A Washington Health Care Directive, a Durable Power of Attorney for Health Care, and a POLST form do three different jobs — Puget Sound families usually only find that out in a hospital hallway.
By Diane Whitfield, CSA · September 26, 2026
A parent falls at home in Ballard, or has a stroke driving through Bellevue, and ends up at Harborview or Overlake with no paperwork on file. The emergency team has to guess at what the person would want, and if two adult siblings disagree about a ventilator or a feeding tube, that disagreement plays out at the bedside, not in a calm conversation months earlier. Washington actually has three distinct legal tools for exactly this moment, and Puget Sound families often only learn the difference between them once a crisis is already underway.
None of these documents requires a terminal diagnosis to set up, and none of them costs much or anything to create. The best time to do it is well before a hospital stay, a memory care move, or a diagnosis makes it urgent.
A Health Care Directive (what Washington's Natural Death Act, chapter 70.122 RCW, calls a directive and what most people still call a "living will") only turns on in two narrow situations: a terminal condition, or a permanent unconscious condition. It tells doctors whether to withhold or withdraw life-sustaining treatment in those specific circumstances. It does not name a decision-maker and does not cover ordinary day-to-day medical choices.
A Durable Power of Attorney for Health Care, governed in Washington by the Uniform Power of Attorney Act (chapter 11.125 RCW), is the document that actually names a person — an "agent" — to make health care decisions on someone's behalf any time they can't speak for themselves, not only at the end of life. For most families, this is the single most useful document of the three, because it covers everything from a routine surgery decision to a memory care placement, not just a ventilator question.
A POLST (Portable Order for Life-Sustaining Treatment) is different from both: it's a medical order, signed by the patient (or their surrogate) and a physician, ARNP, or physician assistant, not just a statement of wishes. It translates whatever is in the Directive or the Power of Attorney into specific, actionable instructions — resuscitation, medical interventions, antibiotics, artificial feeding — that travel with the person and that EMS crews and hospital staff act on immediately, without having to track down or interpret a longer legal document first.
A Washington Durable Power of Attorney for Health Care needs either notarization or two qualified witnesses; if witnesses are used instead of a notary, they cannot be related to the person by blood, marriage, or state registered domestic partnership, and they cannot be someone who provides that person's care at home or in a long-term care facility — a rule worth knowing before asking a caregiver or a facility staff member to sign. No attorney is required for either the Directive or the Power of Attorney, though families with a blended household, a contested relationship, or a large estate often still want one involved.
A POLST is different again: it's created with a doctor or other qualified provider, usually once someone is already dealing with a serious or advancing illness, and it should be reviewed whenever their condition changes significantly. It's meant to be visible — on the refrigerator, near the bed, in the car for a facility transfer — not filed away in a drawer with other legal papers.
Most Washington assisted living communities and adult family homes ask for a copy of these documents at admission, and DSHS surveyors may check whether a resident's file reflects their actual wishes. Memory care communities in particular rely on a clear Power of Attorney once a resident with dementia can no longer participate in day-to-day decisions themselves.
Hospital social workers at Harborview, UW Medicine, Swedish, EvergreenHealth, and MultiCare Tacoma routinely help patients and families complete these forms during a hospital stay, but that's the hardest possible moment to think clearly about them. Community organizations including Honoring Choices Pacific Northwest and End of Life Washington offer free or low-cost help completing a Directive or Power of Attorney well ahead of any crisis, and local Area Agencies on Aging — Aging and Disability Services in King County, Homage in Snohomish County, and Aging and Disability Resources of Pierce County — can point families to local resources too.
Without a Power of Attorney or court-appointed guardian, Washington law provides a priority list of family members — typically starting with a spouse, then adult children, then parents, then siblings — who can be asked to make health decisions together. When those family members agree, this can work reasonably well. When they don't, or when an unmarried partner has no legal standing at all under that list, it's often the family, not the hospital, that ends up in the hardest spot. Naming an agent in advance, in writing, is what prevents that.
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