5 Wishes Document PDF Template

5 Wishes Document PDF Template

Five Wishes is a document that allows individuals to express their personal, emotional, and medical preferences for care if they become seriously ill. It empowers you to choose a trusted person to make health care decisions on your behalf and outlines how you wish to be treated. Take control of your health care decisions by filling out the form below.

Article Guide

In a world where health decisions can become overwhelming, the Five Wishes document offers a way to express your preferences clearly. This form allows you to designate a trusted person to make healthcare decisions on your behalf if you become unable to do so. It goes beyond standard medical directives by addressing your emotional and spiritual needs alongside your medical wishes. You can specify the type of medical treatment you want or do not want, ensuring your comfort in times of serious illness. Additionally, it provides guidance on how you wish to be treated and what you want your loved ones to know. The Five Wishes document is designed to be straightforward and easy to fill out, making it accessible for everyone aged 18 and older. Once completed and signed, it holds legal validity in many states, allowing your wishes to be honored. By using this document, you can foster open conversations with your family, alleviating the burden of making difficult decisions during challenging times. With over 19 million users, Five Wishes has become a trusted resource for individuals and families alike, ensuring that personal values and desires are respected when it matters most.

5 Wishes Document Preview

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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.
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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.)
↓ 5 Wishes Document

File Properties

Fact Name Details
Definition Five Wishes is a legal document that allows individuals to express their medical, personal, and emotional wishes regarding end-of-life care.
Eligibility Anyone aged 18 or older can complete a Five Wishes document, regardless of marital status or family situation.
Health Care Agent The document allows individuals to designate a Health Care Agent to make medical decisions on their behalf if they are unable to do so.
State Validity Five Wishes is recognized in 42 states and the District of Columbia, provided it meets state legal requirements.
Governing Laws In states where Five Wishes is valid, it is governed by state laws regarding advance directives and living wills.
Ease of Use The form is designed to be simple to complete, requiring individuals to check boxes, circle options, or write brief statements.
Emotional Considerations Five Wishes addresses not only medical preferences but also emotional and spiritual needs, ensuring holistic care.
Changing Wishes Individuals can revoke previous advance directives by completing a new Five Wishes document and informing relevant parties.
Support for Families This document helps families understand and respect the wishes of their loved ones during difficult times, reducing stress and uncertainty.
Language Accessibility Five Wishes is available in 27 languages, making it accessible to a diverse population.

Instructions on Utilizing 5 Wishes Document

Filling out the Five Wishes document is a straightforward process that allows you to express your healthcare preferences in a clear and organized manner. Once completed and signed, this document serves as a legal directive in most states, ensuring that your wishes are respected in times of serious illness.

  1. Begin by printing your full name and birthdate at the top of the form.
  2. Identify the person you want to make healthcare decisions for you if you cannot do so. This person is your Health Care Agent. Provide their full name, phone number, and address.
  3. If your first choice for a Health Care Agent is unavailable, list your second and third choices, including their names, phone numbers, and addresses.
  4. Review the list of powers you want to grant your Health Care Agent. Cross out any items you do not want them to do.
  5. Clearly state any limitations or additional instructions regarding your Health Care Agent’s powers in the provided space.
  6. If you change your mind about your Health Care Agent, destroy all copies of the relevant section of the Five Wishes form and inform someone, like your doctor or family, about your decision to revoke.
  7. Once you have completed the form, sign it to make it valid.

After filling out the form, ensure that copies are distributed to your Health Care Agent and any family members or healthcare providers involved in your care. This will help them understand your wishes and ensure they are followed when necessary.

Important Facts about 5 Wishes Document

What is the Five Wishes document?

The Five Wishes document is a unique living will that goes beyond just medical decisions. It allows individuals to express their personal, emotional, and spiritual needs, as well as their medical preferences. By completing this form, you can designate a trusted person to make healthcare decisions on your behalf if you become unable to do so. This document ensures that your wishes regarding treatment and care are known and respected, providing peace of mind for both you and your loved ones.

Who should consider using Five Wishes?

Five Wishes is designed for anyone aged 18 or older. Whether you are single, married, a parent, or a friend, this document is for you. Over 19 million people have utilized it to communicate their healthcare preferences. It’s especially helpful for those who want to relieve their family from the burden of making tough decisions during difficult times. By expressing your wishes clearly, you can guide your loved ones and healthcare providers in accordance with your desires.

How does Five Wishes differ from a traditional living will?

Unlike a traditional living will, which typically focuses solely on medical treatments, Five Wishes encompasses a broader range of concerns. It addresses your emotional and spiritual needs, as well as how you want to be treated by others. This holistic approach allows you to express not only what medical interventions you want or don’t want but also how you wish to be comforted and supported by family and friends during serious illness.

How can Five Wishes benefit my family?

Five Wishes can significantly ease the emotional burden on your family during challenging times. By clearly stating your preferences, you eliminate the guesswork for your loved ones. They won’t have to make difficult decisions without knowing what you truly want. This clarity can foster open conversations about healthcare choices, ensuring that everyone is on the same page. Ultimately, it allows your family to focus on being there for you rather than struggling with uncertainty.

What steps should I take to change my existing advance directive to Five Wishes?

If you already have a living will or durable power of attorney for healthcare and wish to switch to Five Wishes, the process is straightforward. First, fill out and sign the Five Wishes document. This new form will automatically revoke any previous directives you have in place. To ensure clarity, destroy all copies of your old documents or mark them as "revoked." It’s also essential to inform your healthcare agent, family members, and healthcare providers about your new wishes to avoid any confusion.

Is Five Wishes legally valid in my state?

Five Wishes is legally valid in the District of Columbia and 42 states across the U.S. If you live in one of these areas, you can confidently use this document to express your healthcare preferences. However, if your state is not listed, Five Wishes may not meet specific legal requirements. In such cases, many individuals still complete the form as a guide for their loved ones and healthcare providers, ensuring their wishes are known, even if not legally binding.

Common mistakes

Filling out the Five Wishes Document is an important step in ensuring your healthcare preferences are respected. However, many people make mistakes that can lead to confusion or invalidate their wishes. Here are eight common mistakes to avoid.

One frequent error is not clearly naming a Health Care Agent. This person is responsible for making decisions on your behalf if you cannot. Failing to choose someone who understands your values and wishes can create complications during critical moments. Make sure to discuss your choices with them beforehand.

Another mistake is neglecting to update the document when circumstances change. Life events such as divorce, the death of a chosen agent, or changes in relationships can affect your preferences. If your agent is no longer suitable, it’s crucial to fill out a new document to reflect your current wishes.

Some individuals mistakenly leave sections blank. Each part of the Five Wishes Document serves a purpose. Omitting information can lead to uncertainty about your desires. Take the time to complete every section, even if it means writing a few sentences to clarify your wishes.

People often forget to sign and date the document. A signed Five Wishes Document is what gives it legal standing. Without your signature, the document may not be honored. Always double-check that you have signed and dated the form appropriately.

Another common oversight is failing to inform family members and healthcare providers about the completed document. If your loved ones are unaware of your wishes, they may struggle to honor them in a time of crisis. Share your completed Five Wishes Document with those closest to you.

Some individuals do not review their document regularly. As life changes, so too may your preferences regarding medical treatment and end-of-life care. Regularly revisiting your Five Wishes ensures it accurately reflects your current desires.

Another mistake is choosing an agent who is not emotionally capable of making tough decisions. While it’s important to select someone who cares about you, they should also be able to handle the emotional weight of making healthcare choices. Consider whether they can advocate for your wishes effectively.

Lastly, people sometimes assume that the Five Wishes Document is recognized in all states. While it is valid in many, it is essential to check if your state honors it. If you live in a state that does not recognize Five Wishes, you may need to complete additional forms to ensure your preferences are legally binding.

Documents used along the form

The Five Wishes document is an essential tool for expressing your health care preferences and ensuring your wishes are honored when you cannot speak for yourself. Alongside this document, there are several other forms and documents that can help clarify your intentions and provide guidance to your loved ones and medical providers. Below is a list of commonly used forms that complement the Five Wishes document.

  • Durable Power of Attorney for Health Care: This document allows you to designate someone to make medical decisions on your behalf if you become incapacitated. It is a legal way to ensure your health care preferences are followed.
  • Living Will: A living will specifies the types of medical treatment you do or do not want in situations where you are unable to communicate your wishes. This document focuses mainly on life-sustaining treatments.
  • Do Not Resuscitate (DNR) Order: A DNR order is a medical order that prevents healthcare providers from performing CPR if your heart stops or you stop breathing. It is crucial for individuals who do not wish to undergo resuscitation efforts.
  • Healthcare Proxy: Similar to a durable power of attorney, a healthcare proxy allows you to appoint someone to make health care decisions for you. This document can be used when you are unable to communicate your wishes.
  • Advance Directive: An advance directive is a broader term that encompasses various documents, including living wills and durable powers of attorney. It outlines your preferences for medical treatment and appoints someone to make decisions on your behalf.
  • Organ Donation Consent Form: This form allows you to express your wishes regarding organ donation after your death. It can be included with other advance directives to ensure your preferences are known.
  • Funeral Planning Document: This document outlines your wishes for funeral arrangements, including burial or cremation preferences, and can alleviate stress for your loved ones during a difficult time.
  • Personal Health Care Record: Keeping a personal health care record helps document your medical history, medications, allergies, and preferences. This can be beneficial for your healthcare agent and providers.
  • Patient Advocate Form: This form designates an individual to advocate for your rights and preferences in a healthcare setting, ensuring that your wishes are respected throughout your treatment.
  • State-Specific Health Care Forms: Many states have their own specific forms for advance directives or health care proxies. Familiarizing yourself with these can ensure compliance with state laws and facilitate the recognition of your wishes.

Utilizing these forms alongside the Five Wishes document can create a comprehensive plan for your health care preferences. This proactive approach not only empowers you to express your wishes but also provides peace of mind for you and your loved ones during challenging times.

Similar forms

The Five Wishes document serves as an essential tool for expressing your healthcare preferences. It shares similarities with several other important legal documents that help individuals articulate their wishes regarding medical care and end-of-life decisions. Here are five documents that are comparable to the Five Wishes form:

  • Living Will: Like the Five Wishes document, a living will outlines your preferences for medical treatment in situations where you cannot communicate your wishes. It typically focuses on life-sustaining treatments and end-of-life care, ensuring that your desires are honored even when you are unable to voice them.
  • Durable Power of Attorney for Health Care: This document designates a specific person to make healthcare decisions on your behalf if you become incapacitated. Similar to the Five Wishes, it empowers a trusted individual to act according to your preferences, but it may not delve into the emotional or spiritual aspects of care.
  • Advance Directive: An advance directive is a broader term that encompasses both living wills and durable powers of attorney. It serves as a comprehensive guide for medical professionals and loved ones, detailing your healthcare choices and the person authorized to make decisions for you, much like the Five Wishes document.
  • Do Not Resuscitate (DNR) Order: A DNR order specifically instructs healthcare providers not to perform CPR or other life-saving measures if your heart stops or you stop breathing. While Five Wishes covers a wider range of preferences, both documents aim to communicate your desires regarding medical interventions at critical moments.
  • Health Care Proxy: This document allows you to appoint someone to make medical decisions for you if you are unable to do so. It is similar to the health care agent designation in the Five Wishes form, focusing on the appointment of a trusted individual to ensure your medical wishes are followed.

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 form carefully before starting.
  • Do choose a trusted person as your Health Care Agent.
  • Do discuss your wishes with your chosen agent and family members.
  • Do be specific about your medical treatment preferences.
  • Do sign and date the form in the appropriate places.
  • Don't rush through the form; take your time to think about your choices.
  • Don't leave any sections blank; provide as much detail as possible.
  • Don't choose someone as your agent who may be unable to fulfill your wishes.
  • Don't forget to inform your health care provider about your completed form.
  • Don't ignore the laws of your state regarding living wills.

Misconceptions

Misconceptions about the Five Wishes Document form can lead to confusion and misunderstandings about its purpose and effectiveness. Below are six common misconceptions along with clarifications.

  • Five Wishes is only for the elderly. Many people believe that this document is only necessary for older adults. In reality, anyone aged 18 or older can benefit from creating a Five Wishes document, regardless of their current health status.
  • Five Wishes is a legal document that cannot be changed. Some think that once they complete the form, it is set in stone. However, individuals can change their Five Wishes at any time by filling out a new form and revoking the previous one.
  • Five Wishes is the same as a traditional living will. While both documents address end-of-life decisions, Five Wishes goes beyond medical choices. It also encompasses personal, emotional, and spiritual needs, making it a more comprehensive option.
  • My family will know my wishes without a formal document. Many assume that their loved ones can guess their preferences. However, having a Five Wishes document ensures that family members are aware of specific wishes, reducing the burden of guesswork during difficult times.
  • Five Wishes is not legally recognized in all states. Some people believe that Five Wishes is not valid everywhere. In fact, it is recognized in 42 states and the District of Columbia, making it a viable option for many individuals.
  • Only lawyers can help complete the Five Wishes form. It is a common misconception that legal assistance is required to fill out the document. In truth, Five Wishes is designed to be user-friendly, allowing individuals to complete it on their own with minimal guidance.

Key takeaways

Here are some key takeaways about filling out and using the 5 Wishes Document form:

  • Understand the Purpose: The 5 Wishes Document helps you express your medical, emotional, and spiritual wishes in case you become seriously ill.
  • Choose Your Agent Wisely: Select someone who knows you well and can make health care decisions on your behalf. This person should be at least 18 years old.
  • Easy to Complete: The form is straightforward. You can fill it out by checking boxes, circling options, or writing brief sentences.
  • Legal Validity: Once signed, the 5 Wishes Document is valid in most states, ensuring your wishes are respected.
  • Communication is Key: Discuss your wishes with family and friends. This helps them understand your preferences and reduces their stress during difficult times.
  • Revoking Previous Documents: If you have an existing living will or health care power of attorney, you must destroy those documents or mark them as revoked when you complete the 5 Wishes Document.
  • Accessible to All: The 5 Wishes Document is suitable for anyone aged 18 or older, regardless of marital status or family situation. Millions have already used it.