Advance Directive District of Columbia — Living Will and Healthcare POA Combined

What an Advance Directive Includes in DC

An advance directive in the District of Columbia is actually two documents combined into one: a Living Will (Declaration) that states your parent's preferences about life-sustaining treatment, and a Durable Power of Attorney for Health Care that names an agent to make medical decisions when they cannot. DC law allows both to be executed as a single document, and combining them is the standard approach among eldercare practitioners in the District.

The living will component addresses the situations no family wants to think about — whether your parent wants CPR, mechanical ventilation, artificial nutrition and hydration, and other life-prolonging interventions when recovery is not expected. The healthcare POA component handles everything else: selecting care facilities, authorizing surgeries, managing medication changes, and accessing medical records.

Execution Requirements

The combined advance directive must meet the execution rules for the healthcare POA under D.C. Code §§ 21-2205 to 21-2207:

• The principal must sign the document
• Two adult witnesses must also sign, affirming that the principal appeared of sound mind and free from duress
• Neither witness can be the named healthcare agent, the principal's healthcare provider, or an employee of that provider
• At least one witness must be unrelated to the principal by blood, marriage, or adoption and cannot inherit under the principal's will or DC intestacy law

If your parent resides in an intermediate care or skilled nursing facility, D.C. Code § 7-623 adds one more requirement: one of the two witnesses must be a designated patient advocate or ombudsman from the DC Long-Term Care Ombudsman program. Without this, the directive is legally invalid.

Notarization is not required for the healthcare directive portion, but it does not hurt to notarize anyway. Some out-of-state facilities and providers are more comfortable accepting notarized documents, and if your parent splits time between DC and another jurisdiction, notarization provides extra assurance.

The MOST Form — A Separate but Related Tool

DC also has the Medical Orders for Scope of Treatment (MOST) form, governed by D.C. Code § 21-2221.14a. The MOST is not a replacement for an advance directive — it is a clinical order that translates your parent's treatment preferences into specific medical instructions.

The key differences:

• An advance directive is signed by the patient (or surrogate) and witnesses. The MOST is signed by the patient (or surrogate) and a DC-licensed physician or advanced practice registered nurse.
• An advance directive is a legal document. The MOST is a medical order that first responders, EMTs, and hospital staff follow immediately without interpretation.
• An advance directive becomes relevant only when the patient cannot communicate. The MOST is actionable at all times across all clinical and emergency settings.

For aging parents, the MOST is particularly valuable because it travels with the patient. If your parent is transferred from home to the emergency room, the MOST tells paramedics exactly what interventions to use or withhold. An advance directive sitting in a filing cabinet at home does not help in the back of an ambulance.

The MOST covers three primary decisions: CPR status (attempt resuscitation or do not attempt), scope of treatment (full treatment, selective treatment, or comfort-focused), and artificially administered fluids and nutrition. You can obtain the MOST form through DC Health's website or through your parent's physician.

Drafting the Living Will Provisions

The living will section requires specific, clear language about treatment preferences. Vague statements like "I don't want to be kept alive on machines" create confusion and litigation. Effective living will provisions in DC address:

• Life-sustaining treatment: Whether your parent wants CPR, mechanical ventilation, dialysis, or other interventions under the conditions described in the directive
• Artificial nutrition and hydration: Whether tube feeding and IV hydration should be continued, withheld, or withdrawn under terminal or vegetative conditions
• Pain management: Whether comfort measures should be provided even if they may hasten death — a critical distinction that many families overlook
• Organ and tissue donation: Preferences about donation, which should be documented here in addition to any DMV registry

Making Sure the Directive Is Accessible

An advance directive is useless if nobody can find it during an emergency. After execution:

1. Give copies to the named healthcare agent, all backup agents, and the primary care physician
2. File a copy with every hospital your parent may use — MedStar, George Washington University Hospital, Howard University Hospital, and any facility within the MedStar or Children's National networks that handles adult patients
3. Keep the original in a known, accessible location (not a safe deposit box — these are inaccessible evenings and weekends)
4. If your parent has a MOST form, ensure it is posted visibly in the home (typically on the refrigerator or near the front door) so EMTs can locate it

The DC Power of Attorney & Guardianship Kit includes the full advance directive with healthcare POA and living will provisions combined in one document, along with the MOST form instructions and the witness attestation blocks — including the ombudsman witness section for nursing facility residents.

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