Free 5 Wishes Document PDF Form

How to Fill Out 5 Wishes Document

The Five Wishes document is a comprehensive tool designed to specify one’s preferences for medical treatment, comfort, personal interactions, and final wishes should they be unable to communicate these desires themselves due to serious illness. As a legally recognized form in most states, it empowers individuals by ensuring their healthcare and personal dignity are maintained according to their desires. Here are the steps you'll need to follow in order to complete the Five Wishes document accurately.

1. Print your name and birthdate at the top of the document to identify yourself as the person making these wishes.
2. In Wish 1, specify the Person You Want to Make Health Care Decisions for You When You Can’t. This involves:
   • Filling in the name, address, city/state/zip, and phone number of your first choice for your Health Care Agent.
   • Naming a second and third choice in case your first choice isn't able or willing to make these decisions, ensuring continuity in respecting your wishes.
3. Identify specifically how and when this appointed agent is authorized to act on your behalf in medical decisions. This includes recognizing the legal standards for determining incapacity within your state or region.
4. Consider the criteria for Choosing the Right Person to be your Health Care Agent, focusing on their ability to respect your wishes, emotional resilience, and proximity to be available when needed.
5. Outline the scope of power you're granting your Health Care Agent in Wish 1. This could involve decisions about medical care, accessing your medical records, moving you to obtain necessary healthcare, interpreting your wishes, hiring or firing health care workers, making decisions about life-sustaining treatments, and dealing with legal matters to enforce your wishes.
6. Explicitly cross out any powers you do not wish to grant to your Health Care Agent if there are specific actions you want to exclude.
7. Under the section labeled “If I change my mind about having a Health Care Agent,” be sure to understand the steps to revoke the document, including destroying all copies of the Five Wishes form or marking it as "Revoked."

Once completed and properly signed, the Five Wishes document serves as a legally valid directive in most states, providing peace of mind and ensuring that one's personal, medical, and end-of-life wishes are understood and respected. It's important to discuss your preferences with your designated Health Care Agent and loved ones to ensure they are fully informed and prepared to advocate on your behalf.

What is the Five Wishes Document?

The Five Wishes document is a comprehensive tool that addresses personal, emotional, spiritual, and medical needs in the event of serious illness. It allows individuals to outline their preferences for healthcare decisions, types of medical treatment, comfort levels, how they wish to be treated by others, and what they want their loved ones to know. Once completed and properly signed, it is recognized under the laws of most states.

Who can use the Five Wishes Document?

Anyone aged 18 or older, regardless of their marital status, parenthood, or any other aspect of their life, can use the Five Wishes Document. This includes married individuals, single people, parents, adult children, and friends. More than 19 million people have used it across a variety of demographics, showing its versatility and acceptance.

In which states is the Five Wishes Document recognized?

The Five Wishes Document meets the legal requirements in 42 states and the District of Columbia. These states include Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. If you don't live in one of these states, it's recommended to complete Five Wishes along with your state's legal forms to ensure your wishes are known.

How does the Five Wishes Document help families?

It provides a platform for individuals to communicate their health care preferences with family, friends, and doctors, thus reducing the burden on loved ones to make difficult decisions during serious illnesses. Knowing the wishes of their loved ones helps families avoid conflict and uncertainty, ensuring that the care given aligns with the patient's desires.

How do I choose a Health Care Agent in the Five Wishes Document?

When selecting a Health Care Agent, it's crucial to pick someone who knows you well, cares about you, and can confidently execute your wishes. The agent should be at least 18 years old and not be your health care provider or an employee of a health facility you are using. Discussing your wishes with your chosen agent and ensuring they are willing and able to act on your behalf are critical steps.

Can the Five Wishes Document override previous living wills or health care directives?

Yes, completing a new Five Wishes Document and properly signing it will revoke any previous advance directives, including living wills or durable powers of attorney for health care. It's important to destroy all copies of any old documents and inform your health care agent, family members, and doctors of the update to your wishes.

How do I complete the Five Wishes Document?

The process involves checking boxes, circling directions, or writing short sentences to express your wishes across the five areas covered by the document. After filling it out, it must be signed according to your state’s laws to become valid. Discussing your wishes with your chosen health care agent and family ensures everyone understands your preferences.

What should I do if I change my mind after completing the Five Wishes Document?

If you decide to change any part of your Five Wishes Document, you should discuss these changes with your Health Care Agent and family, destroy all copies of the old document, and complete a new one. Ensure that it is signed according to state laws to make sure the revisions are legally recognized.

When filling out the Five Wishes Document form, many individuals tend to overlook crucial aspects that ensure the document captures their true end-of-life wishes. This not only ensures clarity but also aids in avoiding unnecessary stress for loved ones and healthcare providers. Here are ten common mistakes to avoid:

1. Failing to designate a primary Health Care Agent who is fully informed and capable of making decisions. This oversight can lead to confusion or disputes at a critical time.

2. Not discussing the details with the chosen Health Care Agent. It's crucial that the agent fully understands the responsibilities and wishes of the person.

3. Choosing a Health Care Agent without considering their availability or willingness to serve in such a capacity. The agent's ability to act according to one's wishes under stress is vital.

4. Skipping over the discussion of specific medical treatments and conditions. A detailed conversation about what treatments one wants or doesn't want is essential for informed decisions later.

5. Omitting instructions on pain management and comfort measures. This can leave caregivers guessing about one's preferences for end-of-life care.

6. Not specifying the desired level of interaction with others, including visits and religious practices. This wish can greatly affect one's quality of life in their final days.

7. Leaving out instructions for after death, including organ donation preferences. This decision should be clearly communicated to avoid any uncertainty during a distressing time.

8. Failing to indicate preferences for information sharing with loved ones and the medical team. Clear communication preferences can prevent misunderstandings and ensure that one's wishes are followed.

9. Not regularly reviewing and updating the document. As circumstances and relationships change, so too might one's wishes.

10. Forgetting to sign and have the document witnessed as required by law. An unsigned or improperly signed document may not be legally valid.

To ensure that the Five Wishes Document truly reflects one's end-of-life wishes, individuals must avoid these errors. Thoughtful consideration, open discussion with loved ones and Health Care Agents, and regular review and updating of the document can help ensure that the wishes outlined are respected and followed.

When planning for future healthcare and personal decisions, the Five Wishes document provides a comprehensive approach, yet it is often beneficial to accompany it with other legal forms and documents to ensure all aspects of one's wishes are covered and legally recognized. These additional forms provide clarity and legal authority in various scenarios, ranging from specific healthcare wishes to financial management and beyond.

• Advance Healthcare Directive: This legal document allows you to outline specific healthcare preferences and appoint a healthcare agent. It goes beyond the Five Wishes by specifying in more detail the types of medical care you desire or wish to avoid.
• Durable Power of Attorney for Healthcare: This appoints someone to make medical decisions on your behalf if you are unable to do so, similar to the first wish in the Five Wishes document but solely focused on health care decisions.
• Living Will: A living will specifically outlines the types of life-sustaining treatments you would or would not like to receive in the event of a terminal illness or incapacitation.
• Durable Power of Attorney for Finances: This grants a trusted person authority to manage your financial affairs, separate from healthcare decisions. It can cover anything from paying bills to managing investments.
• Do Not Resuscitate Order (DNR): A medical order to healthcare providers not to perform CPR if your breathing stops or if your heart stops beating. It is more specific than general statements in advance directives.
• POLST (Physician Orders for Life-Sustaining Treatment): Similar to a DNR but more comprehensive, detailing other types of medical interventions you would or wouldn't want in addition to CPR.
• Organ Donation Registration: A form that registers your wish to donate your organs and tissues after death. This can also be noted in your Advance Healthcare Directive but is legally binding when registered separately.
• HIPAA Release Form: This document allows healthcare providers to share your health information with individuals you designate, which can be crucial for family members or friends involved in your care.
• Guardianship Designation: A legal document naming a guardian to make decisions for you if you become unable to do so yourself, not only about health care but also about personal and financial matters.
• Last Will and Testament: While not specifically about healthcare, a will is essential for specifying how your assets are distributed after death and can include funeral and burial wishes.

Combining the Five Wishes document with these forms can ensure that all aspects of your healthcare and personal wishes are known and can be acted upon. Conversations with legal professionals can help to integrate these documents effectively, tailoring them to individual needs and ensuring they work cohesively to honor your wishes.

The Five Wishes Document is a comprehensive advance directive tool designed to help articulate personal, medical, emotional, and after-life wishes. Its unique approach makes it akin to several other legal forms, yet with distinctive features tailored towards holistic end-of-life planning. Here are nine documents similar to the Five Wishes Document and how they compare:

• Living Will: Similar to the medical treatment preferences section of the Five Wishes, a living will enables individuals to outline the medical care they wish to receive or refuse in the event they cannot communicate their decisions.
• Durable Power of Attorney for Health Care: This parallels the first wish in the Five Wishes Document, appointing a Health Care Agent to make decisions when the individual is unable. It focuses specifically on health care decisions, similar to the directive within Five Wishes.
• Do Not Resuscitate (DNR) Order: While narrower in scope, a DNR form specifies a single, critical wish concerning end-of-life care—similar to specific medical treatment preferences outlined in the Five Wishes Document. It prevents emergency medical personnel from performing CPR.
• Physician Orders for Life-Sustaining Treatment (POLST): Like the Five Wishes, the POLST form goes beyond traditional living wills by providing specific instructions for health care providers to follow for end-of-life care, tailored to the individual’s health condition.
• Medical Power of Attorney (MPOA): Similar to the component of the Five Wishes that designates a health care agent, an MPOA grants a trusted person the authority to make all health-related decisions, topically similar but broader in potential application than Five Wishes.
• Hospice Care Directive: This document outlines preferences for hospice care, much like how the Five Wishes Document addresses the desire for comfort and the nature of treatment during the final phase of life.
• Organ and Tissue Donation Registration: Corresponding to the aspect of after-life wishes in the Five Wishes Document, this form enables individuals to express their intent to donate organs and tissues upon death.
• Disposition Authorization Affidavit: This form specifies one's wishes for the disposition of their remains, similar to the after-life preferences in the Five Wishes Document regarding funeral arrangements and handling of the body.
• Personal Statement or Ethical Will: Though not a legally binding document, an ethical will resembles the emotional and personal aspects of the Five Wishes Document, allowing individuals to share values, life lessons, and hopes for their loved ones.

Each of these documents shares a common purpose with the Five Wishes Document—to prepare for future health care situations and end-of-life care—but varies in specificity, legal standing, and scope of decisions covered. The Five Wishes Document uniquely combines elements from all these forms into one comprehensive advance directive.

When completing the Five Wishes Document, a tool that allows you to express how you want to be treated if you become seriously ill, there are several important dos and don'ts to keep in mind. This guide outlines five key points to help you fill out this form effectively and ensure your wishes are clearly understood and respected.

Dos when filling out the Five Wishes Document:

1. Take your time: Think carefully about your wishes regarding healthcare decisions, comfort levels, how you want to be treated, and what you want your loved ones to know.
2. Choose the right Health Care Agent: Pick someone who knows you well, understands your wishes, and is willing to advocate on your behalf. This decision is crucial, as this person will have the authority to make healthcare decisions for you if you're unable to.
3. Discuss your wishes: Have open conversations with your Health Care Agent, family members, and healthcare providers about your decisions. This clarity can provide peace of mind to everyone involved.
4. Review and update: Life circumstances change, and so might your wishes. Review your document periodically and make updates as necessary to ensure it always reflects your current preferences.
5. Store it properly: Keep the original document in a safe but accessible place, and provide copies to your Health Care Agent, family members, and healthcare providers to ensure everyone is aware of your wishes.

Don'ts when filling out the Five Wishes Document:

1. Rush the process: Avoid filling out the form in a hurry. Each decision requires thoughtful consideration to ensure it accurately reflects your wishes.
2. Be vague: Ambiguity can lead to confusion and conflict. Be as clear and specific as possible about your preferences to prevent misunderstandings.
3. Forget to sign and date: An unsigned or undated document might not be considered valid. Make sure to complete this step in the presence of the required witnesses or notary, depending on your state's laws.
4. Overlook legal requirements: Each state has its own laws regarding healthcare directives. Make sure your Five Wishes Document meets your state's legal criteria to ensure it's recognized and enforceable.
5. Keep your decisions a secret: Failing to communicate your wishes with the people who need to know can negate the purpose of filling out the document. Ensure that your Health Care Agent and loved ones are well-informed.

By adhering to these guidelines, you can confidently create a Five Wishes Document that thoughtfully reflects your healthcare preferences and decisions. This preparation not only empowers you but also greatly assists those who may need to act on your behalf during difficult times.

Many people have misconceptions about the Five Wishes Document, which can lead to confusion and a lack of proper use of this important tool for healthcare planning. Here are 10 common misunderstandings and the truth behind each:

• Only for the Elderly: Some believe that the Five Wishes Document is only for older adults. However, anyone 18 or older can and should use it to document their healthcare wishes.
• Legally Complex: There's a misconception that filling out the Five Wishes requires legal expertise. In reality, it's designed to be easy for anyone to complete without specialized legal knowledge.
• Substitutes for a Will: Another common misunderstanding is that the Five Wishes can serve as a substitute for a last will and testament. This is not true; it pertains only to healthcare decisions, not the distribution of assets.
• Only About End-of-Life Care: While it includes preferences for end-of-life care, the Five Wishes Document also covers other aspects of care preferences and personal wishes beyond just those critical final moments.
• Requires a Lawyer to Complete: Folks often think they need a lawyer to fill out the Five Wishes. It's designed for individuals to complete on their own, although reviewing it with legal counsel can be beneficial.
• Not Recognized by Doctors: Some are under the impression healthcare providers might ignore the document. In fact, when properly signed, the Five Wishes is legally valid in most states, and healthcare providers are generally familiar with it and respect it.
• Difficult to Change: There's a fear that once the Five Wishes Document is signed, it's difficult to alter. You can change your wishes at any time by completing a new document and destroying the old one.
• State-Specific: A common belief is that if your state isn't listed as one of the 42 states where the document meets legal requirements, you can't use it. While it's true that it may not meet the technical requirements in all states, it can still serve as a powerful guide for your wishes and is accepted by many healthcare providers regardless of location.
• Cost Prohibitive: Concerns about cost sometimes prevent people from using the Five Wishes. In reality, the document is affordable and accessible, part of its appeal and widespread use.
• Only for Physical Health Decisions: Some people mistakenly believe the document only covers decisions about physical health treatment. The Five Wishes also includes wishes for how one wants to be treated personally, comfort care, and what loved ones should know, covering emotional and spiritual needs as well.

Addressing these misconceptions encourages more people to take control of their healthcare decisions, providing peace of mind for them and their families. The Five Wishes Document empowers individuals to communicate their desires clearly, ensuring they are treated according to their personal wishes and values during critical health care situations.

The Five Wishes Document empowers individuals to direct their medical, personal, and spiritual care in the event that they are unable to communicate their desires due to serious illness. It serves as a comprehensive living will, recognized in many states, that addresses more than just medical treatment preferences.

Choosing the right Health Care Agent is crucial. This person will have the authority to make health care decisions on behalf of the individual if they are incapacitated. The document allows for the designation of a primary choice for a Health Care Agent along with secondary options, ensuring that there is always someone available to act in the individual's best interests.

Legal recognition varies by location. The Five Wishes Document meets the legal requirements for an advance directive in 42 states and the District of Columbia. In states where it is not recognized as a legal document, it can still serve as a guide for loved ones and healthcare providers to understand and respect the patient's wishes.

• The form includes provisions for not only who can make decisions on behalf of the incapacitated individual (Wish 1) but also the type of medical treatment desired (Wish 2), comfort level (Wish 3), how the individual wishes to be treated (Wish 4), and what they want their loved ones to know (Wish 5).
• Communication with the designated Health Care Agent and family members about one's wishes is encouraged to prevent any confusion or challenges at the time of illness.
• It is possible to revoke or change the Health Care Agent by destroying all copies of the current document or making a new Five Wishes document and informing family members and healthcare providers of the change.
• The document stresses the importance of making health care decisions in advance, allowing for a more dignified treatment and peace of mind for both the patient and their loved ones.
• Compatibility with existing legal documents such as living wills or durable powers of attorney for health care is seamless; filling out the Five Wishes Document supersedes any previous advance directives once signed.

In summary, the Five Wishes Document is a valuable tool for anyone over the age of 18 to communicate their values and preferences regarding end-of-life care. It encourages thoughtful dialogue among individuals, families, and healthcare providers, ensuring that one's healthcare wishes are known, respected, and legally protected where applicable.