Durable Power of Attorney for Health Care - Washington

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.
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