In an earlier post, I wrote about why people should consider having an advance medical directive that appoints a trusted relative or friend to make medical decisions for her if she is unable to make those decisions herself because she’s in a coma, or is otherwise unable to communicate with doctors. This post concerns the form in which a medical directive should or could be made.
One well-known directive is called Five Wishes. Many hospitals distribute this directive, which meets the requirements of the District of Columbia and 35 states. It can be ordered from the Internet at www.agingwithdignity.org/5wishes.html, and there is a list on the website of the states where it is legal. Persons who live in other states should consult with a lawyer in their state to see how the requirements compare. Five Wishes is also available from Aging with Dignity at P.O. Box 1661, Tallahassee, Florida 32302-1661.
Five Wishes contains five sections. Wish One allows your loved one to select a health care agent and an alternate and to authorize her to exercise a given level of decision-making. A detailed list of what she may be authorized to do is included and your loved one may cross out anything she does not want her to do. There is also space to write specific instructions.
Wish Two allows your loved one to tell you and her loved ones just what “life-support treatment” means to her. There is space to write exactly what “extra-ordinary measures” means to her. In addition, she can choose different levels of life support depending on three specific situations: where she is close to death, where she is in a coma and not expected to wake up or recover, and where she is suffering permanent and severe brain damage and is not expected to recover.
Wish Three allows your loved one to tell you and your family how comfortable she wants to be. A long list of options for care and treatment that individuals might naturally want are listed, and she may cross out anything she doesn’t want. Thus, the need to anticipate options is already done for her and individualizing the form to her own particular value system is very easy.
Wish Four allows your loved one to tell you and her family how she wants to be treated – whether she wants someone at her bedside, whom she wants there, whether she wants pictures of her family nearby, and so on.
Wish Five is called “What I Want my Loved Ones to Know.” This section allows your loved one to give end-of-life messages to you and your family and to address issues related to grieving and funerals or memorial services.
Five Wishes is not only clear, it can be individualized. It is a document that most individuals are comfortable with because it isn’t written in “legalese.” The Miami Herald called Five Wishes a “living will with a heart and soul.”
Having an advance directive and designating a patient advocate or health care agent provides your loved one with assurance that her wishes regarding her last days or hours will be honored. It also helps families make difficult end-of-life decisions about issues that can be distressing to families. Family caregivers may need reassurance that carrying out their loved one’s last wishes will not cause her pain and discomfort. This is particularly true if she has expressed a wish that nutrition and/or hydration be withheld or withdrawn, as that type of decision can be very, very difficult for her children to make.
For more information on end of life choices, including more information about whether to begin or to terminate tube feeding, see Chapter Nine, Taking Charge: Good Medical Care for the Elderly and How to Get It, by Jeanne M. Hannah.
To contact Jeanne Hannah with your questions or to view her Family Law website, click here.
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