The Interplay of Directive to Physicians, Healthcare Power of Attorney, and POLST Forms in Washington State: A Story of Collaboration

In the realm of healthcare, making decisions about future treatment options can be a complex process. It requires a deep understanding of one’s values, aspirations, and the realities of their health. In Washington State, three key documents play a crucial role in this process: the Directive to Physicians (also known as a Living Will), the Healthcare Power of Attorney, and the POLST (Physician Orders for Life-Sustaining Treatment) form. To illustrate how these documents work together, let’s consider a hypothetical scenario.

The Story of John

John, a resident of Washington State, has been diagnosed with a serious illness. He understands the importance of planning for his future healthcare and decides to prepare a Directive to Physicians, a Healthcare Power of Attorney, and a POLST form. 

Directive to Physicians: John’s Beacon in the Fog of Uncertainty

John starts with the Directive to Physicians. This legal document allows John to outline his wishes regarding medical treatment when he’s unable to communicate them himself. It’s a reflection of his values and beliefs about end-of-life care, and it provides guidance to his healthcare team about treatments he would or would not want to prolong his life. The Directive to Physicians is outlined in the Washington State Natural Death Act (RCW 43.70.480). 

Healthcare Power of Attorney: Appointing His Trusted Guide

Next, John appoints his sister, Mary, as his healthcare agent through a Healthcare Power of Attorney (POA). Mary is now authorized to make healthcare decisions on John’s behalf when he’s unable to do so. The Healthcare POA is broader than a Directive to Physicians—it applies anytime John is incapacitated, not just at the end of life. Mary is expected to make decisions that align with John’s expressed wishes, values, and beliefs, as outlined in his Directive to Physicians. 

POLST Form: Creating John’s Roadmap for Healthcare Providers

Finally, John and his doctor complete a POLST form. This medical order translates John’s treatment preferences into actionable orders for his healthcare team. The POLST form in Washington State, approved by the Washington State Department of Health and the Washington State Medical Association, should be completed after a conversation with the healthcare provider. It’s a reflection of John’s wishes and should be consistent with the directives in his Directive to Physicians and the guidance provided to his healthcare agent, Mary. 

However, there may be situations where John’s health deteriorates rapidly, or the existing POLST form does not cover the current situation. In such cases, Mary, as John’s healthcare agent, is authorized to sign a new or revised POLST form in consultation with John’s doctor. This ensures that John’s treatment preferences are respected, even in unexpected situations. 

The Symphony of the Three Documents

In John’s case, the Directive to Physicians, Healthcare POA, and POLST form work together in harmony to ensure his healthcare preferences are respected. The Directive to Physicians and Healthcare POA provide a legal framework for expressing his wishes and appointing his advocate, Mary. The POLST form translates these wishes into medical orders. 

Mary, as John’s healthcare agent, is directed to follow the Directive to Physicians. She is also authorized to sign the POLST form with the doctor in place of John when necessary, ensuring that John’s wishes are respected at all times. 


Understanding these key documents—Directive to Physicians, Healthcare POA, and POLST form—can empower you to take control of your healthcare journey. By reflecting on your values, discussing your wishes with your healthcare provider and loved ones, and documenting your preferences, you can ensure your voice is heard, even when you can’t speak for yourself.  

Remember, these documents are not set in stone. They should evolve with you, reflecting your current health status, values, and wishes. Regular review and conversation with your healthcare provider and loved ones are crucial to keeping them relevant and effective.