Content Overview
Understanding how to communicate one's healthcare preferences during periods of serious illness is an overwhelming yet crucial part of personal planning. Here's where the Five Wishes document steps in—as a beacon guiding individuals in laying out their medical, personal, and emotional wishes. Designed with inputs from experts and the American Bar Association on Law and Aging, this document stands out for its simplicity and legal validity in most states once properly completed. It covers comprehensively who should make decisions when one cannot, the type of medical treatment desired or not, levels of comfort, how one wishes to be treated by others, and the essential thoughts or messages one wants to leave behind for loved ones. This compassionate approach to end-of-life planning not only clarifies one's wishes but significantly eases the decision-making burden on family members, ensuring they are not left guessing in times of crisis. Available in 27 languages and recognized in 42 states plus the District of Columbia, the Five Wishes document has touched over 19 million lives, offering a mix of legal formality with the tenderness of personal touch—making it a unique tool for articulating healthcare choices. Transitioning to Five Wishes from any previous advance directive is straightforward, ensuring that one’s current healthcare directives align with their evolving wishes and values.
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MY WISH FOR:
The Person I Want to Make Care Decisions for Me When I Can’t
The Kind of Medical Treatment I Want or Don’t Want
How Comfortable I Want to Be
How I Want People to Treat Me
What I Want My Loved Ones to Know
Print Your Name
Birthdate
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here are many things in life that are out of our hands. This Five Wishes
document gives you a way to control something very important — how
you are treated if you get seriously ill. It is an easy-to-complete form that
lets you say exactly what you want. Once it is filled out and properly signed,
it is valid under the laws of most states.
Five Wishes is the first living will (also called an advance directive) that talks about your personal,
emotional, and spiritual needs as well as your medical wishes. It lets you choose the person you want
to make health care decisions for you if you are not able to make them for yourself. Five Wishes lets
you say exactly how you wish to be treated if you get seriously ill. It was written with the help of the
nation’s leading experts in end-of-life care. It’s also easy to use. All you have to do is check a box,
circle a direction, or write a few sentences.
What Is Five Wishes?
• It lets you talk with your family, friends and
doctor about how you want to be treated if
you become seriously ill.
• Your family members will not have to guess
what you want. It protects them
if you become seriously ill, because
they won’t have to make hard choices
without knowing your wishes.
• You can know what your mom, dad,
spouse, or friend wants. You can be there
for them when they need you most. You will
understand what they really want.
How Five Wishes Can Help You And Your Family
How Five Wishes Began
For 12 years, Jim Towey worked closely with Mother Teresa, and, for one year, he lived in a hospice
she ran in Washington, DC. Inspired by this first-hand experience, Mr. Towey sought a way for
patients and their families to plan ahead and to cope with serious illness. The result is Five Wishes and
the response to it has been overwhelming. It has been featured on CNN and NBC’s Today Show and
in the pages of Time and Money magazines. Newspapers have called Five Wishes the first “living will
with a heart and soul.” Today, Five Wishes is available in 30 languages.
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Five Wishes was created with help from the American Bar Association’s Commission on Law and
Aging. If you live in the District of Columbia or most states you can use Five Wishes and have
the peace of mind to know that it substantially meets your state’s requirements under the law.
If you live in one of four states (Kansas, New Hampshire, Ohio, or Texas) you can still use Five
Wishes but may need to take an extra step. Find out more at FiveWishes.org/states.
You may already have a living will or a durable power of attorney for health care. If you want to use
Five Wishes instead, all you need to do is fill out and sign a new Five Wishes as directed. As soon as
you sign it, it takes away any advance directive you had before. To make sure the right form is used,
please do the following:
Five Wishes is for anyone 18 or older — married, single, parents, adult children, and friends. More
than 40 million people of all ages have already used it. Because it works so well, lawyers, doctors,
hospitals and hospices, faith communities, employers, and retiree groups are handing out this
document.
People who use Five Wishes find that it helps them express all that they want and provides a helpful
guide to family members, friends, care givers and doctors. Most doctors and health care professionals
know they need to listen to your wishes no matter how you express them.
Who Should Use Five Wishes
Five Wishes In My State
How Do I Change To Five Wishes?
• Destroy all copies of your old living will or
durable power of attorney for healthcare.
Or you can write “revoked” in large letters
across the copy you have. Tell your lawyer
if he or she helped prepare those old forms
for you.
• Tell your Health Care Agent, family
members, and doctor that you have filled out
a new Five Wishes. Make sure they know
about your new wishes.
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f I am no longer able to make my own health care
decisions, this form names the person I choose to
make these choices for me. This person will be my
Health Care Agent (or other term that may be used in
my state, such as proxy, representative, or surrogate).
This person will make my health care choices if both
of these things happen:
• My attending or treating doctor finds I am no
longer able to make health care choices, AND
• Another health care professional agrees that
this is true.
If my state has a different way of finding that I am not
able to make health care choices, then my state’s way
should be followed.
WISH 1
The Person I Want To Make Health Care Decisions For Me
When I Can’t Make Them For Myself.
Choose someone who knows you very well, cares
about you, and who can make difficult decisions.
A spouse or family member may not be the best
choice because they are too emotionally involved.
Sometimes they are the best choice. You know
best. Choose someone who is able to stand up for
you so that your wishes are followed. Also, choose
someone who is likely to be nearby so they can
help when you need them. Whether you choose a
spouse, family member, or friend as your Health
Care Agent, make sure you talk about these wishes
and be sure that this person agrees to respect and
follow your wishes. Your Health Care Agent
should be at least 18 years or older (in Colorado,
21 years or older) and should not be:
• Your health care provider, including the
owner or operator of a health or residential
or community care facility serving you.
• An employee or spouse of an employee of
your health care provider.
• Serving as an agent or proxy for 10 or
more people unless he or she is your
spouse or close relative.
Picking The Right Person To Be Your Health Care Agent
If this person is not able or willing to make these choices for me, OR is divorced or legally separated from
me, OR this person has died, then these people are my next choices:
First Choice Name
Address
Phone
City/State/Zip
The Person I Choose As My Health Care Agent Is:
Second Choice Name
Address
City/State/Zip
Phone
Third Choice Name
Address
City/State/Zip
Phone
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I understand that my Health Care Agent can make health care decisions for me. I want my Agent to be able to do
the following: (Please cross out anything you don’t want your Agent to do that is listed below.)
• Make choices for me about my medical care or
services, like tests, medicine, or surgery. This
care or service could be to find out what my
health problem is, or how to treat it. It can also
include care to keep me alive. If the treatment or
care has already started, my Health Care Agent
can keep it going or have it stopped.
• Interpret any instructions I have given in this
form or given in other discussions, according to
my Health Care Agent’s understanding of my
wishes and values.
• Consent to admission to an assisted living
facility, hospital, hospice, or nursing home for
me. My Health Care Agent can hire any kind of
health care worker I may need to help me or take
care of me. My Agent may also fire a health care
worker, if needed.
• Make the decision to request, take away, or not
give medical treatments, including artificially-
provided food and water, and any other
treatments to keep me alive.
• See and approve release of my medical records
and personal files. If I need to sign my name to
get any of these files, my Health Care Agent can
sign it for me.
• Move me to another state to get the care I need or
to carry out my wishes.
• Authorize or refuse to authorize any medication
or procedure needed to help with pain.
• Take any legal action needed to carry out my
wishes.
• Donate useable organs or tissues of mine as
allowed by law.
• Apply for Medicare, Medicaid, or other programs
or insurance benefits for me. My Health Care
Agent can see my personal files, like bank
records, to find out what is needed to fill out
these forms.
• Listed below are any changes, additions, or
limitations on my Health Care Agent’s powers.
• Destroy all copies of this part of the Five Wishes
form. OR
• Tell someone, such as my doctor or family, that I
want to cancel or change my Health Care Agent.
OR
• Write the word “Revoked” in large letters across
the name of each agent whose authority I want to
cancel. Sign my name on that page.
If I Change My Mind About Having A Health Care Agent, I Will
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My Wish For The Kind Of Medical Treatment
I Want Or Don’t Want.
I
believe that my life is precious and I deserve to be treated with dignity. When the time comes that
I am very sick and am not able to speak for myself, I want the following wishes, and any other
directions I have given to my Health Care Agent, to be respected and followed.
What You Should Keep In Mind As My Caregiver
• I do not want to be in pain. I want to be
comfortable. Wish 3 says what can be done to
make me comfortable.
• I want to be offered food and fluids by mouth if it
is safe for me to eat and drink. I want to be kept
clean and warm.
• I do not want anything done or omitted by my
doctors or nurses with the intention of taking
my life.
Life-support treatment means any medical procedure, device, or medication to keep me alive. Life-support
treatment includes: medical devices put in me to help me breathe; food and water supplied by medical device
(tube feeding); cardiopulmonary resuscitation (CPR); major surgery; blood transfusions; dialysis; antibiotics;
and anything else meant to keep me alive. If I wish to limit the meaning of life-support treatment because of
my religious or personal beliefs, I write this limitation in the space below. I do this to make very clear what I
want and under what conditions.
What “Life-Support Treatment” Means To Me
If you have a medical emergency and
ambulance personnel arrive, they may look
to see if you have a Do Not Resuscitate form
or bracelet. Many states require a person to
have a Do Not Resuscitate form filled out
and signed by a doctor if you choose not to be
resuscitated. This form lets ambulance personnel
know that you don’t want them to use life-support
treatment when you are dying. Please check with
your doctor to see if you need to have a Do Not
Resuscitate form filled out.
In Case Of An Emergency
WISH 2
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Close To Death:
If my doctor and another health care professional both
decide that I am likely to die within a short period of
time, and life-support treatment would only delay the
moment of my death (choose one of the following):
o
I want to have life-support treatment.
o I do not want life-support treatment. If it has been
started, I want it stopped.
o I want to have life-support treatment if my doctor
believes it could help. But I want my doctor to
stop giving me life-support treatment if it is not
helping my health condition or symptoms.
In A Coma And Not Expected To
Wake Up Or Recover:
If my doctor and another health care professional
both decide that I am in a coma from which I am
not expected to wake up or recover, and I have brain
damage, and life-support treatment would only
delay the moment of my death (choose one of the
following):
o
I want to have life-support treatment.
o I do not want life-support treatment. If it has been
started, I want it stopped.
o
I want to have life-support treatment if my doctor
believes it could help. But I want my doctor to stop
giving me life-support treatment if it is not helping
my health condition or symptoms.
Permanent And Severe Brain Damage
And Not Expected To Recover:
If my doctor and another health care professional both
decide that I have permanent and severe brain damage,
(for example, I can open my eyes, but I can not speak
or understand) and I am not expected to get better, and
life-support treatment would only delay the moment
of my death (choose one of the following):
o I want to have life-support treatment.
o I do not want life-support treatment. If it has been
started, I want it stopped.
o I want to have life-support treatment if my doctor
believes it could help. But I want my doctor to
stop giving me life-support treatment if it is not
helping my health condition or symptoms.
In Another Condition Under Which I
Do Not Wish To Be Kept Alive:
If there is another condition under which I do not wish
to have life-support treatment, I describe it below. In
this condition, I believe that the costs and burdens of
life-support treatment are too much and not worth the
benefits to me. Therefore, in this condition, I do not
want life-support treatment. (For example, you may
write “end-stage condition.” That means that your
health has gotten worse. You are not able to take care
of yourself in any way, mentally or physically. Life-
support treatment will not help you recover. Please
leave the space blank if you have no other condition
to describe.)
Here is the kind of medical treatment that I want or don’t want in the four situations listed below. I want my Health
Care Agent, my family, my doctors and other health care providers, my friends, and all others to know these directions.
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• I wish to have people with me when possible.
I want someone to be with me when it seems that
death may come at any time.
• I wish to have my hand held and to be talked to
when possible, even if I don’t seem to respond to
the voice or touch of others.
• I wish to have others by my side praying for me
when possible.
• I wish to have the members of my faith
community told that I am sick and asked to pray
for me and visit me.
• I wish to be visited by a chaplain or clergy.
• I wish to be cared for with kindness and
cheerfulness, and not sadness.
• I wish to have pictures of my loved ones in my
room, near my bed.
• I wish to have my favorite music played when
possible until my time of death.
• I want to die in my home, if that can be done.
• I wish to be called by my name.
Please call me:
• I do not want to be in pain. I want my doctor
to give me enough medicine to relieve my pain,
even if that means I will be drowsy or sleep
more than I would otherwise.
• If I show signs of depression, nausea, shortness
of breath, or hallucinations, I want my care givers
to do whatever they can to help me.
• I wish to have a cool moist cloth put on my head
if I have a fever.
• I want my lips and mouth kept moist to stop
dryness.
• I wish to have warm baths often. I wish to be
kept fresh and clean at all times.
• I wish to be massaged with warm oils as often as
I can be.
• If I am not able to control my bowel or bladder
functions, I wish for my clothes and bed linens to
be kept clean, and for them to be changed as soon
as they can be if they have been soiled.
• I wish to have personal care like shaving, nail
clipping, hair brushing, and teeth brushing, as
long as they do not cause me pain or discomfort.
• I wish to have religious or spiritual readings and
well-loved poems read aloud when I am near
death.
• I wish to know about options for hospice care to
provide medical, emotional, and spiritual care for
me and my loved ones.
T
he next three wishes deal with my personal, spiritual, and emotional wishes. They are important to me.
I want to be treated with dignity near the end of my life, so I would like people to do the things written
in Wishes 3, 4, and 5 when they can be done. I understand that my family, my doctors and other health care
providers, my friends, and others may not be able to do these things or are not required by law to do these
things. I do not expect the following wishes to place new or added legal duties on my doctors or other health
care providers. I also do not expect these wishes to excuse my doctor or other health care providers from giving
me the proper care asked for by law.
WISH 3
My Wish For How Comfortable I Want To Be.
(Please cross out anything that you don’t agree with.)
WISH 4
My Wish For How I Want People To Treat Me.
(Please cross out anything that you don’t agree with.)
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WISH 5
My Wish For What I Want My Loved Ones To Know.
(Please cross out anything that you don’t agree with.)
• I wish to have my family and friends know that I
love them.
• I wish to be forgiven for the times I have hurt my
family, friends, and others.
• I wish to have my family, friends, and others
know that I forgive them for when they may have
hurt me in my life.
• I wish for my family and friends to know that I
do not fear death. I think it is not the end, but a
new beginning for me.
• I wish for all of my family members to make
peace with each other before my death, if they
can.
• I wish for my family and friends to think about
what I was like before I became seriously ill. I
want them to remember me in this way after my
death.
• I wish for my family and friends and caregivers
to respect my wishes even if they don’t agree
with them.
• I wish for my family and friends to look at
my dying as a time of personal growth for
everyone, including me. This will help me live a
meaningful life in my final days.
• I wish for my family and friends to get
counseling if they have trouble with my death. I
want memories of my life to give them joy and
not sorrow.
• After my death, I would like my body to be
(circle one): buried OR cremated.
• My body or remains should be put in the
following location:
• The following person knows my funeral wishes:
If anyone asks how I want to be remembered, please say the following about me:
If there is to be a memorial service for me, I wish for this service to include the following
(list music, songs, readings, or other specific requests that you have):
It is important for my health care providers to know what matters most to me. I wish for them to know the
following:
Please use the space below for any other wishes. For example, you may want to donate any or all parts of your
body when you die. You may also wish to designate a charity to receive memorial contributions. Or you may
want to give instructions on what should be done with your social media or other electronic records. Please
attach a separate sheet of paper if you need more space.
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Please make sure you sign your Five Wishes in the presence of two witnesses.
I, , ask that my family, my doctors, and other health care providers, my
friends, and all others, follow my wishes as communicated by my Health Care Agent (if I have one and he or
she is available), or as otherwise expressed in this form. This form becomes valid when I am unable to make
decisions or speak for myself. If any part of this form cannot be legally followed, I ask that all other parts of this
form be followed. I also revoke any health care advance directives I have made before.
STATE OF___________________________________ COUNTY OF________________________________
On this _____ day of __________________, 20_____, the said ________________________________________________________,
_______________________________, and ______________________________, known to me (or satisfactorily proven) to be the person named in
the foregoing instrument and witnesses, respectively, personally appeared before me, a Notary Public, within and for the State and County aforesaid,
and acknowledged that they freely and voluntarily executed the same for the purposes stated therein.
My Commission Expires:
Notary Public
Signing My Five Wishes
Notarization
• Only required for residents of Missouri, North Carolina, South Carolina, and West Virginia
If you live in Missouri, only your signature should be notarized. If you live in North Carolina, South Carolina or West Virginia, you should have your
signature, and the signatures of your witnesses, notarized.
Witness Statement • (2 witnesses needed):
I, the witness, declare that the person who signed or acknowledged this form (hereafter “person”) is personally
known to me, that he/she signed or acknowledged this [Health Care Agent and/or Living Will form(s)] in my
presence, and that he/she appears to be of sound mind and under no duress, fraud, or undue influence.
I also declare that I am over 18 years of age (19 in Alabama) and am NOT:
(Some states may have fewer rules about who may be a witness. Unless you know your state’s rules, please follow the above.)
Signature of Witness #1
Printed Name of Witness
Address
Phone
Signature of Witness #2
Printed Name of Witness
Address
Phone
• The individual appointed as (agent/proxy/
surrogate/patient advocate/representative) by this
document or his/her successor,
• The person’s health care provider, including
owner or operator of a health, long-term care,
or other residential or community care facility
serving the person,
• An employee of the person’s health care provider,
• Financially responsible for the person’s health care,
• An employee of a life or health insurance
provider for the person,
• Related to the person by blood, marriage, or
adoption,
• A beneficiary of any legal instrument, account, or
benefit plan of the person, and,
• To the best of my knowledge, a creditor of the
person or entitled to any part of his/her estate
under a will or codicil, by operation of law.
Signature Address
Phone Date Address (cont.)
Form Specifications
| Fact Name | Description |
|---|---|
| Overview of Five Wishes | Five Wishes is a comprehensive living will that addresses personal, emotional, spiritual needs, and medical wishes. |
| Legal Status | Once completed and signed, it is legally valid in most states under specific statutes. |
| Purpose | It enables individuals to outline how they wish to be treated if seriously ill, minimizing difficult decisions for family members. |
| Origin | Inspired by Jim Towey’s experience with Mother Teresa and designed to help families plan for serious illness. |
| User Demographic | Recommended for anyone over 18, including married, single, parents, adult children, and friends. |
| State Compatibility | Valid in the District of Columbia and 42 states, individuals in other states may need to supplement with state-specific forms. |
| Transition to Five Wishes | To adopt Five Wishes, individuals must revoke any prior living will or durable power of attorney for healthcare and notify relevant parties. |
| Choosing a Health Care Agent | Details the importance of selecting a reliable health care agent who understands and respects the individual’s wishes. |
5 Wishes Document: Usage Guidelines
The Five Wishes document offers a way for individuals to outline their desires regarding healthcare and personal matters in the event that they are unable to communicate their wishes themselves. This document is unique because it covers personal, emotional, and spiritual needs in addition to medical wishes. It is recognized in many states as a legal document when completed and signed appropriately. Below are step-by-step instructions for filling out the Five Wishes Document to ensure your preferences are known and respected.
- Wish 1: Choosing Your Health Care Agent
- Begin by considering who you trust to make healthcare decisions on your behalf if you're unable to do so. This person will be your Health Care Agent.
- In the designated sections, write the name, address, and phone number of your first choice for Health Care Agent.
- Identify and document second and third choices for your Health Care Agent, including their contact information, to act in the role should your first choice be unable to fulfill their duties.
- Guidelines for Your Health Care Agent
- Think about the decisions your agent may have to make. These could range from medical treatment options to end-of-life care.
- Document any specific wishes you have about your medical care, including treatments you do or do not want.
- Discuss your wishes with the person you've chosen to ensure they are willing and understand your preferences.
- Powers of Your Health Care Agent
- Carefully review the list of actions your Health Care Agent can take on your behalf. Cross out any powers you do not wish to grant them.
- If there are specific limitations or additional instructions you want to include regarding the powers of your Health Care Agent, write these down in the provided spaces.
- Communicating Your Wishes
- Have detailed conversations with your chosen agent(s) about your healthcare preferences, ensuring they understand the responsibility and your expectations.
- Inform family members, close friends, and your healthcare providers about your Five Wishes document and who you have chosen as your Health Care Agent.
- Finalizing the Document
- Once completed, your Five Wishes document needs to be signed as required by your state's laws to be legally valid. This may include signing in the presence of witnesses or a notary, depending on local regulations.
- Distribute copies of the signed document to your Health Care Agent, alternative agents, family members, and healthcare providers to ensure your wishes are known.
- Review and Update as Necessary
- Periodically review your Five Wishes document to make sure it still reflects your desires, especially after major life changes such as marriage, divorce, the birth of a child, or a significant change in health.
- If you decide to change your Health Care Agent or any of your wishes, update your Five Wishes document, destroy all copies of the old version, and notify everyone who had a copy of the changes.
By carefully completing the Five Wishes document, you take a significant step toward ensuring your healthcare preferences are honored. Remember, open and honest communication with your chosen Health Care Agent and loved ones about your wishes is key to this process.
Your Questions, Answered
What is the Five Wishes Document?
The Five Wishes Document is an innovative tool that addresses not only medical wishes but also personal, emotional, and spiritual desires in the event of a serious illness. It's considered the first living will of its kind, designed to guide family, friends, and healthcare providers about how one wishes to be treated if they are unable to communicate their wishes themselves. It allows an individual to appoint a Health Care Agent to make decisions on their behalf, specify types of medical treatment desired, detail comfort measures, identify how they wish to be treated by others, and express any final messages to loved ones.
Who should use Five Wishes?
Any person over the age of 18 can benefit from completing a Five Wishes document. This includes individuals who are married, single, parents, adult children, or friends. It has gained widespread acceptance, with over 19 million people having used it. Its versatility makes it a helpful resource for attorneys, medical professionals, hospitals, hospices, faith groups, employers, and retirement organizations to distribute and discuss within their communities.
Is the Five Wishes Document legally valid in all states?
Five Wishes meets the legal requirements for an advance directive in the District of Columbia and 42 states. In these locations, filling out and signing the document provides a legally binding expression of one’s desires regarding medical treatment and end-of-life care. However, if you live outside these states, while your medical wishes might not meet the technical statutes of your state, Five Wishes can still serve as a powerful guide for your loved ones and healthcare providers. It's always recommended to check with your state's requirements or a legal professional for guidance.
How can Five Wishes help families?
Five Wishes facilitates open and meaningful conversations among family members about preferences in medical treatment, comfort, and personal sentiments at the end of life. It provides clarity and reassurance to both the individual and their loved ones, significantly reducing the stress of making tough decisions during emotional times. The document ensures that family members are aware of their loved one's wishes, eliminating the need for guesswork and potentially conflicted decisions among relatives and healthcare providers.
How do I change to Five Wishes from another advance directive?
If you already have an existing living will or durable power of attorney for healthcare but wish to switch to the Five Wishes document, you simply need to complete a new Five Wishes form and sign it as directed. Upon doing this, it's important to nullify any previous advance directives by either destroying them or writing "revoked" across the documents. Inform your health care agent, family members, and doctor of this change to ensure that everyone involved in your care is up to date with your current wishes.
How do I choose the right person to be my Health Care Agent?
Choosing your Health Care Agent is one of the most critical decisions in the Five Wishes process. Select someone you trust deeply, knows you well, and understands your values and wishes. This person should also be capable of making difficult healthcare decisions under stress. While family members are common choices, it's essential to consider their emotional capacity to make such decisions. Discuss your wishes with the chosen individual to ensure they are willing and able to act on your behalf when required.
Common mistakes
Filling out the 5 Wishes Document is a critical step in planning for your future medical care. However, mistakes can often be made during this process. Being aware of common errors can help ensure your wishes are clearly expressed and followed. Here are five common mistakes to avoid:
Not Choosing the Right Health Care Agent: It’s crucial to designate a Health Care Agent who truly knows you and can reliably act on your behalf. This individual should not only be trustworthy but also possess the emotional strength to make difficult decisions under pressure.
Being Vague About Medical Treatment Wishes: Failing to specify your desires regarding medical treatment, including life-sustaining measures, can lead to actions that may or may not align with what you would have wanted. Clear and detailed instructions ensure your healthcare team knows your exact preferences.
Overlooking Comfort and Care Preferences: Comfort and care preferences extend beyond medical treatments to include personal dignity and emotional well-being. Neglecting to detail how you wish to be made comfortable, and how you wish people to treat you, can result in care that does not meet your personal standards or desires.
Not Communicating Wishes to Your Loved Ones: Failing to discuss your wishes with family and your designated Health Care Agent can lead to uncertainty and stress during difficult times. Open conversations can reassure your loved ones that they are honoring your preferences.
Improper Signing or Not Meeting State Requirements: Each state has its own legal requirements for making the 5 Wishes Document valid. Not thoroughly completing, signing, or following your state’s specific processes can render the document ineffective. This highlights the importance of understanding and adhering to your local laws.
Avoiding these mistakes requires thoughtful consideration, clear communication, and occasionally, guidance from professionals knowledgeable about your state's laws. Taking these steps ensures that your healthcare wishes are respected and followed, providing peace of mind for both you and your loved ones.
Documents used along the form
When preparing for the future, especially regarding healthcare decisions, the Five Wishes Document is a valuable tool that allows individuals to outline their preferences clearly. Along with the Five Wishes Document, there are several other forms that can play a pivotal role in ensuring one's wishes are respected and followed. These documents complement the Five Wishes by covering additional aspects of advance planning.
- Durable Power of Attorney for Health Care: This document allows you to appoint someone to make healthcare decisions on your behalf if you become unable to do so. Unlike the Five Wishes, which covers personal, emotional, and spiritual needs along with medical wishes, a Durable Power of Attorney for Health Care strictly designates a decision-maker.
- Living Will: A living will is a written document that specifies the types of medical treatments and life-sustaining measures you want or don't want if you're unable to communicate your decisions. It focuses on end-of-life care, such as the use of ventilators and feeding tubes.
- Last Will and Testament: Though not directly related to healthcare decisions, a Last Will and Testament is crucial for outlining how you want your assets distributed after your death. It also allows you to appoint a guardian for minor children.
- Do Not Resuscitate (DNR) Order: A DNR order is a medical order that tells healthcare professionals not to perform CPR if your breathing stops or if your heart stops beating. It's different from the above documents because it's used in emergency medical situations and goes into effect immediately upon your incapacity.
These documents, used together, can provide a comprehensive plan for your healthcare and personal wishes, offering peace of mind for both you and your family. Each serves a unique purpose, addressing different aspects of your care and ensuring that your values and preferences are honored. Preparing these forms in advance is a profound act of care for yourself and your loved ones.
Similar forms
Living Will: Similar to the Five Wishes document, a living will enables individuals to outline their preferences regarding the medical treatments they want to receive or refuse, particularly life-sustaining measures, when they're unable to communicate these decisions themselves. Both documents are aimed at guiding healthcare providers and loved ones in making care decisions that align with the individual's wishes.
Durable Power of Attorney for Healthcare: This legal document allows a person to appoint another individual to make healthcare decisions on their behalf if they become unable to do so. It is similar to the first wish in the Five Wishes document, where one nominates a health care agent, but it typically focuses more on the delegation of decision-making authority rather than on specific care preferences.
Do Not Resuscitate (DNR) Order: A DNR is a medical order that tells healthcare providers not to perform CPR if a patient's breathing stops or if the heart stops beating. The Five Wishes document covers a broader range of treatments and care preferences, but similar to a DNR, it may include wishes about not wanting certain life-sustaining treatments.
Medical Orders for Life-Sustaining Treatment (MOLST) or Physician Orders for Life-Sustaining Treatment (POLST): These medical orders translate a patient’s wishes into actionable medical orders, applicable across a variety of healthcare settings. Similar to Five Wishes, these documents address critical decisions like the use of ventilators, feeding tubes, and other life-sustaining treatments based on the patient’s values and goals for care.
Hospice Care Instructions: These instructions outline a patient’s wishes regarding end-of-life care, focusing on comfort and quality of life rather than curative treatments. The Five Wishes document also addresses how comfortable a person wants to be (Wish 3), including pain management and palliative care preferences, aligning closely with the principles of hospice care.
Organ and Tissue Donation Registration: This expresses an individual's decision regarding the donation of organs and tissues after death. While primarily a registration rather than a comprehensive document, it can relate to the medical care decisions outlined in the Five Wishes, specifically if an individual includes wishes about organ donation as part of their end-of-life care preferences (within Wish 5).
Dos and Don'ts
When completing the Five Wishes Document form, making thoughtful decisions can help ensure your health care preferences are respected. Here are some essential dos and don'ts to consider:
- Do take your time to thoroughly read and consider each section before you make any decisions.
- Do discuss your wishes with the person you intend to appoint as your Health Care Agent to make sure they understand and are willing to respect your choices.
- Do provide clear, specific instructions about your medical treatment preferences to avoid any confusion later on.
- Do use the space provided for additional instructions to detail any beliefs, values, or preferences that you want your Health Care Agent and caregivers to consider.
- Do sign and date the document in the presence of the required witnesses or a notary, depending on your state’s laws, to ensure it's legally valid.
- Don't choose a Health Care Agent without considering their ability to act on your behalf under stressful circumstances.
- Don't leave any sections blank; if certain wishes don't apply or you prefer not to choose, indicate this clearly to avoid any potential oversights.
- Don't forget to inform family members, close friends, and your primary physician where your completed Five Wishes Document is stored.
- Don't hesitate to update your document if your wishes change. Ensure you destroy all copies of the old document and communicate the changes to everyone involved.
Completing the Five Wishes Document is a proactive step in planning for your future health care. It helps alleviate the burden on loved ones during challenging times by clearly outlining your health care preferences. Ensuring all steps are followed correctly and your document is kept up to date will support the execution of your wishes as intended.
Misconceptions
Many misconceptions surround the Five Wishes Document, a critical form for expressing healthcare preferences. Understanding these can ensure wishes are honored accurately.
- Misconception 1: The Five Wishes Form is legally valid in all 50 states.
While the Five Wishes document is designed to meet the legal requirements in 42 states and the District of Columbia, not all states automatically recognize it as a legal document without accompanying state-specific forms.
- Misconception 2: The document is challenging to fill out.
Contrary to some beliefs, the Five Wishes document is user-friendly, written in simple language designed to be easy for anyone to complete without legal assistance.
- Misconception 3: It's only for the elderly or those with terminal conditions.
The document is recommended for anyone over the age of 18, regardless of health status, to ensure their healthcare preferences are known and respected.
- Misconception 4: It can only be executed by legal professionals.
Actually, individuals can complete and sign the form themselves, as long as it's witnessed correctly according to the laws of their state.
- Misconception 5: It replaces the need for a Durable Power of Attorney for Healthcare (DPOA).
While the Five Wishes document includes naming a healthcare proxy, it serves broader purposes than a DPOA, covering personal, emotional, and spiritual needs in addition to medical wishes.
- Misconception 6: Once signed, it cannot be changed.
Individuals can update their Five Wishes document any time as their circumstances or preferences change, but must ensure it is re-signed, witnessed, and others are informed about the update.
- Misconception 7: Doctors can ignore the document if it conflicts with their medical advice.
Healthcare providers are generally required to follow the wishes as expressed in the document, unless doing so would violate their professional responsibilities or the law.
- Misconception 8: It covers financial decisions as well as healthcare.
The Five Wishes document strictly pertains to healthcare decisions and does not encompass financial powers or responsibilities.
- Misconception 9: It is only effective in a hospital setting.
The document guides healthcare decisions in any setting, including at home, in hospice care, or in residential care facilities.
- Misconception 10: Filling out the form means giving up control of healthcare decisions immediately.
The directive only takes effect under specific conditions, such as if the individual becomes unable to make decisions on their own behalf.
Dispelling these misconceptions is crucial in empowering individuals to take proactive steps toward ensuring their healthcare wishes are understood and respected.
Key takeaways
The Five Wishes document is a comprehensive way to communicate your preferences concerning medical treatment, comfort, and how you want to be treated in case you become seriously ill. Here are key takeaways for completing and using this document:
- Universal Application: Five Wishes is designed to meet the legal requirements in 42 states plus the District of Columbia, making it broadly applicable for most individuals in the United States.
- Comprehensive Coverage: Unlike a standard living will, Five Wishes covers personal, emotional, and spiritual needs alongside medical choices, providing a holistic approach to end-of-life planning.
- Clear Communication: By setting out your wishes in advance, the document helps families avoid difficult decisions and disagreements during stressful times, ensuring your wishes are respected.
- Designating a Health Care Agent: Five Wishes allows you to nominate a trusted person to make health care decisions on your behalf if you become unable to do so, ensuring decisions are made by someone who understands your desires.
- Detailed Preferences: You can specify the type of medical treatment you want or don't want, how you wish to be made comfortable, how you expect to be treated, and what you want your loved ones to know.
- Changing Your Mind: The document is flexible; you can revoke or amend it if your circumstances or wishes change, offering peace of mind that your directive remains up-to-date.
- Legal Validation: Once completed and properly signed, Five Wishes becomes a valid legal document in the states where it is recognized, making it an essential part of estate and healthcare planning.
- Accessibility: The document is available in 27 languages, making it accessible to a wide audience, and it is designed for anyone 18 years or older, ensuring that adults at any stage of life can utilize it.
In conclusion, the Five Wishes document is a powerful tool for communicating your healthcare and personal wishes. Its ease of use, combined with its comprehensive approach, makes it a valuable resource for ensuring your desires are known and respected.
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