Article Structure
When facing serious illness, many people find themselves grappling with difficult decisions about their medical care and treatment. The Five Wishes document provides a comprehensive way to address these concerns, allowing individuals to express their preferences regarding health care decisions. This form is designed to name a trusted person to make medical choices on your behalf if you are unable to do so. It also outlines the specific types of medical treatments you desire or wish to avoid, ensuring that your personal values and comfort levels are respected. Additionally, Five Wishes encourages open communication with family members, sparing them from making tough choices without knowing your wishes. Beyond medical directives, it addresses emotional and spiritual needs, making it a unique living will that resonates on a personal level. Created with the guidance of legal experts and inspired by the compassionate work of Mother Teresa, Five Wishes aims to empower individuals to articulate their desires clearly and thoughtfully. With its straightforward format, anyone aged 18 and older can easily fill out the document, making it a valuable resource for countless people across the country.
Form Sample
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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.)
Document Specifications
| Fact Name | Fact Description |
|---|---|
| Purpose | The Five Wishes document allows individuals to express their medical, emotional, and spiritual preferences for care when they cannot communicate these wishes themselves. |
| Legal Validity | Once completed and signed, Five Wishes is valid in most states, including the District of Columbia and 42 specific states, as per local laws. |
| Target Audience | Five Wishes is designed for anyone aged 18 or older, including married individuals, single people, and parents, making it widely applicable across various demographics. |
| Ease of Use | The form is straightforward to fill out, requiring only simple actions like checking boxes or writing brief responses, making it accessible for everyone. |
Steps to Filling Out 5 Wishes Document
Filling out the Five Wishes document is an important step in expressing your healthcare preferences. This form allows you to communicate your wishes regarding medical treatment and appoint a person to make decisions on your behalf if you are unable to do so. Follow these steps to complete the form accurately.
- Begin by printing your name and birthdate at the top of the document.
- Identify the person you want to make healthcare decisions for you when you can’t. This person is your Health Care Agent. Fill in their name, phone number, and address.
- List two additional choices for your Health Care Agent in case your first choice is unable to act on your behalf. Include their names, phone numbers, and addresses.
- Clearly state what you want your Health Care Agent to be able to do. Review the list of powers and cross out any that you do not want them to have.
- If you change your mind about your Health Care Agent, indicate your intention to revoke their authority by destroying all copies of this part of the form or writing “Revoked” across their name.
Once the form is filled out, ensure that it is signed and dated to make it valid. Keep a copy for your records and share the completed document with your chosen Health Care Agent and relevant family members or healthcare providers.
More About 5 Wishes Document
What is the Five Wishes document?
The Five Wishes document is a unique living will that allows individuals to express their personal, emotional, and spiritual needs, alongside their medical preferences. It empowers you to designate a person who will make healthcare decisions on your behalf if you are unable to do so. This form is designed to ensure that your wishes regarding medical treatment and care are known and respected, providing peace of mind for you and your loved ones.
Who should consider using Five Wishes?
Anyone aged 18 or older can benefit from the Five Wishes document. This includes married individuals, singles, parents, adult children, and friends. With over 19 million users, it has gained acceptance among various groups, including lawyers, doctors, hospitals, and faith communities. The document serves as a valuable tool for anyone looking to communicate their healthcare preferences to family and medical providers.
How does Five Wishes help families?
Five Wishes facilitates open conversations about healthcare preferences among family members. By clearly outlining your wishes, it relieves your loved ones from the burden of making difficult decisions without knowing what you would have wanted. This clarity not only helps them support you better during a health crisis but also fosters understanding and connection among family members.
Is Five Wishes legally valid?
Yes, the Five Wishes document is legally recognized in the District of Columbia and 42 states across the U.S. It is important to check your state’s specific laws to ensure compliance. Once properly filled out and signed, it serves as a valid advance directive, allowing your healthcare agent to act according to your wishes.
How can someone change their existing advance directives to Five Wishes?
If you currently have a living will or durable power of attorney for healthcare and wish to switch to Five Wishes, the process is straightforward. Simply complete and sign the Five Wishes document. This new form will revoke any previous advance directives. To ensure clarity, destroy all copies of your old documents and inform your healthcare agent and medical providers about your new wishes.
What kind of decisions can my healthcare agent make?
Your healthcare agent can make a wide range of decisions on your behalf, including choices about medical treatments, medications, and even end-of-life care. They can also authorize transfers to different healthcare facilities, interpret your instructions, and manage any legal actions necessary to uphold your wishes. It’s essential to choose someone who understands your values and will advocate for your preferences.
Can I specify how I want to be treated in the Five Wishes document?
Absolutely. Five Wishes allows you to express how you want to be treated in various situations, focusing on your comfort, dignity, and emotional needs. You can outline your preferences for medical treatments, pain management, and even the kind of environment you wish to be in during care. This level of detail helps ensure that your unique needs are met.
What if my state is not listed as a Five Wishes state?
If you reside in a state that does not recognize Five Wishes as a valid advance directive, you can still complete the document for your personal use. Many healthcare professionals understand the importance of honoring your wishes, regardless of the format. However, it is advisable to also complete your state’s legal forms to ensure your preferences are recognized by law.
How do I ensure my wishes are followed after completing Five Wishes?
After completing the Five Wishes document, it’s crucial to share it with your healthcare agent, family members, and medical providers. Make sure they understand your wishes and the importance of this document. Regular discussions about your preferences can further reinforce your intentions and ensure that everyone involved is prepared to advocate for your care when needed.
Common mistakes
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Not Naming a Health Care Agent: Failing to designate a specific person to make health care decisions can lead to confusion and conflict among family members.
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Choosing the Wrong Person: Selecting someone who may not fully understand your wishes or who is emotionally involved can complicate decision-making during a difficult time.
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Inadequate Communication: Not discussing your wishes with the chosen health care agent can result in decisions that do not reflect your values or preferences.
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Leaving Out Important Details: Omitting specific medical treatments or preferences can lead to unintended outcomes, as your agent may not know your exact wishes.
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Failure to Update the Document: Not revising the Five Wishes document after significant life changes, such as divorce or the death of a chosen agent, can render it ineffective.
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Not Signing the Document: Forgetting to sign or date the form can invalidate it, meaning your wishes may not be honored when needed.
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Ignoring State Requirements: Not ensuring that the document meets your state’s legal requirements can lead to complications in enforcing your wishes.
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Failing to Inform Family Members: Not informing family members about the existence of the document can lead to disputes and stress during an already difficult time.
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Neglecting to Review Regularly: Not reviewing your Five Wishes periodically can result in outdated preferences that no longer reflect your current values or beliefs.
Documents used along the form
The Five Wishes document is a vital tool for individuals looking to express their healthcare preferences in the event of a serious illness. Alongside this document, several other forms and documents may be used to ensure comprehensive planning and communication regarding healthcare decisions. Below is a list of commonly used documents that complement the Five Wishes form.
- Durable Power of Attorney for Health Care: This document designates a specific individual to make healthcare decisions on behalf of another person if they are unable to do so. It is legally binding and allows the appointed agent to act according to the individual's wishes.
- Living Will: A living will outlines an individual's preferences regarding medical treatments and interventions in situations where they cannot communicate their wishes. It typically covers end-of-life care and life-sustaining treatments.
- Do Not Resuscitate (DNR) Order: This order indicates that an individual does not wish to receive cardiopulmonary resuscitation (CPR) or other life-saving measures in the event of cardiac arrest or respiratory failure. It must be signed by a physician to be valid.
- Health Care Proxy: Similar to a durable power of attorney, a health care proxy allows an individual to appoint someone to make healthcare decisions on their behalf. This document can be used in conjunction with a living will.
- Advance Directive: An advance directive is a general term that encompasses both living wills and durable powers of attorney for health care. It serves to communicate an individual's healthcare preferences ahead of time.
- Organ Donation Registration: This document indicates an individual's wishes regarding organ donation after death. It may be included in a driver's license application or as a separate form.
- Medical Records Release Form: This form allows individuals to authorize the sharing of their medical records with specified parties, such as family members or healthcare providers, ensuring that their wishes are known and respected.
- Patient Advocate Designation: This document allows individuals to appoint a patient advocate who can help navigate the healthcare system and ensure that their preferences are honored, especially in complex medical situations.
- Emergency Medical Information Form: This form provides essential medical information, including allergies, medications, and emergency contacts. It can be useful for first responders and healthcare providers in urgent situations.
Utilizing these forms in conjunction with the Five Wishes document can help ensure that an individual's healthcare preferences are clearly communicated and respected. It is important for individuals to review these documents periodically and discuss their contents with family members and healthcare providers.
Similar forms
The Five Wishes document is similar to a traditional living will, which is a legal document that allows individuals to specify their preferences for medical treatment in the event they become unable to communicate those wishes. Both documents serve the purpose of guiding healthcare providers and loved ones in making decisions about medical care. However, while a living will typically focuses solely on medical treatment preferences, Five Wishes expands the conversation to include emotional, spiritual, and personal considerations, making it a more holistic approach to end-of-life planning.
Another document akin to Five Wishes is the durable power of attorney for healthcare. This document designates a specific individual to make healthcare decisions on behalf of someone who is incapacitated. Like Five Wishes, it empowers a trusted person to act in the best interest of the individual. However, Five Wishes goes further by incorporating the individual's specific wishes and values regarding treatment, comfort, and personal interactions, ensuring that the appointed agent understands not just the legal authority but also the emotional context of the decisions they will make.
The advance healthcare directive is another document similar to Five Wishes. This directive combines elements of a living will and a durable power of attorney, allowing individuals to outline their medical treatment preferences and designate an agent for healthcare decisions. While both documents aim to ensure that a person’s wishes are honored, Five Wishes uniquely emphasizes the importance of comfort and personal treatment preferences, providing a more comprehensive framework for discussing end-of-life care.
A healthcare proxy is also comparable to the Five Wishes document. This legal arrangement allows individuals to appoint someone to make medical decisions on their behalf. The proxy acts when the individual is unable to communicate their wishes. Five Wishes enhances this relationship by explicitly outlining the individual's desires regarding treatment and care, thus providing the proxy with a clearer understanding of the individual’s values and preferences.
The POLST (Physician Orders for Life-Sustaining Treatment) form is another document that shares similarities with Five Wishes. POLST is designed for individuals with serious illnesses to convey their treatment preferences in a medical setting. While POLST focuses on immediate medical interventions, Five Wishes addresses broader aspects of care, including emotional and spiritual needs, thus allowing for a more rounded approach to patient preferences.
Another relevant document is the Do Not Resuscitate (DNR) order. This document instructs medical personnel not to perform CPR if a patient stops breathing or their heart stops. While a DNR focuses specifically on resuscitation efforts, Five Wishes encompasses a broader range of wishes regarding medical treatment and personal care, allowing individuals to express their preferences in a more detailed manner.
The statement of wishes, often used in conjunction with estate planning, is another document similar to Five Wishes. This statement allows individuals to express their desires regarding the distribution of their assets and care of dependents after death. While it primarily addresses financial and logistical matters, Five Wishes complements this by focusing on healthcare and personal treatment preferences, ensuring that all aspects of a person's wishes are considered.
Lastly, the advance directive for mental health treatment is comparable to the Five Wishes document. This directive allows individuals to specify their preferences regarding mental health care and treatment. While both documents empower individuals to express their wishes, Five Wishes stands out by integrating both physical and mental health considerations into a singular, cohesive document that addresses the whole person.
Dos and Don'ts
When filling out the Five Wishes Document form, it’s important to approach the process thoughtfully. Here’s a list of things you should and shouldn’t do to ensure your wishes are clearly expressed.
- Do read the entire document carefully before filling it out.
- Do choose a Health Care Agent who knows you well and understands your wishes.
- Do communicate your decisions with your family and the person you select as your agent.
- Do sign and date the document as required to make it valid.
- Do keep copies of the signed document in a safe place and share them with relevant parties.
- Don't leave any sections blank; fill in all required information to avoid confusion later.
- Don't choose someone as your agent who may be unable to make tough decisions on your behalf.
By following these guidelines, you can ensure that your Five Wishes Document accurately reflects your preferences and provides clarity for your loved ones during difficult times.
Misconceptions
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Misconception 1: Five Wishes is only for elderly individuals.
This document is designed for anyone aged 18 or older, regardless of their health status. It allows young adults, parents, and even friends to express their healthcare preferences. Many people mistakenly believe that only the elderly need to prepare for potential health crises, but anyone can benefit from having a plan in place.
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Misconception 2: Five Wishes is a complicated legal document.
In reality, the Five Wishes form is straightforward and easy to complete. It requires individuals to check boxes, circle options, or write brief statements about their preferences. The simplicity of the form is intentional, making it accessible to everyone, regardless of their familiarity with legal documents.
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Misconception 3: Five Wishes is not legally recognized.
Many people think that Five Wishes lacks legal standing. However, it is valid in most states across the U.S. as long as it is completed and signed correctly. This document meets the legal requirements for advance directives in numerous jurisdictions, providing peace of mind to those who use it.
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Misconception 4: Once completed, Five Wishes cannot be changed.
This is not true. Individuals can change their Five Wishes at any time by filling out a new form and revoking the previous one. It's important to communicate these changes to family members and healthcare providers to ensure that everyone is aware of the updated wishes.
Key takeaways
1. Understanding the Purpose: The Five Wishes document allows individuals to express their medical, emotional, and spiritual preferences for end-of-life care. It empowers you to make your wishes known, ensuring that your desires are respected if you become unable to communicate them.
2. Choosing a Health Care Agent: Selecting the right person to make health care decisions on your behalf is crucial. This individual should be someone who knows you well, understands your values, and is willing to advocate for your wishes. It’s important that they are at least 18 years old and not directly involved in your medical care.
3. Simplicity of Use: Completing the Five Wishes form is straightforward. You only need to check boxes, circle options, or write brief notes. The clarity of the document helps ensure that your intentions are communicated effectively to your family and healthcare providers.
4. Legal Validity: Once filled out and signed, the Five Wishes document is recognized under the laws of most states. However, it is advisable to check if your state is one of the 42 where it is explicitly valid to avoid any complications.
5. Open Communication: The Five Wishes document encourages discussions with family members about your health care preferences. By sharing your wishes, you relieve your loved ones from making difficult decisions without knowing your desires, fostering understanding and support during challenging times.
6. Updating Your Wishes: If you have existing advance directives, you can replace them with the Five Wishes document. To ensure clarity, destroy old copies and inform your healthcare agent and family members about your new choices. This step helps prevent confusion and ensures that your current wishes are honored.