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Five Wishes


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December 8, 2010

The Five Wishes document helps you express how you want to be treated if you are seriously ill and unable to speak for yourself. It is unique among all other living will and health agent forms because it looks to all of a person's needs: medical, personal, emotional and spiritual. Five Wishes also encourages discussing your wishes with your family and physician.

Five Wishes lets your family and doctors know:

  1. Who you want to make healthcare decisions for you when you can't make them for yourself.
  2. The kind of medical treatment you want or don't want.
  3. How comfortable you want to be.
  4. How you want people to treat you.
  5. What you want your loved ones to know.

Download this page as a PDF (530 K) or to receive the full Five Wishes booklet see order information below.

There are a few states in which Five Wishes does not yet meet the legal requirements. These states either require a specific state form or that the person completing an advance directive be read a mandatory notice or "warning." Residents of these states can still use Five Wishes to put their wishes in writing and communicate their wishes to their family and physician. Most healthcare professionals understand they have a duty to listen to the wishes of their patients no matter how they are expressed.

Five Wishes was created by the national non-profit organization Aging with Dignity, and originally distributed with support from a grant by The Robert Wood Johnson Foundation, the nation's largest philanthropy devoted exclusively to health and healthcare. Over 11 million copies of Five Wishes have been distributed worldwide through a network of more than 15,000 organizations. With support from the United Health Foundation, Aging with Dignity recently introduced Five Wishes translated into 20 new languages.

For more information, or to obtain copies of the 11-page Five Wishes booklet and other resources, contact Aging with Dignity at 888-5 WISHES (594-7437) or online at Individual copies are $5, bulk orders of 25 or more are only $1 per copy.

For more tips about talking with your seniors about a variety of subjects, see the resources on our additional resources page or contact your nearest Home Instead office.

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Thoughts and stories from others
  1. March 11, 2016 at 7:20 pm | Posted by Abby Dees

    Please think carefully about using the 5 Wishes document. It looks great on the surface but it has many potential problems. First of all, it is written vaguely, which may lead to potential litigation around the meaning of the form. Second, the form is potentially internally inconsistent if you choose any provisions the ask for food, life support or water to be removed. It allows you to specifically choose what you'd like in various scenarios, but earlier language (presented as a fixed part of the form, rather than a choice) states that no action that may hasten the end of life may be taken (I don't have the form in hand, but that is the gist of it). It is deeply flawed and may result in an unintended outcome.


  2. December 3, 2014 at 8:20 pm | Posted by Jay

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  3. October 26, 2013 at 7:04 pm | Posted by Diane Hampel

    Would like more info on the 5 Wishes. Dealing with a loved one with a terminal disease and how to talk to them about end-of-life decisions. We are a "Family of Denial" and I guess that's what is so hard to bring up the critical conversions. Thanks, Diane


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