Washington State Health Care Directive (Living Will) (Page 2 of 4) in pdf

Washington State Health Care Directive (Living Will) Page 2

Notice To

Person Executing the Washington State

Health Care Directive

This is an important legal document. Before executing this document you should know

these facts:

This document becomes effective only when you lose the capacity to make informed

health care decisions for yourself. As long as you have the capacity to make informed

health care decisions for yourself, you retain the right to make all medical and other

health care decisions.

Think about whether or not you want life-sustaining treatment should you become

terminally ill if such treatment would only prolong the process of dying.

If you do not want such treatment used, carefully read the Health Care Directive

document to ensure you agree with it.

This document also provides the option of also consenting to withholding and withdrawal

of artificial hydration and nutrition by inserting your initials in the box provided.

You must be 18 years of age or older to sign the Directive. You must sign the document

in the presence of two witnesses.

There are restrictions on who can witness the Directive. Witnesses may not be:

• Related to you by blood, marriage or adoption;

• Entitled to any portion of your estate or have any claim on it; or

• A physician attending you, a person employed by such a physician, or

someone employed by a health care facility in which you are a patient.

The original signed and witnessed copy should be kept by a designated person or in a

designated place of safe keeping where they can be obtained in any emergency situation.

Copies should be given to your close family members, physician(s), attorney, spiritual

advisor, and any others who may be called upon to act on your behalf should you be

unable to do so. Each copy should state where the original is kept, and who else has

copies. You should bring a copy with you each time you are admitted to a hospital

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Washington State Health Care Directive (Living Will) Page 2