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The Washington Living Will form serves as a crucial document for individuals wishing to express their healthcare preferences in advance, particularly in situations where they may be unable to communicate their wishes. This form allows a person to outline their desires regarding life-sustaining treatments, ensuring that their choices are respected by healthcare providers and family members. It typically includes specific instructions about medical interventions, such as resuscitation efforts and the use of feeding tubes. Additionally, the Living Will can address preferences for pain management and comfort care, reflecting the individual's values and beliefs. By completing this form, residents of Washington can take proactive steps to guide their medical care, providing clarity during difficult times and alleviating the burden on loved ones who may otherwise face challenging decisions. Understanding the importance of this document can empower individuals to advocate for their own health and well-being, making it an essential part of advance care planning.
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Washington Living Will
This Living Will is designed in accordance with the Washington Natural Death Act, RCW 70.122, to express the wishes of the undersigned regarding medical treatment in the event they become incapacitated and can no longer communicate their desires.
Personal Information
Name of Declarant: _______________________________________________
Date of Birth: ___________________________________________________
Address: ________________________________________________________
City: ___________________________ State: WA Zip Code: ____________
Declaration
I, _________________________ (name of declarant), being of sound mind, hereby declare my desire that my dying shall not be artificially prolonged under the circumstances set forth below. If at any time I am incapacitated and
- I have a terminal condition confirmed by two physicians who have examined me, one of whom is my attending physician, and they conclude that my death is imminent except for artificial life sustaining treatments; or
- I am in a permanent unconscious condition confirmed by two physicians who have examined me, one of whom is my attending physician, and they conclude that there is no reasonable expectation of my regaining consciousness,
I direct that life-sustaining treatment be withheld or withdrawn and that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure necessary to provide me with comfortable care.
This Living Will does not affect any non-life-sustaining treatments, such as the provision of nutrition and hydration, unless they are used solely to prolong the dying process.
Signature
Declarant's Signature: _______________________________ Date: ____________
Witness Statement: We declare that the person who signed or acknowledged this document is personally known to us, that they signed or acknowledged this Living Will in our presence, and that they appear to be of sound mind and under no duress, fraud, or undue influence.
Witness 1 Signature: _______________________________ Date: ____________
Witness 1 Printed Name: ___________________________________________
Witness 2 Signature: _______________________________ Date: ____________
Witness 2 Printed Name: ___________________________________________
State Specific Declaration
This document is executed as a directive instrument under the laws of Washington State. This Living Will shall be interpreted and construed in accordance with the laws of the State of Washington.
Revocation
This Living Will remains effective until revoked. I reserve the right to revoke this Living Will at any time and in any manner.
Remember, a Living Will should reflect your current wishes and can be updated as your situation or preferences change. Keep a copy where it is easily accessible and ensure your health care provider and loved ones are informed of your wishes.
PDF Data
| Fact Name | Description |
|---|---|
| Purpose | A Washington Living Will outlines your wishes regarding medical treatment in case you become unable to communicate your preferences. |
| Governing Laws | The Washington Living Will is governed by the Revised Code of Washington (RCW) 70.122. |
| Requirements | To create a valid Living Will, you must be at least 18 years old and of sound mind. |
| Witnesses | Two witnesses must sign the document, affirming that you are not under duress and understand the contents. |
| Revocation | You can revoke your Living Will at any time, as long as you communicate your decision clearly. |
| Storage | It is advisable to keep your Living Will in an accessible place and share copies with your healthcare providers and family members. |
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