Advance Directive


The term "Advance Directive" refers to your oral and written instructions about your future medical care in the event you are unable to express your medical wishes.  There are two types of Advance Directives: A Health Care Directive and a Power of Attorney for Health Care.


Do I need an Advance Directive?

Advance Directives are the best possible assurance that decisions regarding your future medical care will reflect your own wishes in the event that you are unable to voice these wishes.


Health Care Directive (Living Will)

This directive is used only if you have a terminal condition, as certified by your Physician, where life-sustaining treatment  would only prolong the process of dying; or you are certified by two Physicians to be in an irreversible coma or other permanent unconscious condition and there is no reasonable hope of recover.  In either situation, the directive allows treatment to be withheld or withdrawn so that you may die naturally.


You may also direct whether you would want artificially-provided nutrition and hydration stopped under these circumstances.  Also, in the directive, you can give further instructions regarding your care.  The Heath Care Directive must be signed by you and two witnesses who are not related to you or involved in your care as a health professional and will not inherit anything from you.  You can change or revoke this directive at any time.


The Physician Orders for Life Sustaining Treatment (POLST) form is a "portable" physician order form that describes the patient's wishes regarding life-sustaining treatment.  This is identified in an Advance Directive such as a Health Care Directive or Power of Attorney for Health Care.


It is intended to go with the patient from one health care setting to another and includes the following:


1. Patient wishes for resuscitation

2. Medical interventions

3. Antibiotics

4. Artificial feedings


Power of Attorney for Health Care

Who would you want making your health care decisions if you were unable?  The Durable Power of Attorney for Health Care is a legal document allowing you to name a person as your health care agent - someone who is authorized to consent to, stop, or refuse most medical treatment for you if a physician determines you cannot make these decisions yourself.  The person you choose should be a trusted family member or friend with whom you have discussed your values and medical treatment choices.


Do I Need Both a Living Will and a Power of Attorney for Health Care?

Having both a Living Will and a Power of Attorney for Health Care will provide the best protection for your treatment wishes.  A power of Attorney will allow for some flexibility regarding treatment decisions, since the agent that you choose to represent your wishes will be able to respond to unexpected changes in your condition and base decisions not just on your written wishes, but also on their familiarity with you and your feelings regarding your care.


How is a Durable Power of Attorney Different?

A Durable Power of Attorney can become effective immediately OR when you are unable to make your own decisions.  You decide depending on the form you use and how you complete it.


1. Immediately, This doesn't mean that you lose control over your affairs; rather the person you have chosen to be your agent can now exercise the powers you gave them when needed.


2.  When you are unable to - When it is determined you are unable to make your own decisions by your agent or doctors.


A Living Will is necessary to provide instruction in case your agent is unable to serve- Provides evidence that the agent is acting in good faith.  If the agent is challenged, this will serve as the primary record of your wishes.


Who will speak for me if there are no directives in place?  According to State of Washington Law:


1. Spouse.

2. Child over 18 years of age.  If more than one child, ALL must agree on any decision.

3. Parents.  If both are living, BOTH must agree on any decision.

4. Adult Siblings.  If more than one, ALL must agree on any decision.


A Horizon Hospice Social Worker can assist you with completing your Advance Directives and Power of Attorney Health Care.


Information for Advance Directives provided by: Washington State Department of Health, Washington Medical Association, and Columbia Legal Services