5 Wishes Document Template

Guidelines on Filling in 5 Wishes Document

Filling out the Five Wishes document is a step forward in ensuring your personal, emotional, and spiritual needs, as well as your medical wishes, are understood and respected. This living will allows you to communicate how you wish to be treated in the event you cannot make decisions for yourself due to serious illness. Completing this document not only provides you peace of mind but also assists your family and doctors in adhering to your preferences. Here’s how you can fill out the form:

1. Begin with printing your name and birthdate at the top of the document to ensure it clearly represents your wishes.
2. Wish 1: Decide on the person you want to make health care decisions for you when you can’t. This is your Health Care Agent. Provide their name, phone number, and address.
3. If your first choice for Health Care Agent is unable or unwilling to serve, select a second and third choice. Write down their names, addresses, and phone numbers as well.
4. Review the criteria for choosing the right Health Care Agent. Think about someone who knows you well, cares about you, and can make tough decisions. Ensure the person is at least 18 years old and not your health care provider or affiliated with a health care facility you are using.
5. Understand the authority you are giving to your Health Care Agent. Cross out any duties you do not wish them to have. This might include decisions about medical care, access to your medical records, moving you to another state for care, and legal actions to fulfill your wishes.
6. Specify any changes, additions, or limitations to your Health Care Agent’s powers in the space provided at the end of Wish 1.
7. Sign at the bottom of Wish 1 if you decide to revoke the authority of a Health Care Agent, indicating you have changed your mind. Remember to destroy all copies of this section of the document or write “Revoked” in large letters across the name of each agent you no longer authorize.

Once you complete these steps, you will have taken a significant action towards ensuring your health care choices are known and can be honored. Keep this document in a safe place and inform your chosen Health Care Agent(s) and family about where it is stored. Additionally, consider providing a copy to your primary care physician and any other health care providers to ensure your wishes are easily accessible when needed.

What is the Five Wishes Document?

Five Wishes is a comprehensive document that allows individuals to outline their personal, emotional, spiritual, and medical wishes should they become seriously ill and unable to communicate their preferences themselves. It serves as a living will that not only specifies medical treatments one does or does not want but also addresses comfort measures, how one wishes to be treated by others, and what one wants their loved ones to know. Created with guidance from The American Bar Association's Commission on Law and Aging and leading experts in end-of-life care, it's designed to be easy to use by checking a box, circling a response, or writing a few sentences. Once properly completed and signed, it is legally valid in the majority of states.

How can the Five Wishes Document benefit you and your family?

The Five Wishes Document facilitates meaningful conversations between you, your family, friends, and healthcare providers about your care preferences, thus relieving loved ones of the burden of making hard choices without knowing your wishes. It ensures:

1. Clear communication of your medical, personal, emotional, and spiritual needs.
2. Peace of mind for you and your family, knowing wishes will be respected.
3. Support for family members and healthcare agents with guided decision-making.

Who should use the Five Wishes Document?

Anyone over the age of 18 can and should use the Five Wishes Document, regardless of their current health status. This includes married individuals, single adults, parents, adult children, and friends. Over 19 million people of various ages have utilized it for its thorough and compassionate approach to planning for future healthcare needs.

Is the Five Wishes Document legally valid in my state?

The Five Wishes Document is recognized and can be used as a legal document in the District of Columbia and 42 states. If you reside outside these jurisdictions, it’s recommended to complete Five Wishes alongside your state’s legal forms. This ensures your healthcare preferences are known and can serve as a guide for your family and healthcare providers, even if not technically meeting state-specific legal requirements.

How do I implement the Five Wishes Document if I already have an advance directive?

To switch from an existing advance directive to the Five Wishes document, simply complete and sign the new Five Wishes form as directed. Doing so automatically revokes any previous directives. Ensure to:

• Destroy all copies of your old documents.
• Inform your healthcare agent, family members, and doctors of the change.
• Ensure everyone involved in your care is aware of your current wishes.

How do I choose a person to make healthcare decisions for me as outlined in Wish 1?

When selecting a Health Care Agent, consider someone who knows you well, understands your values, and is willing to advocate on your behalf. It’s crucial this person is at least 18 years old and capable of making difficult decisions under pressure. Discuss your wishes with them to ensure they are comfortable and willing to act according to your preferences in the event you cannot communicate your wishes.

Can I change my mind after completing the Five Wishes Document?

Yes, you can change your mind at any time after completing the Five Wishes Document. To do so, you should:

• Physically destroy all copies of the document.
• Communicate your decision to revoke or amend the document to your healthcare agent, family, and physicians.
• Create a new document reflecting your current wishes and go through the proper procedures to ensure it is legally recognized.

What should I do if my state does not recognize the Five Wishes Document as a legal document?

If your state does not recognize Five Wishes as legally binding, it's still beneficial to complete it. The document can serve as a powerful communication tool, providing a clear guide for your loved ones and healthcare providers about your preferences. Additionally, consider also completing your state’s official advance directive forms to ensure your medical wishes are respected and legally enforceable.

When people fill out the Five Wishes Document form, it's not uncommon for mistakes to occur. These mistakes can significantly impact the effectiveness and enforceability of the document. Understanding and avoiding these common errors can help ensure that the document reflects true intentions and can be implemented as planned.

1. Not choosing the right person as the Health Care Agent. It's essential to select someone who truly understands the signer's wishes and has the emotional strength and availability to act on those wishes under stress.

2. Failing to communicate with the chosen Health Care Agent about their appointment and discuss the specifics of the signer's wishes. This lack of communication can lead to confusion and difficulty in decision-making during critical times.

3. Not being specific enough in the description of medical treatment preferences. Vague statements can lead to unwanted treatments or the omission of desired ones.

4. Skipping over sections of the form without realizing that each part is vital for comprehensive care planning. This includes preferences for comfort care, how the individual wants to be treated, and what the person wants loved ones to know.

5. Assuming that filling out the form once covers all bases forever. People's wishes can change, and it's important to review and update the document as necessary.

6. Incorrectly completing the form due to misunderstanding its sections or what information is needed, leading to incomplete or unclear directives.

7. Neglecting to sign and witness the document according to the state’s requirements, which could result in the document not being legally recognized.

8. Not making enough copies or not distributing the copies to the right people — such as the Health Care Agent, family members, and doctors — which can prevent the document from being accessed when needed.

9. Assuming the document alone is sufficient for all medical and legal situations without consulting with a legal or medical professional to ensure it complements other legal documents like a will or power of attorney.

To avoid these mistakes, it's advisable to carefully consider the choices made on the form, thoroughly discuss and share these choices with the Health Care Agent and family, and regularly review the document to ensure it still reflects current wishes and legal requirements.

When considering end-of-life planning, the Five Wishes document offers individuals a way to articulate their preferences in terms of medical treatment, comfort, and how they wish to be remembered. However, this comprehensive approach to outlining one’s desires during serious illness or incapacity is often supplemented by other essential documents to ensure a well-rounded and fully articulated plan. Here are four additional forms and documents that are typically utilized alongside the Five Wishes document:

• Living Will: A living will is a written document that specifies what types of medical treatment are desired at the end of life if you are unable to communicate your decisions due to illness or incapacity. It can include preferences about the use of resuscitation, mechanical ventilation, and artificial nutrition and hydration.
• Durable Power of Attorney for Health Care: This legal document appoints a health care agent (also known as a proxy or surrogate) to make medical decisions on your behalf if you are unable to make them yourself. It’s more focused on appointing the decision-maker than on specific medical treatments.
• Do Not Resuscitate (DNR) Order: A DNR order is a medical order signed by a doctor that instructs health care providers not to perform cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. Unlike the living will, it is immediately actionable and used specifically in medical settings.
• Organ and Tissue Donation: A document that specifies your wishes regarding organ and tissue donation can be included as part of your end-of-life care planning. It states whether you wish to donate your organs and tissues for transplantation or for medical research after your death.

Together, these documents complement the Five Wishes by covering a broader range of circumstances, providing clarity to your loved ones and medical providers about your preferences. They play a crucial role in ensuring that your health care and personal values are respected, even when you are not able to communicate them. Crafting a comprehensive end-of-life plan often involves discussing these options with family members and health care professionals to ensure that your wishes are well understood and can be legally and practically implemented.

The Five Wishes Document is a unique tool for expressing healthcare and end-of-life preferences, blending medical, personal, emotional, and spiritual considerations. It closely mirrors several other legal documents, although with its own distinctive focus. Understanding these similarities can help you recognize its place within a broader context of advance care planning.

• Living Will: Much like the Five Wishes Document, a living will allows individuals to outline their medical treatment preferences in the event that they are unable to communicate their decisions due to illness or incapacity. Both documents address scenarios involving life-sustaining treatment and end-of-life care.
• Durable Power of Attorney for Health Care: This legal document enables a person to appoint a healthcare proxy or agent, similar to the first wish in the Five Wishes Document, which specifies someone to make healthcare decisions on their behalf if they cannot do so themselves.
• Do Not Resuscitate (DNR) Order: A DNR focuses specifically on the wish not to have cardiopulmonary resuscitation (CPR) in the event that one's heart stops or they stop breathing. While the Five Wishes Document covers a wider range of healthcare decisions, it can include preferences about resuscitation.
• Organ Donation Registration: Individuals can express their wishes regarding organ donation in various documents, including driver’s licenses and separate organ donor cards. The Five Wishes Document also allows space to indicate organ donation preferences, consolidating this choice with other end-of-life wishes.
• HIPAA Release Form: The Health Insurance Portability and Accountability Act (HIPAA) release form permits healthcare providers to share one’s medical information with specified individuals. While the Five Wishes Document does not replace this form, it implicitly acknowledges the importance of choosing healthcare agents who may need access to medical information to make informed decisions.
• Psychiatric Advance Directive: Similar to the medical and personal care preferences outlined in the Five Wishes Document, a psychiatric advance directive allows individuals to state their wishes for treatment in the event of a mental health crisis, including choices about medications, hospitalization, and ECT (electroconvulsive therapy).
• Advance Instruction for Mental Health Treatment: This document lets individuals specify their preferences for mental health treatment if they are unable to make decisions for themselves, somewhat similar to wishes 2 and 3 in the Five Wishes Document, though the latter has a broader scope.
• Statement of Values and Beliefs: Some individuals prepare a separate document expressing their values, beliefs, and preferences to guide their healthcare proxy or agent in making decisions. The Five Wishes Document integrates these expressions directly, especially in wishes 3, 4, and 5, addressing aspects of comfort care, how one wants to be treated, and what one wants loved ones to know.
• Emergency Medical Services (EMS) Do Not Resuscitate (DNR) Order: Specific to emergency medical situations, an EMS DNR instructs emergency personnel not to perform CPR or advanced life support. While the Five Wishes Document is broader and not limited to emergency settings, it can encompass wishes regarding emergency medical treatment and interventions.

Overall, the Five Wishes Document provides a comprehensive approach to advance care planning, incorporating elements found in various healthcare directives and legal documents, yet tailored to capture a person’s holistic end-of-life preferences.

Filling out the Five Wishes Document is an important step in planning for your future medical care. It communicates your desires regarding healthcare decisions, how you want to be treated in situations when you can't speak for yourself, and what you want your loved ones to know. To make sure your Five Wishes Document accurately reflects your intentions and is legally recognized, here are things you should and shouldn't do:

Do:
• Thoroughly read each section before filling it out to ensure you fully understand the types of decisions you're being asked to make.
• Choose a Health Care Agent who you trust, who understands your values, and is capable of making tough decisions under pressure. This person should also be informed they've been chosen and agree to take on this responsibility.
• Be as specific as possible when detailing your medical treatment preferences, comfort wishes, how you want to be treated, and what you want your loved ones to know. This clarity can be invaluable during difficult times.
• Discuss your wishes with your family, chosen Health Care Agent, and your doctor to ensure everyone understands and respects your preferences.
• Ensure your document is properly signed, witnessed, or notarized as required by your state's laws to ensure it's legally valid.
• Keep the original document in a safe but accessible place and give copies to your Health Care Agent, family members, and doctor.

Don't:
• Leave any sections blank. If a particular wish doesn't apply or you're unsure, seek advice but try to address each section to avoid ambiguity.
• Appoint a Health Care Agent without discussing it with them first. It's crucial they're willing and prepared for this responsibility.
• Forget to update your document if your wishes change, or if your Health Care Agent's situation changes (e.g., they are no longer able to fulfill this role).
• Assume your family and doctors will automatically know where to find your Five Wishes Document or understand your wishes without a discussion.
• Rely solely on verbal instructions. While conversations are important, having your wishes documented is crucial for ensuring they are followed.
• Use outdated forms. Always check that you're using the most current version of the Five Wishes Document to ensure it meets legal requirements.

By following these guidelines, you can help ensure your Five Wishes Document is a clear, legally valid guide for your loved ones and healthcare providers, making your intentions known and respected, no matter what the future holds.

When it comes to preparing for future medical situations, it's essential to understand the tools available to you fully. The Five Wishes Document is a widely recognized form that allows individuals to express their desires regarding healthcare and personal matters if they become unable to make decisions for themselves. However, there are common misconceptions about the Five Wishes Document that need to be addressed:

• Misconception 1: The Five Wishes Document is legally binding in all 50 states. While the Five Wishes Document is designed to meet the legal requirements for a living will in 42 states and the District of Columbia, it's not automatically considered legally binding in the remaining eight states. Individuals in those states should check local laws and possibly include additional forms to ensure their wishes are followed.
• Misconception 2: You need a lawyer to complete the Five Wishes Document. The form is designed to be user-friendly and does not require legal assistance to complete. It involves checking boxes and writing short statements, making it accessible for anyone to fill out without the need for a lawyer.
• Misconception 3: The Five Wishes Document only covers medical treatment wishes. Unlike traditional living wills, the Five Wishes Document also addresses personal, emotional, and spiritual needs in addition to medical wishes. This allows for a more comprehensive approach to end-of-life planning.
• Misconception 4: Once completed, the document cannot be changed. People's preferences and situations can change, and the Five Wishes Document can be updated at any time to reflect these changes. It can be revoked and replaced by a new document that reflects current wishes.
• Misconception 5: Health care providers can ignore the document if it doesn't align with their beliefs. Most health care professionals understand the importance of respecting patients' wishes as expressed in advance directives like the Five Wishes Document. While rare exceptions exist, generally, providers aim to honor the document's instructions as closely as possible.
• Misconception 6: The Five Wishes Document is only for the elderly or terminally ill. Anyone over the age of 18 can benefit from completing a Five Wishes Document. It ensures that anyone, regardless of age or health status, can have their choices known and respected if they're unable to communicate them directly.

Understanding these misconceptions can help ensure that your Five Wishes Document is appropriately recognized and followed, providing peace of mind for you and your loved ones.

The Five Wishes Document is an empowering tool for anyone over 18, offering a comprehensive way to guide your healthcare decisions when you're unable to make them yourself. It's not just about medical preferences; it also encompasses personal, emotional, and spiritual desires, pushing beyond the scope of traditional living wills. Here are key takeaways to consider while filling out and using this form:

• Universal applicability: The form is not confined to specific age groups or marital statuses; it's useful for adults at any stage of life, including married couples, singles, parents, and friends, addressing a broad spectrum of needs and circumstances.
• Comprehensive coverage: Beyond specifying medical treatments, the document allows you to articulate your comfort levels, how you wish to be treated, and what you want your loved ones to know, providing a holistic approach to end-of-life planning.
• Legally valid in most states: Once completed and properly signed, the Five Wishes Document is recognized and valid under the laws of 42 states and the District of Columbia, making it a robust tool for expressing your healthcare preferences.
• Ease of amendment: If you've previously created a living will or healthcare power of attorney, you can easily switch to the Five Wishes Document. Simply fill out and sign the new form, which then invalidates any prior directives.
• Choose the right health care agent: The document emphasizes the importance of carefully selecting a health care agent who knows you well, is willing to respect your wishes, and is capable of making tough decisions on your behalf. Ensure this person or people are willing and understand what is expected of them.
• Communication is key: It encourages open and honest discussions with family, friends, and healthcare providers about your wishes, potentially easing the burden on your loved ones during difficult times and ensuring that your preferences are known and respected.

This document not only serves as a legal tool but also as a conduit for discussing and reflecting upon one's values and wishes, making it an invaluable resource for individuals and families alike. By taking the time to complete the Five Wishes Document, you can afford yourself and your loved ones peace of mind, knowing that your desires are documented and can be honored.