Who Will Decide If You Can’t?

By: Anna DuPen, MN, RN

The Know Your Choices – Ask Your Doctor campaign spearheaded by the Washington State Medical Association encourages patient-centered health care. Fundamental to that are robust conversations about treatment options, expected outcomes and quality of life choices.

One tool developed for the campaign is a brochure called “Who Will Decide If You Can’t?” This great resource includes a blank Health Care Directive and Durable Power of Attorney for Health Care form with a concise explanation of why they are important and a great list of frequently asked questions.

You can pick these brochures up from many doctor’s offices or get to the content at https://wsma.org/advance-directives.

So why is this important? Most of us just don’t want to think about a life-threatening  emergencies, I can understand. None of us really want to go there. But actually, most of us do eventually go there. Only 2.5% of us actually go to sleep one night and don’t wake up.

Not long ago one of our patients realized that if she didn’t fill out an advanced directive that her (estranged, irresponsible, uneducated?) brother—who was next of kin—would make decisions for her if she became incapacitated. Suffice it to say that idea was not comforting.

In the state of Washington, the law enables the following persons in the following order to make health care decisions for you if you are very ill and unable to make decisions for yourself.

  1. A legal guardian with health care decision-making authority, if one has been appointed
  2. The person named in the Durable Power of Attorney with Health Care form with decision-making authority
  3. Your spouse or state-registered domestic partner
  4. Your adult children
  5. Your parents
  6. Your adult brothers and sisters

When there are more than one person, such as children, parents or siblings, all individuals in that class must agree on the health care decision. Having personally seen what can happen when members of a family disagree in a crisis, I can whole-heartedly endorse the need to spell it out clearly ahead of any such medical emergency.

These tools allow you to put into your own words your wishes regarding medical interventions and/or life-prolonging care and to appoint someone you trust to speak for you.

For starters consider this one easy exercise. Of the three categories below, which one is most like how you feel:


Group A: Some people say the only way they want to die, even if their condition is irreversible, is with aggressive/maximum intervention. Do everything!

Group B: Some people say that aggressive intervention is fine but only for reversible conditions. If they were not getting better with a particular intervention they would not want to continue it.

Group C: Some people feel strongly that they do not want any forms of artificial life support under any circumstances.


If you have a good idea which group you fall into, use that as a conversation starter. Your doctor can be a great help in defining your wishes.

Don’t put it off.

Peninsula Cancer Center is offering a free interactive seminar on Healthcare Directives. During this seminar, you’ll have the opportunity to speak to an experienced Oncology RN, MN about your concerns with this sometimes challenging issue. Contact us at 360-697-8000 to reserve your seat since limited space is available.