Washington § 70.245.220 - Form of the request.

Full text of Washington Revised Code of Washington § 70.245.220 — Form of the request., with citation guidance and answers to common questions.

§ 70.245.220. Form of the request.

A request for a medication as authorized by this chapter shall be in substantially the following form:

REQUEST FOR MEDICATION TO END MY LIFE IN A HUMANE AND DIGNIFIED MANNER

I, . . . . . . . . . . . . . . ., am an adult of sound mind.

I am suffering from . . . . . . . . . . . . . . ., which my attending qualified medical provider has determined is a terminal disease that will result in death within six months.

I have been fully informed of my diagnosis, prognosis, the nature of medication to be prescribed and potential associated risks, the expected result, and the feasible alternatives, including comfort care, hospice care, and pain control.

I request that my attending qualified medical provider prescribe medication that I may self-administer to end my life in a humane and dignified manner and to contact any pharmacist to fill the prescription.

INITIAL ONE:

. . . . . I have informed my family of my decision and taken their opinions into consideration.

. . . . . I have decided not to inform my family of my decision.

. . . . . I have no family to inform of my decision.

I understand that I have the right to rescind this request at any time.

I understand the full import of this request and I expect to die when I take the medication to be prescribed. I further understand that although most deaths occur within three hours, my death may take longer and my qualified medical provider has counseled me about this possibility.

I make this request voluntarily and without reservation, and I accept full moral responsibility for my actions.

Signed: . . . . . . . . . . . . . . .

Dated: . . . . . . . . . . . . . . .

DECLARATION OF WITNESSES

By initialing and signing below on or after the date the person named above signs, we declare that the person making and signing the above request:

Witness 1 Initials	Witness 2 Initials
. . . .	. . . .	1. Is personally known to us or has provided proof of identity;
. . . .	. . . .	2. Signed this request in our presence on the date of the person's signature;
. . . .	. . . .	3. Appears to be of sound mind and not under duress, fraud, or undue influence;
. . . .	. . . .	4. Is not a patient for whom either of us is the attending qualified medical provider.

Printed Name of Witness 1:. . . .

Signature of Witness 1/Date:. . . .

Printed Name of Witness 2:. . . .

Signature of Witness 2/Date:. . . .

NOTE: One witness shall not be a relative by blood, marriage, or adoption of the person signing this request, shall not be entitled to any portion of the person's estate upon death, and shall not own, operate, or be employed at a health care facility where the person is a patient or resident.

[ 2023 c 38 s 17; 2009 c 1 s 22 (Initiative Measure No. 1000, approved November 4, 2008).]

Frequently Asked Questions About Washington § 70.245.220

What does Revised Code of Washington § 70.245.220 cover?

Section 70.245.220 ("Form of the request.") is part of the Revised Code of Washington, the codified statutory law of Washington. It sets out the legal rule or procedure described in the text above. Statutes are amended regularly, so always verify against the official source.

How do I cite Washington § 70.245.220?

A common citation format is "Revised Code of Washington § 70.245.220" (Washington). Legal writing may require the code abbreviation, section number, and year or edition. Match the style required by your court, professor, or publisher.

Is this the official text of Washington law?

No. This page is for research and education and may not include the most recent amendments. For official current law, check the Washington official source linked on this page or consult a licensed Washington attorney.

How does Washington § 70.245.220 apply to my situation?

Statutes are interpreted in context, and application depends on your specific facts. Only a licensed attorney in Washington can advise on how this section applies to you. Contact your state or local bar association for a referral.

Sources & Verification

Official text of § 70.245.220 at the Washington source

Not legal advice. Verify against the official source and consult a licensed attorney in Washington.