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Washington Living Will Form (Health Care Declaration)

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The Washington living will, or ‘health care declaration’, is a legal  document that allows a Declarant/Principal to explain in writing what type of medical treatment he or she does or does not want during a terminal (end of life) illness. A Living Will takes effect only at a time when the patient is incapacitated and is no longer able to express their wishes. This document will state which medical treatments may be used, according to the wishes of the Declarant and which may not be used to die naturally and without the patient’s life being artificially prolonged by medical procedures that may not be acceptable to the Declarant. This document may be revoked at any time. If the Declarant is unsure about the language or needs assistance in completing this document, consider consulting with a qualified attorney.

Definition – RCW 70.122.020(3)

Laws – Chapter 70.122 RCW (Natural Death Act)

Medical Power of Attorney – A patient may also choose to also have an agent that is able to hold the responsibility of caring and making decisions on behalf of a principal/patient. If an individual would like to combine both the medical power of attorney and living will, they may use the Advance Directive.

How to Write

Step 1 – Establishing the Declarant  –

  • Date the execution of the document in dd/mm/yyyy format
  • Enter the full legal name of the Declarant/Principal
  • The Declarant must carefully review the following two paragraphs in order to gain a better understanding of what the document will mean to them

Step 2 – Paragraph C Shall require a response.

  • The Declarant must read the statement. Initial your selection inside of the appropriate box

Step 3 – The Declarant must continue to carefully review all sections of the document

  • If the Declarant would like to make additions to the document, they may do so by typing or writing the information into the lines provided under letter G
  • Once the document is complete, the declarant would then enter their signature in the “Signed” line at the end of the page

Step 4 – Witness Signatures – Two witnesses are required in order to authenticate this document. Witnesses may not be related by blood, physician, employee of attending physician or health care facility – further no witness may be able to knowingly lay claim to any portion of the Declarant’s estate on any level. If this is agreed enter the following

Witness 1 – 

  • Witness Signature

Witness 2 – 

  • Witness Signature

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