresses circumstances beyond a terminal condition or permanent unconscious condition may require analysis under other Washington health care decision-making law rather than Chapter 70.122 alone. The agent-appointment portion of an out-of-state advance directive is analyzed separately under Washington’s power-of-attorney recognition rules, including RCW 11.125.060 and 11.125.070.

Frequently asked questions: Washington health care directive requirements

Related Washington documents

Because Washington splits the instrument, this page covers only half the plan — the agent appointment lives in a durable power of attorney, and the express-grant requirement, witness rules, and acceptance timeline for that document are on the Washington durable power of attorney requirements page. Clients whose incapacity plan runs through a trust also need the Washington revocable living trust requirements page.

Two overlapping witness lists across two documents signed in one appointment is better caught at intake than at the signing table — see our estate planning intake forms and automation overview.