Washington Medical Surrogate List: Who Can Consent Under RCW 7.70.065

The Hierarchy That Determines Who Speaks at the Bedside

When a young adult turns 18 in Washington and cannot consent to their own medical treatment — whether because of a developmental disability, a psychiatric crisis, or an accident — the hospital does not simply ask the nearest family member to sign the forms. Washington law prescribes a strict priority list of who can provide informed consent, and where you fall on that list depends on your legal relationship to the patient.

RCW 7.70.065 governs this hierarchy. Understanding it is essential for any parent planning the turning-18 transition, because your position on this list changes depending on whether you have established any formal legal authority.

The Statutory Priority Order

When a patient lacks capacity to provide informed consent and has not executed a healthcare power of attorney, Washington healthcare providers must look to the following people, in this exact order of priority:

1. Court-appointed guardian with healthcare authority
2. Agent designated under a Durable Power of Attorney for Healthcare
3. Spouse or state-registered domestic partner
4. Adult children of the patient
5. Parents of the patient
6. Adult siblings of the patient

The provider goes down the list until they find someone who is available, willing, and competent to make the decision. If no one on the list is available, the provider may proceed with treatment necessary to prevent death or serious harm under implied consent principles.

Where Parents Actually Stand

For parents of a young adult with disabilities, the critical fact is that you sit at position five on this list — behind any guardian, any DPOA agent, any spouse, and any adult children the patient might have.

In practice, for an 18-year-old with no spouse, no adult children, and no court-appointed guardian, a parent is typically the first available person. But "typically" is not "always." If your adult child has a partner, a sibling who asserts authority, or if you are unavailable during an emergency, the hierarchy applies strictly.

More importantly, hospitals and clinics interpret this statute cautiously. Some providers refuse to discuss treatment plans with parents of adult patients without documentation — not because the law forbids it, but because HIPAA compliance departments have trained staff to default to the most restrictive interpretation. Having a formal document changes this dynamic entirely.

How a DPOA Jumps You to Position Two

A Durable Power of Attorney for Healthcare elevates the named agent from wherever they naturally sit on the surrogate list to position two — directly behind a court-appointed guardian and ahead of everyone else.

For parents, this means moving from position five to position two with a single document that requires no court involvement, no filing fees, and no ongoing reporting. The young adult signs the DPOA while competent, names the parent as healthcare agent, and the document takes effect immediately if the young adult later becomes unable to make their own medical decisions.

This is why disability attorneys and transition planners in Washington consistently recommend a healthcare DPOA as the first step in turning-18 planning. It solves the medical consent problem without approaching a courtroom.

When the Surrogate List Is Not Enough

The surrogate list under RCW 7.70.065 has limitations that matter for families with complex medical situations:

• It only applies when the patient currently lacks capacity. If the young adult is conscious, oriented, and can communicate — even if their judgment seems impaired — the provider must seek their consent directly.
• It covers informed consent for treatment, not medical records access. Getting copies of your adult child's medical records still requires a signed HIPAA authorization, which is a separate document from the surrogate hierarchy.
• It does not apply to psychiatric treatment decisions. Behavioral health has its own framework under RCW 71.32, the Mental Health Advance Directive.
• Multiple people at the same priority level can disagree. If two parents disagree on a treatment decision, the provider may delay treatment and seek guidance from a hospital ethics committee or the court.

Building a Complete Medical Authority Package

For families planning the turning-18 transition, relying on the default surrogate list is a gamble. It works in many situations, but it breaks down precisely when the stakes are highest — during emergencies, in unfamiliar hospitals, or when family members disagree.

A robust medical authority package includes:

• A Healthcare DPOA naming the parent as agent (moves you to position two)
• A signed HIPAA Authorization granting the agent access to medical records
• A Mental Health Advance Directive if the young adult has psychiatric conditions
• A copy of any Supported Decision-Making agreement so providers understand the support structure

The Washington Adult Guardianship & Alternatives Guide walks through each of these documents and explains how they interact with the RCW 7.70.065 surrogate hierarchy, so you know exactly where your authority begins and ends in every clinical scenario.

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