Advance care planning is an ongoing process in which people explore and discuss their goals, values, and experiences related to the end of life, as well as their understanding of their health in order to guide future treatment considerations and choices. Ideally, conversations about these choices occur over a person’s lifetime and are revisited whenever there are significant changes in their health or social support system, or whenever their wishes change. In addition to ongoing conversations and exploration, advance care planning should also include documenting a person’s preferences through written tools such as advance directives and medical orders when appropriate.
If you live in the District of Columbia or most states, you can use the Five Wishes advance directive and have the peace of mind to know that it meets your state’s legal requirements. If you live in one of four remaining states (New Hampshire, Kansas, Ohio, or Texas) you can still use the Five Wishes advance directive but may need to take an extra step.
An advance directive like Five Wishes allows you to guide important medical care decisions that might be made if you ever get seriously ill – such as whether to give you life-support treatment. You may think that your loved ones and doctors will know what you want when you are very ill, but in reality, everyone has different wishes and it’s important to make them clearly known. Expressing your wishes in an advance directive like Five Wishes helps empower your family, friends, and doctor to make the best decisions when the time comes, and helps avoid disagreements about what to do. Completing the Five Wishes advance directive can help you and your loved ones gain peace of mind around these difficult decisions.
The Five Wishes advance directive was created by the national non-profit organization, Aging with Dignity, a leading advocate for the needs of elders and those who care for them. Aging with Dignity founder Jim Towey created Five Wishes with doctors, nurses, lawyers and other experts in end-of-life care to help people of all ages get the treatment they want if they become seriously ill. Jim is an attorney who served as legal counsel to Mother Teresa of Calcutta for 12 years until her death. He was a full-time live-in volunteer at her home for AIDS patients in Washington, DC. He learned that people are most concerned about maintaining their comfort and dignity when they are very sick. This is why the Five Wishes advance directive addresses the personal, emotional, and spiritual needs of a person, not just the medical and legal ones.
The best time to fill out the Five Wishes advance directive is now, before you face a health crisis. Because life is unpredictable, it’s best to be prepared. Anyone over the age of 18 can use the Five Wishes advance directive. It is also a good idea to review and possibly update your Five Wishes advance directive when you experience significant life events like marriage, divorce, having children, or being diagnosed with a major illness.
You will always make your own health care decisions if you are able to talk with your doctor and understand what is being said. The Five Wishes advance directive only takes effect when you are too ill to communicate. If you are unable to make your own decisions or speak for yourself,then your Five Wishes advance directive, and the person you chose to be your healthcare agent, can help direct your care with your doctor.
Yes. It was written with the help of the American Bar Association’s Commission on Law & Aging. It meets the legal requirements of 46 states, but is used widely in all 50, and a federal law requires medical care providers to honor patient wishes as expressed. Seethe advice on page 3 of the Five Wishes advance directive document. Just follow the directions when you sign it.
Yes, the Centers for Medicare & Medicaid Services has ruled the agent or proxy appointed under Five Wishes is treated as the patient's “personal representative” under HIPAA and has the same access to medical records and information as the patient, once the advance directive takes effect.
Take the following steps to use Five Wishes:
- Review the document, possibly with your family as well.
- Fill it out in ink.
- Follow directions for signing it.
- Discuss it with your health care agent and doctor and give each of them a copy.
- Make sure a copy of your Five Wishes is placed in your medical file by your doctor.
- Discuss Five Wishes with your family and friends and give them a copy.
Your doctor is required to follow your wishes according to the laws of your state. Each state has its own rules and conditions that a doctor must observe, and so your doctor has the final word on when your Five Wishes takes effect. To do all you can to have your wishes followed, make sure you do two things:
- Pick a health care agent (Wish 1), talk with him or her about your wishes to make sure they understand what matters to you, and confirm they will speak for you if you ever get sick.
- Tell your family members, friends, doctor - and anyone who might get involved if you become sick - who you choose as your health care agent. Some even make photocopies of their completed Five Wishes and give them to other family members.
Anyone age 18 (21 in Colorado) or older can serve as your health care agent, although your state law will likely disqualify people with an obvious conflict of interest, such as your doctor or other health care personnel. You should choose someone you trust to carry out your wishes, and it does not have to be your spouse or adult children. Some people want to appoint multiple health care agents to serve simultaneously, but we advise against it because one agent may disagree with the others. You can write in the Five Wishesadvance directive that, say, you want your four adult children to decide,but if they can’t, then adult child X will decide.
If you do not feel that you have anyone to act as a healthcare agent, then you should complete Wish 2 (the “living will” portion of the Five Wishes advance directive) so that medical personnel can know what you would want or not want regarding artificial life support treatment. Make very sure your doctor has a copy of your Five Wishes advance directive in your medical file. You should also complete Wishes 3-5 so that your caregivers can better understand you and your wishes.
The health care agent and the living will go hand-in-hand,and you are usually better off with both. You need to have a health care agent to speak for you when you can’t speak for yourself, and you need a living will that expresses your wishes in writing. The law generally requires your healthcare agent to make decisions that they feel you would have made if you could talk. The more information your agent has, the better, which is why we advise that you go over your completed Five Wishes advance directive with your health care agent so there is no misunderstanding later.
You can change your wishes any time you want. It is a good idea to review and update your Five Wishes advance directive at least once a year, or if you have any major changes in your health or your family support network. When you make changes, be sure to inform your health care agent, family, friends and doctor. Destroy all out-of-date copies of the document and distribute copies of your new Five Wishes advance directive.
If you’re changing anything in Wish 2 or anything in Wish 1, other than simple contact information, you should complete a new Five Wishes advance directive. Wishes 1 and 2 deal with legal matters where it’s best to be safe. For any other changes, simply strike through (one line) the old information, write in the new in ink next to it, and then initial and date the new entry. Don’t use Wite-Out or obliterate the old entries.
In each of the four most common life-support treatment scenarios, you can answer that you want it; that you don’t want it; or that you want it if your doctor believes it will help, but you want it stopped if it’snot helping. The Five Wishes advance directive is the only advance directive or living will that offers these three options. It allows the health care agent to consult with the doctor and decide“yes” or “no” based on what the facts are at the time. This is why it’s important that you and your health care agent discuss your Five Wishes advance directive so that he or she has a good understanding of what you would want or not want, and under what circumstances.
This part of Wish 2 means that you are rejecting any treatment or procedure (or the denial of any) that would be done with the intention of ending your life. To give an example: An increase in pain medication helps manage pain levels but can have the unintended consequence of hastening death.If a doctor increases a person’s pain medication to help relieve pain and provide comfort, then the intent is not to end the person’s life, it is focused on comfort. However if a doctor prescribes medication in order to hasten the patient’s death, then the doctor is doing so “with the intention” of taking their life. Intention is the key point here.
No, in the states where this is allowed each state has it’s own protocols and procedures for requesting it, and none allow this to be done through an advance directive.
Being treated with kindness may look different to different people so we encourage people to be as specific as they desire about what they would want, how they wish to be treated and what they want others to know. Doing this helps caregivers better know you as a person and to better tailor your care to your expressed wishes.
No. You are only indicating your preferences. For it to be legally binding, you’d want to sign a “pre-need” contract with a funeral provider or state your wishes in a last will and testament.
Once your Five Wishes has been signed and witnessed/notarized, the original document should be placed in a location where it can be easily obtained if needed, such as in a desk or posted on your refrigerator. There is also a wallet card that should be cut from the document then signed and put in your wallet. We highly recommend scanning and providing scanned copies of your completed and signed Five Wishes to your Doctor, Healthcare Agent, and other loved ones.
Witnesses confirm that you are the one who signed your advance directive and that you were of sound mind, without duress or being coerced to sign it. They do not have to agree with or even see your wishes, just see that you are the one signing. Most state laws disqualify certain people from serving as witnesses, usually those with a conflict of interest, such as a relative or beneficiary. Be sure to follow the witness instructions on page 10 of Five Wishes.
If you live in North Carolina, South Carolina, West Virginia, or Missouri you must have your Five Wishes notarized. If you live in any other state, notarization is not a requirement.
There are witnessing and signing instructions on page 10 of the Five Wishes advance directive that will tell you about your state. You can also check your state law to see if your state offers notarization as an option in lieu of having two witnesses.
An advance directive that meets the legal requirements of the state in which it was signed will be honored in all 50 states under reciprocity.
While the Five Wishes advance directive was written for use in the U.S., it is used around the world as an expression of people’s wishes, both medical/legal and personal/spiritual. Though some countries do not have a legal structure for health care agents, most healthcare professionals want to honor patient wishes, so any written expression of your wishes is helpful.
Five Wishes Digital is an electronic version of the Five Wishes advance directive that allows you to complete the document on your computer. If you have a redemption code for Five Wishes Digital, use this link. If you don’t have a redemption code, you can purchase Five Wishes Digital here.
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