SHB 1724
In CommitteeHouse
POLST orders
Improving access and practices relating to portable orders for life-sustaining treatment.
This status may be delayed. See Action History below for the latest updates.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
This bill creates a statewide registry for portable orders for life-sustaining treatment (POLST) forms, making it easier for emergency responders and health care providers to access and honor a person’s wishes about life-sustaining treatment. It also allows verbal confirmation of POLST forms under certain conditions, requires annual provider reviews, and provides legal protections for providers acting in good faith. A new reporting requirement will study whether alternative forms of evidence (like medical jewelry or apps) should be recognized.
- Establishes a statewide registry for portable orders for life-sustaining treatment (POLST) forms, managed by the Washington Department of Health, and allows future expansion to include other health care directives.
- Permits verbal confirmation of a POLST form (instead of a signature) if in-person or electronic signing would be difficult, as long as a licensed provider witnesses and signs to confirm the individual’s identity and statement.
- Requires health care providers to review POLST forms annually (or more often) with patients to ensure they reflect current wishes and health status.
- Grants broad legal immunity to providers and emergency responders who act in good faith based on a POLST form—even if they don’t have actual knowledge of its existence or if it’s later found invalid.
- Gives individuals the right to opt out of having their POLST form submitted to the registry, and to revoke or update their form at any time through the registry.
- Requires the Department of Health to conduct research and report to the legislature by June 30, 2026 on whether to allow alternative forms of evidence (e.g., medical jewelry, apps, cards) to indicate a person’s POLST wishes.
Who is affected
- Patients and their families — People who have or are considering completing a portable orders for life-sustaining treatment (POLST) form—typically individuals with serious illness or advanced age—will have clearer options for how and when to submit their form to a state registry, and can opt out of submission if they prefer.
- Health care providers — Doctors, nurse practitioners, and physician assistants who help patients complete POLST forms will need to discuss registry submission (unless the patient opts out), review forms annually, and follow new rules about verbal confirmation and liability protections.
- Emergency responders — Emergency medical personnel (EMTs, paramedics, etc.) will follow standardized protocols for honoring POLST forms, and are protected from liability when acting in good faith—even if they don’t have immediate access to the registry.
- Health care facilities and staff — Health care facilities (hospitals, nursing homes, etc.) and their staff must ensure staff are aware of the registry and how to access it, and must comply with new standards for honoring POLST forms.
Pro/Con Analysis
Stronger case for benefits
Potential Benefits (5)
Broad legal immunity for providers acting in good faith—even without actual knowledge of a POLST form—reduces provider liability fears and encourages honoring patient wishes in high-stakes emergency settings, directly protecting patients’ autonomy at the moment of care.
Public SafetyPeopleRef: Sec. 1(2)(a), Sec. 1(2)(c)(i)-(iv)Mandating annual provider reviews of POLST forms ensures ongoing patient-clinician dialogue about evolving health status and goals of care, improving alignment between treatment and patient values—especially critical for those with progressive illness or declining cognition.
HealthcarePeopleRef: Sec. 1(1)(d), Sec. 1(1)(b), Sec. 2(2)(b)(i), Sec. 2(2)(c)(i)Allowing verbal confirmation of POLST forms—witnessed and signed by a provider—removes barriers for patients who cannot sign (e.g., due to disability, illness, or cognitive impairment), increasing equitable access to formal end-of-life planning.
HealthcarePeopleRef: Sec. 1(1)(b), Sec. 2(2)(b)(i), Sec. 2(2)(b)(ii), Sec. 2(2)(b)(iii)The statewide registry improves emergency access to POLST forms across care settings (e.g., EMS, hospitals, nursing homes), reducing the risk of unwanted resuscitation when a patient’s wishes are known—but previously unfindable—especially for those who move between care settings or live alone.
HealthcarePeopleRef: Sec. 2(2)(a), Sec. 2(2)(d)(i), Sec. 2(2)(d)(ii), Sec. 2(2)(d)(v), Sec. 2(2)(d)(vi)Explicit opt-out rights and the ability to revoke or update forms at any time through the registry empower individuals to retain control over their medical directives—reinforcing bodily autonomy and reducing coercion or outdated mandates.
Rights & LibertiesPeopleRef: Sec. 2(2)(b)(i), Sec. 2(2)(c)(i), Sec. 2(2)(d)(iii)
Potential Concerns (5)
The bill creates a centralized digital registry of sensitive end-of-life medical directives, which increases the risk of data breaches, unauthorized access, or misuse of highly sensitive health information—even with HIPAA-like protections, state agencies lack the same audit and enforcement infrastructure as private health systems.
privacyRef: Sec. 2(2)(a), (2)(b)(i), (2)(c)(i), (2)(d)(v), (2)(e)Annual automated notices to registry participants may create a false sense of security—many elderly or medically vulnerable individuals may not check or update their forms, leading to outdated or revoked directives remaining active and potentially honored in emergencies against the patient’s current wishes.
Public SafetyRef: Sec. 2(2)(d)(iv), Sec. 2(2)(d)(v), Sec. 4(4)(b), Sec. 4(4)(c)Allowing providers (not patients) to submit forms by default—even when the patient has not explicitly requested submission—risks unintended inclusion in the registry, especially for patients who are cognitively impaired, linguistically isolated, or lack access to digital tools to opt out.
Public SafetyRef: Sec. 2(2)(b)(i), Sec. 2(2)(b)(ii), Sec. 2(2)(b)(iii)Broad access to the registry for “health care providers” and “health facilities” without clear audit trails or usage logging increases the risk of non-consensual or non-emergency access—e.g., administrative staff checking forms for billing or staffing purposes rather than clinical need.
Public SafetyRef: Sec. 2(2)(d)(vi), Sec. 4(4)(d)The bill’s research mandate to explore alternative evidence (e.g., apps, jewelry) by June 2026 is under-resourced and lacks funding or implementation authority—making it highly unlikely to result in actionable policy, potentially creating confusion if unvetted methods (e.g., unsecured apps) are adopted informally by providers.
Public SafetyRef: Sec. 3, Sec. 2(2)(d)(i), Sec. 2(2)(d)(ii)
Who Is Most Affected
Patients with serious illness or advanced age—especially those with limited mobility, cognitive decline, or limited digital access—may benefit from improved access to care aligned with their wishes, but face higher risk if they cannot actively opt out or update their form. The registry’s design assumes digital literacy and access, potentially excluding vulnerable subgroups.
Emergency responders gain legal protection and standardized protocols, reducing liability and enabling faster, more confident action in emergencies. However, they face increased administrative burden to verify registry access and interpret forms in time-sensitive settings.
Health care providers benefit from liability shielding and clearer guidance, but must now conduct annual reviews and navigate new documentation and submission requirements—adding time and administrative cost, especially for small practices.
Health facilities (hospitals, nursing homes) gain standardized POLST protocols and legal protections, but must train staff, integrate registry access into EHR systems, and manage compliance with new reporting and revocation procedures—costs likely passed to state-funded programs.
Families and caregivers benefit from reduced uncertainty and conflict over end-of-life care, but may be burdened with managing registry access, revocations, or disputes if a patient’s form is outdated or unclear.