Durable Power Of Attorney For Health Care Template printable pdf download

Durable Power of Attorney for Health Care

I, __________________________________, domiciled in the State of Washington, designate

_____________________________ as my attorney in fact, to act for me in making health care

decisions if I become incapacitated. I hereby revoke all health care powers of attorney previously

granted by me.

1. Alternate Attorney in Fact. If for any reason ___________________________ fails or ceases to act, I

designate _____________________________, then __________________________ as alternate

attorneys in fact, to serve in the order named. An attorney in fact may resign by delivering written notice

to that effect, in recordable form, to an alternate, successor, or co-attorney in fact. In this Power of

Attorney, the "attorney in fact" means the then acting attorney in fact.

2. Power to Make Health Care Decisions. My attorney in fact shall have the right to make decisions, and to

give informed consent on my behalf, as to my health care. This authority shall include, but not be limited

to, consent to the withholding or withdrawal of life-sustaining treatment, including*/but not including*

artificially provided nutrition and hydration, if at any time (1) I should be diagnosed in writing by my

attending physician to be in a terminal condition (an incurable and irreversible condition caused by injury,

disease, or illness, that would within reasonable medical judgment cause death within a reasonable

amount of time in accordance with accepted medical standards) or (2) in a permanent unconscious

condition (an incurable and irreversible condition in which I am medically assessed within reasonable

medical judgment as having no reasonable probability of recovery from an irreversible coma or persistent

vegetative state) by two physicians; and where the application of life-sustaining treatment would serve

only to artificially prolong the process of dying. I give this authority with the intent that it be honored by

my attorney-in-fact to permit me to die naturally.

* (cross out one)

3. Effectiveness. This Power of Attorney shall become effective upon my incapacity. Incapacity shall include

the inability to make health care decisions effectively for reasons such as mental illness, mental deficiency,

incompetency, physical illness or disability, chronic use of drugs or chronic intoxication. Incapacity may be

determined (i) by court order or (ii) by a qualified regularly attending physician, whose affidavit in

recordable form to that effect shall be conclusive of incapacity. An affidavit executed as described herein

may be relied upon without inquiry by any person dealing with the attorney in fact.

4. Duration. This Power of Attorney becomes effective as provided in Section 3 and shall remain in effect to

the fullest extent permitted by Chapter 11.94 of the Revised Code of Washington, or until revoked or

terminated as provided in Section 5 or 6.

5. Revocation. This Power of Attorney may be revoked, suspended, or terminated by written notice from

me to the designated attorney in fact and, if this power has been recorded, by recording the notice in the

office where deeds are recorded for real estate located in ____________________ County, Washington.

6. Termination. If appointed a guardian of my person may, with court approval, revoke, suspend, or

terminate this Power of Attorney.

7. Reliance. Any person dealing with the attorney in fact shall be entitled to rely upon this Power of

Attorney so long as the person with whom the attorney in fact was dealing, at the time of any act taken

pursuant to this Power of Attorney, had neither actual knowledge nor written notice of any revocation,

suspension, or termination of this Power of Attorney. Any action so taken, unless otherwise invalid or

unenforceable, shall be binding on my heirs, devisees, legatees, or personal representatives.

8. Indemnity. My estate shall hold harmless and indemnify the attorney in fact from all liability for acts or

omissions done in good faith.

9. Applicable Law. The internal law of the State of Washington shall govern this Power of Attorney.

Durable Power Of Attorney For Health Care Template

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