Five Wishes

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 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 healthcare 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 44 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.
• Complete it on your device or print it out and complete it by hand. Follow directions for signing it.
• Discuss it with your healthcare 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 healthcare 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 healthcare 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 healthcare agent, although your state law will likely disqualify people with an obvious conflict of interest, such as your doctor or other healthcare 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 healthcare agents to serve simultaneously, but we advise against it because one agent may disagree with the others. You can write in the Five Wishes advance 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 healthcare agent and the living will go hand-in-hand, and you are usually better off with both. You need to have a healthcare 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 review your completed Five Wishes advance directive with your healthcare 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 healthcare agent, family, friends and doctor. Destroy all out-of-date copies of the document and distribute copies of your new Five Wishes advance directive.