The Five Wishes serve as helpful planning tool

By Maggie Finley

One of the better tools available for beginning a discussion around advanced directives may well be The Five Wishes. Used by some hospitals and hospices, the Five Wishes function as something of a manual, capturing what needs to be considered about aging with dignity and putting an end-of-life plan in place without solely relying on legalese.

The opening pages define terms and state how the wishes help and who could benefit the most from implementing them. It contains a listing of the 42 states and the District of Columbia where the Five Wishes comply with state requirements by law. But even where it fails to meet state statutes, the Five Wishes is still a helpful workbook or guide in how to have what are difficult conversations, even in the best of circumstances. One section suggests that some people may even choose to revoke a living will and durable power of attorney in favor of the Five Wishes.

The document spells out each wish in clear, accessible language and proposes considerations as well as action steps around each:

1. The Person I Want to Make Healthcare Decisions for Me When I Can’t Make Them for Myself:
   The initial section includes what to consider when picking a healthcare agent, along with a list of their duties and expectations. Space is provided for personal notes and a subset titled “If I Change My Mind About Having a Healthcare Agent.”
2. My Wish for the Kind of Medical Treatment I Want or Don’t Want:
   Wish two begins with a belief statement about the preciousness of life and human dignity. It defines and expands what it means to have a patient’s wishes respected and followed, plus the patient’s understanding of what constitutes life support.
   Five Wishes is a helpful workbook or guide in how to have difficult conversations, even in the best of circumstances.

   On paper, the discussion now opens up to accommodate what to do in particular patient scenarios: in case of an emergency; close to death; in a coma and not expected to recover; permanent and severe brain damage; or “another condition under which I do not wish to be kept alive.”

3. My Wish for How Comfortable I Want to Be:
   The next three pages focus on personal, spiritual, and emotional preferences. There are nine statements to be reviewed, and any with which the person disagrees are to be crossed out.
4. My Wish for How I Want People to Treat Me:
   This brief section covers a couple of wishes that unfold like spiritual care assessment: Does the person want pastoral presence from a minister or a praying community? Does the patient wish to be touched and talked to even if it appears they can’t respond? Does the patient wish to die at home, and does the patient wish to have others present when death seems imminent?
5. My Wish for What I Want My Loved Ones to Know:
   Again, this seems to be within the scope of spiritual care as the patient is asked to reflect on family dynamics, issues of forgiveness and reconciliation, disposition of the body, and funeral arrangements. There is room to articulate more on the patient’s autonomy and personal belief system.

The booklet concludes with what steps to take once the Five Wishes are completed. Particular steps are articulated, which make the document legal, binding, and a matter of public record. The wishes conclude with special attention to institutional residents, particularly in those states where witnessing requirements are in effect.

Maggie Finley, BCC, is a retired chaplain from Providence Hospice of Seattle.