An advance directive for healthcare (living will) is a document that tells everyone what treatments you want in the event you are terminally ill or permanently unconscious and cannot make decisions for yourself. To be terminally ill means that your attending physician has diagnosed an incurable, irreversible condition that will cause you to die within a reasonable period of time and life-sustaining measures will only prolong the process of dying. Your attending physician is the doctor chosen by you or assigned to you and is responsible for your primary care and treatment. Alternatively, this document applies if two physicians determine you are in a permanently unconscious state. A permanently unconscious state is one in which the patient has no reasonable probability of recovery from a persistent vegetative state, or irreversible coma.
This directive tells your medical care team and family members what life sustaining treatments you do or do not want under the circumstances defined above. These measures include, but are not limited to, CPR, breathing machines, IV nutrition and hydration, and dialysis. You can specify that you want all measures to sustain your life to be taken, or which ones you do and which ones you do not want. It also allows you to convey your health care values to your medical team and loved ones. Health care values are things like “I am afraid of choking, please do what you can to avoid me feeling that sensation.” “I love being outside. If I can no longer be outside, life is not worth living to me and I do not wish to prolong my life.” “I do not want to experience any pain or discomfort. If I seem to be in discomfort, please administer pain medications even if doctors think it my speed up my death.” These statements can help loved ones understand why certain measures are not being taken on your behalf even if they are asking for them to be done.
You may also include special instructions regarding your wishes should you become terminally ill and/or are in a permanently unconscious state while you are pregnant.
A mental health advance directive is another planning tool available to Washington residents. This advance directive deals only with your wishes regarding mental health treatments. It can include the appointment of an agent to make mental health decisions for you upon your incapacity, separate from your power-of-attorney for medical decisions. It differs from the advance directive for healthcare in that it can take effect at any time of incapacity throughout your life, not just if you are terminally ill or permanently unconscious. Some of the things that you can include in this document are your preferences for interventions, hospitals, and medications. Incapacity is determined by two physicians, one of which must be a mental health professional, or a court order requested by you or your agent.
Advanced directives should be given to your healthcare providers to be made part of your medical record. Copies should also be kept where you and your loved ones can access them. Both advanced directives can be revoked if you change your mind.