5 Wishes Document Template

5 Wishes Document: Usage Instruction

Filling out the Five Wishes document is a straightforward process that provides an opportunity to express your health care preferences clearly. Ensuring your loved ones understand your desires during a time of serious illness can ease their burden and give you peace of mind. Below are the steps to complete the form accurately.

1. Begin by entering your full name and birthdate at the top of the document.
2. Identify the person you want to make health care decisions for you when you can’t make them yourself. This person will be your Health Care Agent.
3. Provide the first choice Health Care Agent’s name, phone number, and address. Ensure they are at least 18 years old.
4. If your first choice cannot serve, list your second and third choice agents with their names, phone numbers, and addresses.
5. Review the capabilities you want your Health Care Agent to have. Cross out any options that you don’t want them to be able to do.
6. Fill in any additional changes or limitations regarding the powers granted to your Health Care Agent in the provided space.
7. If you change your mind about your Health Care Agent, destroy all copies of that section of the document and inform your health care provider, family, or any related individuals.
8. Finally, sign the document to validate it. Make sure to date it as well.

Once you have completed the form, ensure that you share your wishes with your appointed Health Care Agent and family members. This proactive communication can greatly aid in making informed decisions when it matters most.

1. What is the Five Wishes document?

   The Five Wishes document is a form that allows individuals to outline their personal, emotional, and spiritual needs related to healthcare, in addition to medical wishes. It provides a way to express who they want to make healthcare decisions for them if they cannot do so themselves, and how they wish to be treated in case of a serious illness.

2. Who can fill out the Five Wishes form?

   Anyone who is 18 years or older can fill out the Five Wishes form. This includes married individuals, single people, parents, adult children, and friends. It aims to help anyone who wants to communicate their healthcare preferences to their loved ones.

3. Why is it important to have a Five Wishes form?

   Having a Five Wishes form is crucial because it ensures that your healthcare preferences are known and respected, especially when you cannot speak for yourself. This document prevents your family from having to make difficult decisions without knowing your wishes during a challenging time.

4. How does the Five Wishes document work?

   The Five Wishes document works by allowing you to name a Health Care Agent, describe the medical treatments you do or do not want, and express how you wish to be treated by others. After filling it out, you must sign the document to ensure it is valid under state laws. Once signed, it supersedes any previous advance directives you may have.

5. Can I change my mind after completing the Five Wishes form?

   Yes, you can change your mind. To revoke or alter your Five Wishes, you should destroy all copies of the original form, inform your healthcare agent, and ensure that anyone else who needs to know about your decision is aware of the changes.

6. Is Five Wishes recognized by all states?

   The Five Wishes document is valid in 42 states and the District of Columbia. However, not all states have recognized it under their specific legal requirements. It is advisable to check if your state honors the document, or you may use it alongside your state’s legal forms.

7. Who should I select as my Health Care Agent?

   Your Health Care Agent should be someone you trust, who knows your values, and is willing to carry out your wishes. Ideally, this person should be at least 18 years old and should not be your healthcare provider or their employee. Discussing your decisions with them beforehand is essential for clarity.

Filling out the Five Wishes document is a crucial step for many individuals in planning their healthcare preferences. However, mistakes can occur during this process that may affect the document's effectiveness. One common mistake is not fully understanding the role of the Health Care Agent. Many people simply check a name without considering if that person is willing and capable of carrying out their wishes. Choosing someone without discussing this responsibility can lead to confusion and potential disagreements later on.

Another common error is failing to provide complete and accurate contact information for the designated Health Care Agent. Missing details, such as phone numbers or addresses, may hinder a healthcare provider’s ability to reach the chosen agent when it matters most. Additionally, a failure to keep this information updated can complicate situations where quick decisions are required.

Some individuals overlook the importance of discussing their wishes with their selected agents. Without clear communication, the agent might not fully understand what is expected of them. It is vital to have these conversations ahead of time to ensure that the person chosen for this role is truly aligned with one’s values and desires regarding healthcare.

Moreover, signers may neglect to review the entire document before submitting it. Every section deserves careful attention, as errors or omissions can unintentionally alter the intent of the choices made. For instance, failing to cross out specific options that are not desired can lead to misunderstandings during critical times.

Another mistake is related to legal requirements. Not all states recognize the Five Wishes document, and individuals may assume it carries the same weight everywhere. It is essential to confirm that your state acknowledges this form as a valid advance directive. If it's not recognized, individuals may need to consider additional legal documents to complement it.

Additionally, some people fail to revoke previous advanced directives in writing when they decide to use the Five Wishes form. Neglecting to officially cancel an old directive can lead to conflicts and confusion about which document is controlling. Clearly marking old documents as “revoked” and informing relevant parties is a necessary step not to be overlooked.

People sometimes assume that filling out the Five Wishes document once is sufficient. However, life circumstances can change—relationships may evolve, or health care preferences may shift over time. Regularly reviewing and updating the document is crucial to ensure it accurately reflects one’s current wishes.

Finally, not sharing the completed document with family members and healthcare providers can result in significant challenges. While it is essential to have a designated agent, it is equally vital for other loved ones and professionals involved in care to be aware of the wishes expressed. This enhances clarity and reduces the chances of conflicting decisions in the future.

In addition to the Five Wishes Document, several other forms and documents can assist individuals in expressing their healthcare preferences and wishes. Each document plays a unique role in ensuring that a person's desires are known and respected, particularly when they cannot communicate them. Here is a list of eight commonly used forms.

• Advance Directive: This is a general term for legal documents outlining a person's healthcare preferences. It typically includes a living will and a durable power of attorney for healthcare decisions.
• Living Will: This document specifies the types of medical treatments an individual desires or does not wish to receive in case of a terminal illness or condition that would prevent them from communicating their wishes.
• Durable Power of Attorney for Health Care: This designates a specific individual to make healthcare decisions on behalf of someone if they become incapacitated and unable to make those decisions themselves.
• Do Not Resuscitate (DNR) Order: This is a specific instruction indicating that a person does not wish to receive CPR or advanced cardiac life support in the event of cardiac arrest or respiratory failure.
• Physician Orders for Life-Sustaining Treatment (POLST): This form translates a patient’s preferences into actionable medical orders, ensuring that medical staff knows how to proceed in emergencies.
• Health Care Proxy: This document names an individual, referred to as a proxy, who will make medical decisions on behalf of the patient if they become unable to communicate their preferences.
• Organ Donation Consent Form: By completing this form, an individual expresses their wishes regarding the donation of organs or tissues after death, allowing their desires to be known and fulfilled.
• Emergency Medical Information Form: This document contains essential medical information and preferences, serving as a quick reference for healthcare providers in urgent situations.

Utilizing these documents, along with the Five Wishes Document, can facilitate meaningful conversations with family and healthcare providers. These forms help ensure that individual preferences are honored, ultimately making difficult situations easier for loved ones and caregivers.

• Living Will: Similar to the Five Wishes document, a living will outlines your medical preferences when you can no longer express them. It primarily focuses on specific medical treatments you wish to receive or refuse, particularly at the end of life. While Five Wishes emphasizes emotional and spiritual needs alongside medical wishes, a standard living will is often less comprehensive in those areas.
• Durable Power of Attorney for Health Care: This document allows you to designate someone to make health care decisions on your behalf if you become incapacitated. Like Five Wishes, it empowers a chosen individual (your health care agent) to act in your interest, but it does not usually include your personal, emotional, or spiritual preferences regarding care.
• Advance Directive: This umbrella term encompasses both living wills and durable powers of attorney for health care. It helps guide medical decision-making when you cannot communicate your wishes. Five Wishes fits into this category but stands out by explicitly addressing how you want to be treated emotionally and spiritually, creating a more holistic approach.
• POLST (Physician Orders for Life-Sustaining Treatment): A POLST form is often used alongside advance directives for patients with serious illnesses. It details specific medical treatments you want or do not want at the end of life. While both POLST and Five Wishes communicate your medical preferences, Five Wishes goes further by addressing personal comfort and interactions with family and caregivers.

When filling out the Five Wishes Document form, it's important to ensure your wishes are accurately conveyed. Here are some recommendations about what to do and what to avoid during this process.

• Do write clearly and legibly to avoid any misunderstandings.
• Don't use complicated medical terms or phrases that may confuse others.
• Do discuss your choices with the person you are naming as your Health Care Agent.
• Don't forget to review the document carefully before signing to make sure everything is correct.

Following these guidelines can help ensure that the Five Wishes Document effectively captures your preferences and is respected by others when the time comes.

• Five Wishes is only for older adults. Many people believe that this document is only suitable for seniors, but it is actually designed for anyone aged 18 and older, including young adults and parents.
• Five Wishes is a complicated legal document. In reality, the form is straightforward and user-friendly. It allows individuals to express their medical and personal wishes in simple terms.
• Five Wishes is not legally binding. Conversely, once filled out and properly signed, the Five Wishes document is legally valid in most states, providing clear directives for healthcare decisions.
• Five Wishes is the same as a standard living will. Unlike traditional living wills, Five Wishes addresses not only medical treatment but also personal, emotional, and spiritual desires regarding end-of-life care.
• Five Wishes requires a lawyer to complete. This form can be filled out by anyone without legal assistance. The process involves checking boxes, circling options, or writing a few sentences, making it accessible to all.
• Five Wishes is only for people with terminal illnesses. This document is beneficial for anyone, regardless of their current health status. It allows individuals to voice their preferences for healthcare at any stage of life.
• Using Five Wishes invalidates other healthcare directives. On the contrary, filling out a new Five Wishes form will revoke any previous advance directives, ensuring that your most current wishes are known and respected.

Filling out and using the Five Wishes Document form can significantly impact personal health care decisions. Below are some key takeaways to consider:

1. Purpose: The Five Wishes document provides a way to specify how you wish to be treated during a serious illness, covering medical, personal, and spiritual needs.
2. Choice of Agent: You can designate a trusted person, referred to as your Health Care Agent, to make medical decisions on your behalf if you are unable to do so.
3. Accessible Format: The form is designed to be straightforward, requiring only checks, circles, or brief written notes. You don't need to fill it out perfectly.
4. State Laws: The document is valid in most states, but it’s crucial to confirm that your state recognizes it to ensure your wishes are honored.
5. Communication: Discussing your Five Wishes with family members can prevent confusion and anxiety about your health care preferences during a crisis.
6. Revoking Previous Documents: If you opt to use Five Wishes instead of an existing living will or health care directive, destroy old copies to avoid confusion.
7. Health Care Agent Selection: Choose someone empathetic, reliable, and able to communicate on your behalf, ideally not an employee of your health care provider.
8. Completeness is Key: Fill out all sections of the document to ensure it best reflects your wishes, covering all aspects of your desired care.
9. Updating Wishes: If you change your mind about your Health Care Agent or any preferences, make sure to inform relevant parties and update the document accordingly.
10. Legal Rights: Completing this form does not change your legal rights and allows you to express your wishes clearly, guiding your family and healthcare providers.

Using the Five Wishes Document can ease the burden on your loved ones and ensure your values and preferences are respected in challenging times.