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Life often presents us with uncertainties, especially regarding health care decisions. The Five Wishes document offers a compassionate way to address these concerns, allowing individuals to express their preferences about medical treatment and personal care in the event they cannot communicate these wishes themselves. This form encompasses five key areas: it designates a trusted person to make health care decisions on your behalf, outlines the types of medical treatments you desire or wish to avoid, describes your comfort preferences, conveys how you want to be treated by others, and shares important messages for your loved ones. By completing this document, you empower yourself and your family to navigate difficult situations with clarity and respect. It is designed to be straightforward, making it accessible for anyone aged 18 and older. Once properly signed, it is recognized by most states, ensuring that your wishes are honored. With the Five Wishes document, you can take control of your health care decisions and foster open conversations with your family, reducing the burden on them during challenging times.
Preview - 5 Wishes Document Form
M Y W I S H F O R :
The Person I Want to Make Care1Decisions for Me When I Can’t
The Kind of Medical Treatment2 I Want or Don’t Want
How Comfortable3 I Want to Be How I Want People4 to Treat Me What I Want My Loved5 Ones to Know
Print Your Name
Birthdate
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T 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
What Is Five Wishes?
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
How Five Wishes Can Help You And Your Family
• It lets you talk with your family, friends and |
they won’t have to make hard choices |
doctor about how you want to be treated if |
without knowing your wishes. |
you become seriously ill. |
• You can know what your mom, dad, |
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• Your family members will not have to guess |
spouse, or friend wants. You can be there |
what you want. It protects them |
for them when they need you most. You will |
if you become seriously ill, because |
understand what they really want. |
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
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Who Should Use Five Wishes
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.
Five Wishes In My State
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.
How Do I Change To Five Wishes?
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:
• Destroy all copies of your old living will or |
• Tell your Health Care Agent, family |
durable power of attorney for healthcare. |
members, and doctor that you have filled out |
Or you can write “revoked” in large letters |
a new Five Wishes. Make sure they know |
across the copy you have. Tell your lawyer |
about your new wishes. |
if he or she helped prepare those old forms |
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for you. |
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WISH 1
The Person I Want To Make Health Care Decisions For Me
When I Can’t Make Them For Myself.
I 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.
The Person I Choose As My Health Care Agent Is:
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First Choice Name |
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Phone |
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Address |
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City/State/Zip |
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:
Second Choice Name
Address
City/State/Zip
Phone
Third Choice Name
Address
City/State/Zip
Phone
Picking The Right Person To Be Your Health Care Agent
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.
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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.
If I Change My Mind About Having A Health Care Agent, I Will
• Destroy all copies of this part of the Five Wishes |
• Write the word “Revoked” in large letters across |
form. OR |
the name of each agent whose authority I want to |
• Tell someone, such as my doctor or family, that I |
cancel. Sign my name on that page. |
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want to cancel or change my Health Care Agent. |
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OR |
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WISH 2
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 |
• I do not want anything done or omitted by my |
comfortable. Wish 3 says what can be done to |
doctors or nurses with the intention of taking |
make me comfortable. |
my life. |
• 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.
What
In Case Of An Emergency
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
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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.
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
oI want to have
oI do not want
oI want to have
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
oI want to have
oI do not want
oI want to have
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):
oI want to have
oI do not want
oI want to have
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
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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.)
• 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
• I wish to know about options for hospice care to provide medical, emotional, and spiritual care for me and my loved ones.
WISH 4
My Wish For How I Want People To Treat Me.
(Please cross out anything that you don’t agree with.)
• 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 be visited by a chaplain or clergy.
• I wish to be cared for with kindness and cheerfulness, and not sadness.
• 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 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:
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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 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 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 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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Signing My Five Wishes
Please make sure you sign your Five Wishes in the presence of two witnesses.
I, |
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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.
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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:
• 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,
• 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.
(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
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.
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
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Document Specifics
| Fact Name | Description | Governing Law |
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| Purpose | The Five Wishes document allows individuals to express their medical and personal care preferences in case they become seriously ill. | Valid in most states, including specific state laws. |
| Personal Choices | It enables users to designate a Health Care Agent to make decisions on their behalf when they are unable to do so. | State-specific health care proxy laws. |
| Emotional and Spiritual Needs | Five Wishes addresses not only medical wishes but also emotional and spiritual needs, making it unique among living wills. | Recognized under state living will statutes. |
| Accessibility | The form is user-friendly and can be completed by anyone aged 18 or older, regardless of marital status. | Applicable in 42 states and the District of Columbia. |
| Revocation Process | Individuals can revoke a previous living will by completing a new Five Wishes document and notifying relevant parties. | State laws governing advance directives. |
5 Wishes Document: Usage Instruction
Filling out the Five Wishes document is an important step in ensuring your healthcare preferences are known and respected. After completing the form, it is essential to share your wishes with your chosen healthcare agent and loved ones. This will help them understand your desires and make informed decisions on your behalf if necessary.
- Print your name and birthdate: At the top of the form, clearly write your full name and date of birth.
- Choose your healthcare agent: Identify the person you want to make healthcare decisions for you when you cannot. Write their name, phone number, and address in the designated area.
- List alternative choices: If your first choice is unable or unwilling to act, provide the names and contact information for your second and third choices.
- Specify your wishes: In the sections provided, indicate the medical treatments you want or do not want, how comfortable you want to be, how you wish to be treated, and any messages you want your loved ones to know.
- Sign and date the document: Ensure you sign and date the form at the bottom. This signature validates your wishes and makes the document legally binding.
- Share your completed form: Give copies of the signed document to your healthcare agent, family members, and your doctor to ensure they are aware of your preferences.
Learn More on 5 Wishes Document
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What is the Five Wishes document?
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The Five Wishes document is a unique living will that addresses not only medical preferences but also personal, emotional, and spiritual needs. It allows individuals to designate a trusted person to make healthcare decisions on their behalf when they are unable to do so. This document empowers people to express their wishes regarding medical treatment, comfort, and how they wish to be treated by others during serious illness.
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Who should consider using the Five Wishes document?
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Anyone aged 18 or older can benefit from the Five Wishes document, regardless of their marital status or family situation. This includes single individuals, married couples, parents, adult children, and friends. Over 19 million people have utilized this document, making it a popular choice among various groups, including healthcare professionals, legal advisors, and community organizations.
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How does Five Wishes help families?
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Five Wishes facilitates open conversations about end-of-life care among family members. By clearly outlining one's wishes, it alleviates the burden on loved ones who might otherwise struggle to make difficult decisions without guidance. Families can feel more confident in supporting each other during challenging times, knowing they are honoring the expressed desires of their loved ones.
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Is the Five Wishes document legally binding?
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Yes, the Five Wishes document is legally binding in the District of Columbia and 42 states, provided it meets specific state requirements. It is essential to ensure that the document is completed and signed correctly to ensure its validity. Individuals should check the laws in their respective states to confirm compliance.
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How can someone change their existing advance directives to Five Wishes?
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To switch to Five Wishes, individuals need to fill out and sign the new document. This new form automatically revokes any previous advance directives, such as a living will or durable power of attorney for healthcare. It is important to destroy all copies of the old documents and inform family members and healthcare providers about the change to ensure everyone is aware of the new wishes.
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What kind of decisions can my Health Care Agent make?
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Your Health Care Agent can make a wide range of healthcare decisions on your behalf, including:
- Choosing medical treatments, procedures, and medications.
- Making decisions about life-sustaining treatments.
- Moving you to different healthcare facilities if necessary.
- Accessing your medical records to ensure informed decision-making.
- Donating organs or tissues, if applicable.
It is crucial to choose someone who understands your values and wishes, as they will be responsible for making significant decisions during critical times.
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Can I use Five Wishes if I live in a state not listed as compliant?
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While Five Wishes may not meet the technical requirements in states not listed as compliant, many individuals still find it helpful. They often complete Five Wishes alongside their state’s legal forms. Most healthcare professionals recognize the importance of honoring a patient’s wishes, regardless of how they are expressed. Therefore, it can serve as a valuable guide for family members and caregivers.
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What if I change my mind about my Health Care Agent?
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If you decide to change your Health Care Agent, you must take specific steps to ensure that the change is recognized. You can do this by:
- Destroying all copies of the current Five Wishes document.
- Writing “Revoked” across the name of the agent you wish to cancel.
- Informing your healthcare provider and family members about the change.
Clear communication is vital to ensure your new wishes are respected.
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How does Five Wishes differ from traditional living wills?
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Unlike traditional living wills, which typically focus solely on medical treatment preferences, Five Wishes encompasses a broader range of concerns. It addresses emotional and spiritual needs, allowing individuals to express how they want to be treated and what they want their loved ones to know. This holistic approach makes it a more comprehensive tool for end-of-life planning.
Common mistakes
Filling out the Five Wishes Document is an important step in ensuring that your healthcare preferences are honored. However, many people make mistakes that can lead to confusion or invalidation of their wishes. One common error is not clearly identifying the Health Care Agent. This person should be someone you trust completely and who understands your values and wishes. If you fail to discuss your choices with this individual beforehand, they may not feel comfortable making decisions on your behalf.
Another mistake is neglecting to specify your preferences regarding medical treatment. The document allows you to express what kind of treatment you want or do not want. Omitting this information can leave your healthcare providers guessing about your desires, which may lead to decisions that do not align with your wishes. Be explicit about your preferences to avoid any ambiguity.
Some individuals also forget to update their Five Wishes Document when their circumstances change. For example, if your chosen Health Care Agent moves away, becomes unable to serve, or if your relationships change, it’s crucial to revise the document. Failing to do so can result in someone making decisions for you who does not fully understand your current wishes.
People often overlook the importance of signing and dating the document correctly. The Five Wishes Document is only valid if it is signed according to the instructions provided. A missing signature or date can render the document ineffective, which defeats its purpose. Always double-check that all required fields are filled out completely.
Another common oversight is not informing family members or healthcare providers about the existence of the Five Wishes Document. Once you complete it, it is essential to share this information with those who may be involved in your care. Without this knowledge, they may not honor your wishes when the time comes.
Some individuals also make the mistake of using outdated versions of the document. Ensure that you are using the most current version of the Five Wishes Document, as laws and requirements may change over time. Using an outdated form could lead to complications in ensuring your wishes are respected.
Additionally, people sometimes fail to discuss their wishes openly with family members. While the document serves as a guide, having conversations about your preferences can help alleviate stress for your loved ones during difficult times. Open dialogue fosters understanding and ensures that everyone is on the same page regarding your healthcare decisions.
Lastly, individuals may rush through the process without taking the time to think about their choices. Filling out the Five Wishes Document is not something to be done hastily. Take the time to reflect on your values, preferences, and the kind of care you would want. This careful consideration will help ensure that your wishes are accurately represented and respected.
Documents used along the form
The Five Wishes document is an important tool for individuals to express their healthcare preferences in a clear and personal way. Along with this document, several other forms and documents can complement your planning for medical care and end-of-life decisions. Below is a list of commonly used documents that may be beneficial.
- Durable Power of Attorney for Health Care: This document designates a person to make healthcare decisions on your behalf if you are unable to do so. It is a legal form that typically requires signatures and may need to be notarized.
- Living Will: A living will outlines your preferences for medical treatment in situations where you cannot communicate your wishes. It focuses primarily on life-sustaining treatments and end-of-life care.
- Do Not Resuscitate (DNR) Order: This medical order specifies that you do not wish to receive CPR or other life-saving measures in the event of cardiac arrest. It must be signed by a physician and is often kept in your medical records.
- Advance Directive: An advance directive is a broader term that encompasses both living wills and durable powers of attorney. It provides guidance on your healthcare preferences and who will make decisions for you.
- Health Care Proxy: Similar to a durable power of attorney, a health care proxy allows you to appoint someone to make medical decisions on your behalf. This document often includes specific instructions regarding your care preferences.
- HIPAA Authorization: This authorization allows you to designate individuals who can access your medical records and health information. It is essential for ensuring that your designated agents can make informed decisions on your behalf.
- Organ Donation Form: This form indicates your wishes regarding organ donation after death. It can be included with your other advance care planning documents or registered with a state registry.
- Funeral Planning Document: This document outlines your preferences for funeral arrangements, including burial or cremation, service details, and any specific wishes you may have for your memorial.
- Personal Letter of Wishes: While not a legal document, this letter allows you to express your thoughts, feelings, and personal wishes to your loved ones. It can provide emotional guidance and context for your decisions.
Utilizing these documents alongside the Five Wishes form can provide a comprehensive approach to healthcare planning. It is advisable to discuss your preferences with family members and your healthcare provider to ensure that your wishes are understood and respected.
Similar forms
The Advance Directive is a legal document that allows individuals to outline their preferences for medical treatment in case they become unable to communicate their wishes. Like the Five Wishes document, it provides a way for people to express their healthcare decisions. This document typically includes instructions about life-sustaining treatments and appoints a healthcare proxy to make decisions on behalf of the individual. Both documents aim to relieve family members from the burden of making difficult choices during challenging times.
The Durable Power of Attorney for Health Care is another important document. It allows a person to designate someone else to make healthcare decisions for them if they are incapacitated. Similar to Five Wishes, this document ensures that an individual's healthcare preferences are honored. While Five Wishes emphasizes personal and emotional needs, the Durable Power of Attorney focuses primarily on medical decisions. Both documents empower individuals to take control of their healthcare choices.
The Living Will is a document that specifically outlines an individual’s wishes regarding medical treatment in situations where they cannot express their preferences. Like Five Wishes, it addresses critical medical decisions, such as the use of life support. The Living Will is more focused on medical procedures, while Five Wishes includes emotional and spiritual considerations, making it a more comprehensive option for some individuals.
The Healthcare Proxy is a document that allows someone to appoint a person to make healthcare decisions on their behalf. This is similar to the Health Care Agent designation in Five Wishes. Both documents ensure that an individual’s healthcare preferences are respected, and they help to avoid confusion or conflict among family members during a medical crisis.
The Do Not Resuscitate (DNR) order is a specific medical directive that informs healthcare providers not to perform CPR if a person's heart stops beating. While Five Wishes covers a broader range of healthcare decisions, a DNR is a focused instruction regarding resuscitation efforts. Both documents serve to communicate an individual’s wishes about their medical care, particularly in critical situations.
The Physician Orders for Life-Sustaining Treatment (POLST) form is another document that works similarly to Five Wishes. It is designed for patients with serious illnesses to specify their preferences for treatments. Like Five Wishes, the POLST form is intended to ensure that a patient's wishes are honored across different healthcare settings. Both documents aim to facilitate conversations about end-of-life care and ensure that the patient’s values are respected.
The Mental Health Advance Directive allows individuals to outline their preferences for mental health treatment in case they become unable to communicate their wishes. This document is similar to Five Wishes in that it provides a way for individuals to express their desires regarding their care. Both documents empower individuals to take charge of their treatment and ensure that their preferences are known and respected.
The Organ Donation Consent form allows individuals to express their wishes regarding organ donation after death. While Five Wishes includes the option to donate organs as part of the broader conversation about healthcare wishes, the Organ Donation Consent form focuses specifically on this aspect. Both documents help individuals communicate their preferences to their families and healthcare providers, ensuring that their wishes are honored.
The Family Caregiver Agreement is a document that outlines the responsibilities and expectations between a caregiver and the person receiving care. While not directly a medical directive, it shares similarities with Five Wishes in that it aims to clarify preferences and ensure that the needs of the individual are met. Both documents foster open communication and help to create a supportive environment for individuals needing care.
Dos and Don'ts
Filling out the Five Wishes Document is an important step in ensuring that your healthcare preferences are respected. Here are ten things to keep in mind as you complete this form:
- Do read the entire document carefully before starting to fill it out.
- Don’t rush through the process; take your time to think about your wishes.
- Do choose a Health Care Agent who knows you well and understands your values.
- Don’t select someone who may be too emotionally involved, like a spouse, if you think it could cloud their judgment.
- Do discuss your wishes with your chosen Health Care Agent to ensure they are comfortable with the responsibilities.
- Don’t leave any sections blank; provide as much detail as possible to avoid confusion later.
- Do sign and date the document in the presence of a witness, if required by your state.
- Don’t forget to inform your family and healthcare providers about your completed Five Wishes Document.
- Do keep a copy of the signed document in a safe place and share copies with your Health Care Agent and family.
- Don’t hesitate to update your wishes if your circumstances or preferences change over time.
Misconceptions
Understanding the Five Wishes document is crucial for making informed decisions about your healthcare. However, several misconceptions can cloud its importance. Here are nine common misconceptions about the Five Wishes document:
- It is only for the elderly. Many people believe that only older adults need a Five Wishes document. In reality, anyone aged 18 or older can benefit from it, regardless of their current health status.
- It is legally binding in all states. While Five Wishes is recognized in many states, it is not valid everywhere. Check if your state is one of the 42 that accept it.
- It replaces a living will. Five Wishes can serve as a living will, but it is a more comprehensive document. It addresses emotional and spiritual needs alongside medical wishes.
- Only lawyers can help with it. Although legal advice can be helpful, you do not need a lawyer to complete the Five Wishes document. It is designed to be user-friendly.
- It is too complicated to understand. Many people think the form is complicated, but it is straightforward. You simply check boxes, circle options, or write short sentences.
- It only covers medical decisions. Five Wishes goes beyond medical care. It also addresses how you want to be treated and what you want your loved ones to know.
- My family will automatically know my wishes. Without a formal document like Five Wishes, your family may struggle to make decisions during difficult times. Clear communication is essential.
- Once completed, it cannot be changed. You can change your Five Wishes at any time. Simply fill out a new document and revoke the previous one.
- Healthcare providers will not honor it. Most healthcare professionals understand the importance of patient wishes and are trained to honor your directives, regardless of how they are communicated.
Addressing these misconceptions can empower individuals to take control of their healthcare decisions. It is essential to have open conversations with loved ones and ensure that your wishes are documented clearly.
Key takeaways
Here are some key takeaways about filling out and using the Five Wishes Document form:
- Personal Control: The Five Wishes document allows you to express your personal, emotional, and spiritual needs, alongside your medical wishes.
- Easy to Complete: This form is designed to be straightforward. You can fill it out by checking boxes, circling options, or writing brief sentences.
- Legal Validity: Once completed and signed, Five Wishes is valid in most states, giving you peace of mind regarding your health care decisions.
- Family Communication: By using this document, you can communicate your wishes to your family, relieving them from making difficult decisions without knowing your preferences.
- Wide Accessibility: Five Wishes is suitable for anyone aged 18 or older and has been used by over 19 million individuals, making it a trusted resource.
- Revoking Previous Directives: If you decide to use Five Wishes instead of an existing living will or power of attorney, you must destroy old copies and inform relevant parties about your new wishes.
- Health Care Agent: You can choose a trusted individual to make health care decisions on your behalf, ensuring that your preferences are respected when you cannot speak for yourself.