Health Care Directives

A person signs a health care directive (“HCD”), also known as a “living will” or a “directive to physicians,” to indicate that they want to have life support removed if they are permanently unconscious or terminally ill as diagnosed by two physicians.

1.     Options in a HCD.

A HCD allows a person to choose whether he or she wants artificially provided nutrition or hydration if he or she is terminally ill or permanently unconscious.  A person can individualize his or her HCD to include any other treatment the person wants to receive or avoid if they are terminally ill or permanently unconscious.  For example, a HCD could allow a person to choose whether or not he or she wants to receive pain medication to remain comfortable or CPR.  A HCD, like any other estate planning document, can be tailored to meet every individual’s needs; however, a sample of a HCD is in Appendix A.

A HCD for women can also include a paragraph stating that if a woman is pregnant, that the doctor shall keep her alive until after her baby is born.

For example, a truck hits Chris, who is 6 months pregnant, leaving her permanently unconscious.  However, the fetus was not injured.  If Chris had signed a HCD stating that she was to receive life-sustaining treatment until after her baby was born, then life-sustaining treatment will only be removed after Chris’s baby is born. 

2.     When a HCD is Effective.

The HCD only becomes effective if a person cannot make his or her own decisions.  A person should provide a copy of his or her HCD to his or her physician and any family members who will make health care decisions or the attorney-in-fact named in a health care power of attorney.  If family members or the attorney-in-fact making the health care decisions do not support the HCD, it likely will not be followed.

For example, David sustains massive injuries in a horseback riding accident that places him in a coma with no brain activity.  His attorney-in-fact, Martha, believes that David has a chance to recover from the coma.  Martha can override the provisions of the HCD regarding the removal of life support until she believes that David has no chance of recovery.

If paramedics are called or a person goes to an emergency room, the paramedics and the emergency room personnel will not follow a HCD.  They will do everything possible to keep a person alive.  Only after a person has been stabilized will the doctors look for a HCD.

A person can revoke a HCD at any time by tearing up the current HCD and informing the physician and the people making health care choices for him or her that he or she is terminating that document.

Doctors, hospitals and nursing homes cannot be forced to follow a HCD; however, if a doctor refuses to follow a HCD, he or she has an obligation to find a doctor who will follow that directive.

3.     No Codes.

For people who have very strong feelings that they do not want to receive CPR, they should sign an “EMS No CPR Directive.” This form is available from the Washington State Department of Health.  It requires the signature of either the patient or a person making medical decisions for the patient and the patient’s physician.  Although no special form is required to be used, various emergency and health care personnel in the state of Washington have decided that they will only use the one provided by the Department of Health.

4.     Formal Requirements.

A person must sign his or her HCD in the presence of two individuals.  The two individuals cannot be related to the person signing the HCD or a medical provider of the person signing the HCD.

5.     Death with Dignity Act.

Washington state law does not allow for physician-assisted suicide in the HCD. Under the Death with Dignity Act, a person has to self-administer the medication and a HCD is only applicable when the person can no longer make decisions for himself or herself.

6.     Conclusion.

HCDs give family members and attorney-in-fact for health care decisions an option of asking doctors to remove life support when a person is terminally ill or permanently unconscious and unable to make that request personally.  They also assist individuals making health care decisions for a terminally ill or permanently unconscious person by removing guilt for the decisions made.

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