A Health Care Directive (HCD), sometimes called a living will or an advance directive, allows a client to give written instructions about life-sustaining treatment. In Agile EP, the Health Care Directive works together with the Health Care Power of Attorney to cover end-of-life decision-making.
The Directive gives specific instructions about life-sustaining treatment, comfort care and organ donation. The Health Care Power of Attorney appoints the decision-maker and governs all other medical decisions.
This article explains how to complete the Health Care Directive. For appointing a Health Care Agent, see this article.
Complete the End-of-Life Section
The Directive questions are in the lower part of the Health Care Choices tab, under Decide How Health Care Agents Make End-of-Life Decisions. Each selection determines the language in the Directive.
Organ Donation
The tab asks whether the client wishes to donate organs.
- If you select Yes, the Directive states, under chapter 68.64 RCW, that the client wants to donate all or any parts of the body for transplantation, therapy, research or education.
- If you select No, the Directive states that the client does not want to make any anatomical gift at death.
- If you select Unsure - let Client’s Agent decide, the Directive states no preference, and the Agent decides under the Health Care Power of Attorney.
Life-Sustaining Treatment
The tab asks whether the client wants to receive or maintain life support.
- If you select Yes, the Directive instructs providers to continue life-sustaining treatment.
- If you select No, the Directive instructs providers to withhold or withdraw life-sustaining treatment.
The instruction applies only if the attending physician has diagnosed the client in writing as having a terminal condition, or two physicians have diagnosed the client in writing as being in a permanent unconscious condition.
Comfort measures Whatever the client decides about life support, the Directive requests care that gives comfort and relieves pain.
Pregnancy
For a female client, the tab offers a pregnancy provision. If you select Yes, the Directive includes a statement that it has no force or effect during a pregnancy known to the client’s physician. Decisions are then made under the Health Care Power of Attorney.
Binding or Guidance
The tab asks whether the Directive binds the Health Care Agent or is only guidance.
- If you select Binding on Agent, the Directive is titled Binding Directions, and the Agent and medical providers follow the client’s expressed wishes about life-sustaining treatment.
- If you select Guidance only to Agent, the Directive is titled Non-Binding Guidance, and the Agent considers the client’s wishes but may decide based on the circumstances.
Execution
The Directive has its own signature block, separate from the Health Care Power of Attorney. The tab asks how the client will sign it, with a Witness Block or a Notary Block. Under RCW 70.122.030(1), a Health Care Directive may be executed before a notary or two witnesses. Statutory restrictions on who may serve as a witness are stated in the document and in the execution instructions.
Coordination with the Health Care Power of Attorney
The Health Care Directive does not appoint an agent. It gives instructions that apply only in limited situations. The Health Care Power of Attorney appoints the decision-maker and gives a broad grant of authority, with guidance and preferences. When both documents are drafted:
- The Directive governs life-sustaining treatment in a terminal condition or a permanent unconscious condition.
- The Health Care Power of Attorney governs all other medical decisions, and directs the Agent to act consistently with the most recent Directive.
- The Agent must follow or consider the Directive, depending on whether it is binding or guidance only.
Generate Your Documents
When the interview is complete, proceed to the Generate Documents tab. For detailed instructions, see this article.