Fillable Printable Durable Power of Attorney for Health Care - Washington

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.

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.

10. Execution. This Power of Attorney is signed in duplicate on the _________ day of

___________________, to be effective as provided in Section 3.

_____________________________________

Signed

_____________________________________

Witness

____________________________________

Witness

Notarization, If Needed:

STATE OF WASHINGTON )

) ss.

COUNTY OF _____________ )

I certifiy that I know or have satisfactory evidence that ______________________

signed this instrument and acknowledged it to be his/her free and voluntary act for the uses and

purposes mentioned in the instrument.

Dated: _______________________.

(Seal or stamp) ______________________________

Notary Public in and for the State of

Washington, residing at ___________

My appointment expires ___________

(Although there is no statutory requirement for witnessing or notarization of this form of Durable

Power, it is strongly recommended that there always be two witnesses and that these witnesses be

persons qualified as witnesses to a Health Care Directive, so that the Durable Power will itself be valid

as a Directive under the Natural Death Act in case the signer does not have a separate Directive.

Further, if the form of Durable Power used is broader than this form and extends to the handling of

the patient's property and business affairs in addition to health care, it should always be notarized,

whether there are witnesses or not. Witnessing and/or notarization is also important as evidence to

help confirm the patient's competence and help assure the patient's wishes are carried out should

family members or other oppose on the grounds the patient did not understand what he or she was

doing when signing the document.)