Washington: Living Will and Advance Health-Care Instruction Requirements
The short answer
Washington's Natural Death Act calls the living will a 'directive' or 'health care directive.' An adult with health-care decision capacity signs it and either acknowledges it before a notary or other acknowledgment officer, or signs before two disinterested witnesses. It directs withholding or withdrawal of life-sustaining treatment after the statutory written diagnosis of a terminal condition or permanent unconscious condition, and artificial nutrition and hydration are a separate choice in the model form.
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This is the general rule in Washington. Ezel applies current Washington law to your specific facts and answers with citations to the statutes.
| Governing law and document | Natural Death Act, RCW ch. 70.122: written 'directive' or 'health care directive' to withhold/withdraw life-sustaining treatment (§§ 70.122.020, .030). The § .030 form is optional and may include added directions; separate from a durable power of attorney and POLST. |
|---|---|
| Who may make an instruction | Any 'adult person': a person who has reached majority and has capacity to make health-care decisions (§§ 70.122.020(1), .030(1)). |
| Oral, written, and signature form | Written directive signed by the declarer (§§ 70.122.020(3), .030(1)). Chapter 70.122 provides no oral or directed-signature execution route and states no electronic-specific signing method. |
| Witness, notary, and disqualifications | Either acknowledgment before a notary/other acknowledgment officer OR two witnesses (§ 70.122.030(1)). Witnesses cannot be related by blood/marriage, inherit under the current will or intestacy, be the attending physician, the physician's or patient's facility's employee, or hold an estate claim. |
| Covered conditions and trigger | Terminal condition: attending physician's written diagnosis after personal exam. Permanent unconscious condition: written diagnosis by two physicians, one attending, both after personal exam (§§ 70.122.020(6), (8), .030(2)). The directive governs when life-sustaining treatment would only prolong dying; if the patient remains capable, proposed steps must match current desires (§ 70.122.060(1)). |
| Treatment, nutrition, hydration, and comfort | Directs withholding/withdrawal of life-sustaining treatment for a terminal or permanent unconscious condition (§ 70.122.030). Life-sustaining treatment includes artificially provided nutrition and hydration, but the model form makes provide/do-not-provide a separate election. Pain-alleviating medication/procedures are excluded from life-sustaining treatment (§ 70.122.020(5)). |
| Pregnancy and other statutory limits | No pregnancy-specific restriction appears in current ch. 70.122; the 2025 amendment removed pregnancy references from the model form. The chapter does not authorize mercy killing, lethal injection, or active euthanasia (§ 70.122.100). |
| Revocation, notice, and registry | Revoke at any time regardless of mental state/competency by directed destruction, signed dated writing, verbal expression, or registry online method (§ 70.122.040). Written/verbal revocation takes effect on communication to the attending physician, who records it. Optional state registry; nonfiling does not affect validity, and failure to update a valid revocation does not defeat it (§ 70.122.130). |
| Provider duties, recognition, and effect | Attending physician verifies compliance and current desires (§ 70.122.060). A physician/facility policy may decline to honor the directive if disclosed and a written plan is filed; individual practitioners may refuse participation. The unrevoked directive is conclusively presumed to state the patient's directions, with good-faith immunity. An out-of-jurisdiction directive is valid only to the extent Washington and federal constitutional law permit (§ 70.122.030(3)). |
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Requirements one by one
Execution uses a notary or two qualified witnesses
Section 70.122.030 now gives two alternatives. The declarer may sign and
acknowledge the directive before a notary or other authorized acknowledgment
officer, or may sign before two witnesses. The witness route has a detailed
disqualification list covering relatives, heirs, estate claimants, the attending
physician, and certain physician or facility employees.
Terminal and unconscious conditions use different findings
Under § 70.122.020, a terminal condition is diagnosed in writing by the
attending physician after personal examination. A permanent unconscious
condition requires written diagnoses from two personally examining physicians,
one of whom is the attending physician. Section 70.122.030 requires the
applicable diagnosis to become a permanent part of the medical record before
life-sustaining treatment is withheld or withdrawn.
Nutrition and hydration are a separate election
Section 70.122.020 includes artificially provided nutrition and hydration in
"life-sustaining treatment," but the model form in § 70.122.030 asks the
declarer to choose separately whether to receive them. Pain-alleviating
medication and procedures are outside the life-sustaining-treatment definition.
Revocation does not require capacity
Section 70.122.040 permits revocation at any time without regard to mental state
or competency. The declarer may use physical destruction, a signed dated
writing, a verbal expression, or the registry's online route. Written and verbal
revocations become effective on communication to the attending physician, who
must make the specified medical-record entry.
A disclosed refusal policy can control provider procedure
Under § 70.122.060, a physician or facility must disclose a policy that would
prevent honoring the directive when it learns of the directive. If the patient
chooses to remain, the parties prepare a written plan for what the provider will
do if the directive becomes operative. Compliance with that process removes the
provider's obligation to honor the directive. Individual practitioners also may
refuse to participate; the section does not impose a transfer duty.
What trips people up
- Terminal condition takes one physician; permanent unconsciousness takes
two. The definition of qualified patient in § 70.122.020 makes that split
explicit. - Current wishes still matter. Section 70.122.060 requires reasonable effort
to confirm that the directive and proposed steps remain consistent with a
capable patient's present desires. - The registry does not cure execution defects. Section 70.122.130 says
filing does not replace the legal formalities or create a validity
presumption.
Common questions
Is notarization mandatory?
No. Section 70.122.030 allows either an acknowledgment or two qualified
witnesses.
Does Washington suspend a directive during pregnancy?
Current chapter 70.122 contains no pregnancy-specific suspension. The 2025
amendment removed pregnancy references from the model form.
Will a directive signed elsewhere work in Washington?
Section 70.122.030(3) recognizes it only to the extent permitted by Washington
law and federal constitutional law.
Statutes and sources
- RCW 70.122.020 and .030 — definitions, execution, model form, medical
triggers, nutrition and hydration choice, record entry, and out-of-state
effect. Official §
.020 and §
.030 (accessed
2026-07-30). - RCW 70.122.040, .060, and .100 — revocation, provider procedure,
presumptive effect, conscience refusal, and legal limits. Official §
.040, §
.060, and §
.100 (accessed
2026-07-30). - RCW 70.122.130 — optional registry, current text, and the June 30, 2027
terminology update. Official
section (accessed
2026-07-30).
Source links
Every statute quoted above, linked, with the date we checked it.
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