Fill in Your 5 Wishes Document Template

What is the Five Wishes document?

The Five Wishes document is a unique type of living will that allows individuals to express their desires regarding health care and personal treatment in times of serious illness. It caters to both medical and emotional needs, meaning it covers how you want to be treated, who will make decisions for you, and what personal messages you wish to convey to your loved ones. By filling it out, you ensure that your preferences are known and respected, even if you are unable to speak for yourself.

Who should fill out the Five Wishes document?

Anyone aged 18 and older can benefit from having a Five Wishes document. It's designed for a broad audience—whether you are single, married, a parent, or an adult child. Millions of people from all walks of life have already utilized this document, making it a valuable resource for those looking to ensure their wishes are honored during challenging times.

Why is it important to have a Health Care Agent?

A Health Care Agent is the person you designate to make health care decisions on your behalf if you can't make them yourself. Choosing someone you trust is crucial, as this person will advocate for your wishes during critical moments. This reduces the emotional burden on your family, sparing them from having to guess what you would have wanted, ensuring that your desires are clearly understood and followed.

How can I change my existing advance directive to Five Wishes?

If you already have a living will or durable power of attorney, you can switch to Five Wishes easily. Simply fill out and sign the Five Wishes document. Once signed, it negates any prior directives. Make sure to destroy any copies of the old documents and inform your Health Care Agent, family, and medical providers about your new wishes to ensure they are aware of your current preferences.

Is the Five Wishes document valid across all states?

Five Wishes is accepted in the majority of states, specifically in the District of Columbia and 42 states listed in the document. However, it’s always wise to verify whether it meets your state’s legal requirements as laws can vary. Even in states that do not officially recognize Five Wishes, many individuals still find value in using it alongside their state-specific forms, as it effectively communicates their personal wishes to their families and caregivers.

What happens after I fill out the Five Wishes document?

After completing the Five Wishes document, it's essential to share it with your Health Care Agent, family members, and healthcare providers. This proactive communication ensures that everyone is on the same page regarding your health care wishes. It’s also advisable to keep a copy on file with your medical records, so it is easily accessible if needed. Remember, the key is ensuring your preferences are known and respected in your time of need.

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

Absolutely. If you decide to change your Health Care Agent or any specific wishes outlined in the Five Wishes document, you can do so. Just follow the instructions to revoke your previous choices, either by marking the document as “revoked” or destroying all copies of it. Be sure to inform everyone who needs to know about these changes to uphold your current wishes accurately.

1. Not Naming a Health Care Agent: One of the biggest mistakes is failing to designate a health care agent. Without someone to make decisions on your behalf, your wishes may not be honored.

2. Incorrect Information: Entering incorrect contact information for your health care agent can lead to complications when decisions need to be made quickly. Always double-check names, phone numbers, and addresses.

3. Being Vague About Medical Treatment Preferences: When filling out preferences for medical treatment, being too vague can create confusion. Clearly outline what you want and what you don't want, so there is no room for misinterpretation.

4. Not Updating the Document: Life changes and so do preferences. Failing to update the Five Wishes document as circumstances evolve—like changes in health status or relationships—can lead to unanticipated outcomes.

5. Neglecting to Communicate Wishes: It’s crucial to talk with your family and health care agent about your wishes. Not communicating can leave loved ones uncertain during critical moments, potentially leading to decisions that don’t align with your desires.

The Five Wishes document is an essential tool for anyone looking to express their healthcare preferences. However, it can be beneficial to use it alongside other forms and documents to ensure comprehensive planning. Below is a list of other forms that are commonly associated with the Five Wishes document, along with brief descriptions of each.

• Durable Power of Attorney for Health Care: This legal document designates a specific person to make health care decisions on your behalf when you are unable to do so. Unlike Five Wishes, it is often more focused on medical decisions and does not address emotional or spiritual concerns.
• Living Will: A living will expresses your wishes regarding medical treatment in situations where you are terminally ill or permanently unconscious. It details what actions should or should not be taken to prolong your life, based solely on medical circumstances.
• Do Not Resuscitate (DNR) Orders: A DNR order instructs medical personnel not to attempt resuscitation if your heart stops beating or you stop breathing. It is a clear directive in emergencies, separate from the broader preferences outlined in Five Wishes.
• HIPAA Release Form: This document allows you to authorize specific individuals to access your medical records and discuss your health information. It ensures that your designated representatives can make informed decisions regarding your care.
• Medical Proxy or Health Care Agent Designation: Similar to the durable power of attorney, this document often emphasizes the appointment of a designated person who will make health care decisions, but it's typically more specific to medical situations without the personalized touch of Five Wishes.
• Advance Directive: An advance directive allows you to outline your wishes regarding medical treatment and end-of-life care. It includes both a living will and a durable power of attorney for health care, providing a comprehensive guide for medical professionals.
• Organ Donation Registration: This document allows individuals to express their wishes regarding organ and tissue donation after death. It is crucial for ensuring that your intentions are respected and can be an important component of your overall end-of-life planning.
• Personal Letter of Intent: While not a legally binding document, this letter can accompany the Five Wishes and other forms to provide additional context about your values, priorities, and specific desires for your care and treatment.

Utilizing these forms in conjunction with the Five Wishes document can create a more comprehensive outline of your healthcare preferences. Each document plays a unique role in ensuring that your wishes are respected and understood by both your loved ones and healthcare providers.

The Five Wishes document is similar to a traditional living will. Both documents help individuals outline their medical preferences in case they become unable to communicate their wishes. While a living will typically focuses on specific medical treatments one may wish to receive or decline, Five Wishes expands this concept to include more comprehensive elements such as emotional and spiritual needs. This broader approach provides a deeper level of comfort for both individuals and their families during difficult times.

An advance directive can also be compared to the Five Wishes document. Advance directives generally consist of legal documents that specify an individual's health care preferences. Much like Five Wishes, advance directives can appoint a health care agent to make decisions on a person's behalf if they are incapacitated. The main difference lies in the fact that Five Wishes emphasizes personal treatment preferences and the kind of care someone wants, whereas many advance directives are more straightforward and legalistic in language and format.

The durable power of attorney for health care shares similarities with Five Wishes as well. This document grants a person the authority to make medical decisions for someone else. Like Five Wishes, a durable power of attorney is essential for ensuring that another individual can advocate for your wishes in the event of severe illness or incapacity. However, Five Wishes provides a unique opportunity to articulate not just who makes those decisions, but what kinds of experiences and treatment one prefers throughout the medical journey.

The medical power of attorney also aligns with the goals of Five Wishes. This document, specifically designed for health care situations, allows you to designate someone to make health-related decisions if you cannot do so. Both documents aim to relieve family members from the burden of guessing what you would have wanted. Five Wishes goes a step further by allowing individuals to express their desires about compassionate treatment, reflecting their values and life philosophy.

When filling out the Five Wishes Document form, it is important to follow certain guidelines to ensure that your wishes are clearly expressed and legally valid. Below is a list of things to do and avoid.

• Do read through the entire form carefully before filling it out.
• Do clearly print your name and birthdate in the designated areas.
• Do discuss your wishes with the person you choose as your Health Care Agent.
• Do ensure your Health Care Agent is someone who understands your values and desires.
• Do sign and date the form once you have completed all sections.
• Don’t rush through the form; take your time to think about each decision carefully.
• Don’t use initials or nicknames in the areas that require names and contact information.
• Don’t leave any blanks in the form, as this may lead to confusion about your wishes.
• Don’t ignore discussing your preferences with family members after completing the form.
• Don’t forget to destroy any outdated advance directives to avoid conflicts.

Misconceptions about the Five Wishes document can lead to confusion. Here are some common misunderstandings explained clearly:

• Five Wishes is only for older adults. This is not true. Anyone aged 18 or older can use it. It’s for everyone, regardless of age.
• Five Wishes is not legally binding. In fact, once completed and signed, it is valid in most states. It acts as a legal document.
• Completing Five Wishes means I have to give up my existing living will. You do not need to give up your current documents unless you want to. If you fill out Five Wishes, it can replace an existing living will if you choose to do so.
• Using Five Wishes is complicated. Many people find it easy. The document is straightforward. You just check boxes, circle options, or write short sentences.
• My healthcare provider can make decisions even if Five Wishes says otherwise. Five Wishes is meant to express your wishes. Healthcare providers are required to follow the instructions in the document if it is valid.
• Five Wishes only addresses medical treatment. Five Wishes goes beyond medical care. It includes your personal, emotional, and spiritual wishes for end-of-life care.
• Only lawyers can help me fill out Five Wishes. While legal advice is an option, most people can complete it without an attorney. It is designed to be user-friendly.
• If I change my mind, I cannot modify Five Wishes. You can change your mind at any time. Simply fill out a new form and inform your healthcare agent and others involved about your updated choices.

Understanding these points can help you make informed decisions about your healthcare and personal wishes. The Five Wishes document is a valuable tool for expressing what matters most to you.

Here are some key takeaways regarding the Five Wishes document form:

• Purpose of Five Wishes: It offers a way for individuals to express their medical, personal, and emotional preferences in case they become seriously ill.
• Advanced Directive: It serves as a legal document that defines how you want to be treated when you can't voice your wishes.
• Fillable Form: The form is easy to complete, requiring users to check boxes, circle options, or write brief descriptions of their desires.
• Health Care Agent: Users select a person who will make health care decisions on their behalf when they are unable to do so.
• Importance of Communication: The document encourages discussions with family and friends about personal wishes, easing the burden on loved ones during difficult times.
• Eligibility: Anyone aged 18 or older can fill out the Five Wishes document, making it suitable for a wide range of individuals.
• State Requirements: It is valid in the District of Columbia and 42 states in the U.S., but it may not fulfill legal requirements in states not listed.
• Revoking Previous Documents: Signing Five Wishes replaces any prior advance directives. All copies of older documents should be destroyed or marked as revoked.
• Legal Recognition: Once signed, it carries legal weight in most states, ensuring that health care providers honor your outlined wishes.
• Flexibility: If circumstances change, individuals can update their Five Wishes document by simply filling out a new one and following the revocation process.

By understanding these points, individuals can better navigate their healthcare preferences and ensure their desires are respected in times of need.