Ninety percent of people say talking to family about end-of-life care is important yet only 27 percent have done it. Fewer have put end of life wishes in writing.

The good news is we can completely change the end-of-life experience for the better beginning with careful preparation of an Advance Directive.

An Advance Directive consists of a living will and a health care proxy.

Most descriptions of an Advance Directive state it is a document made up of a living will detailing your choices of what you want and what you don’t want for end of life care and the designation of a health care proxy (often called a health care power of attorney) to be the person you choose to make health care decisions for you if you can’t. Both of those statements are untrue.

While an Advance Directive is an ethically moral document, it is not a legal one. If the doctor disagrees with what’s in your Advance Directive, he is not legally required to follow it.

If you or your loved one are diagnosed with a serious illness that indicates the need for standing medical orders, you can ensure end of life wishes are followed by obtaining a Physicians Orders for Life-Sustaining Treatment (POLST) or Medical Orders for Life-Sustaining Treatment (MOLST) form. Your Advance Directive is written into the POLST or MOLST form. It is discussed with and signed by your doctor. It then becomes a legal medical order that must be followed. NOTE: A POLST/MOLST order is not itself an Advance Directive or a substitute for appointing a health care proxy.

Anyone can prepare an Advance Directive. A lawyer is not required, and few states require notarization. Standard Advance Directive forms let you to state your wishes, but they lack subjective thought, scenarios, or holistic values.

A Health Care Proxy’s responsibility is to speak your wishes that you have chosen and made known, not to make decisions for you.

Completing a Health Care Power of Attorney is not about naming a person to make medical decisions if you become unable to make them yourself. The proxy’s role is to inform people of the decisions you already made while you could.

Five Wishes

A popular way to complete your Advance Directive (Living Will + Health Care Proxy) is by using the 5 Wishes program that walks you through the decision-making process before a health crisis arises. It is a way for the patient to communicate what he/she wants. Five Wishes currently meets legal requirements in 42 states and can be used in all 50 states by attaching a completed 5 Wishes document to the standardized state forms required in the others. It does not, on its own, override a doctor’s decisions. It is important to check your state laws to see which parts are binding. Otherwise, you may need to obtain a POLST/MOLST form as discussed above or take other steps.

The 5 Wishes Advance Directive is written in easily understood language. It is changing how we discuss advance care planning by focusing the attention on what the individual wants.

What are the 5 Wishes?

  1. The person I want to make care decisions for me when I can’t.
  2. The kind of medical treatment I want or don’t want.
  3. How comfortable I want to be.
  4. How I want people to treat me.
  5. What I want my loved ones to know.

Wish 1 is where you choose a heath care proxy, as discussed earlier.

Wish 2 asks what kind of medical treatment you want or don’t want. This question constitutes the “living will.” It presents four of the most common life-support treatment scenarios and you choose whether you want any of the options listed.

(NOTE: This is not a Do Not Resuscitate Order, which is a medical order signed by a doctor that generally is used to restore breathing and heart function to patients who are capable of sustaining life.)

Wish 3 asks how comfortable you want to be. It stresses how you want pain managed. It allows you to state your likes and dislikes about your environment, including your favorite music, visitors, etc. It also asks for you to be given information about hospice and comfort care.

Wish 4 is where you can indicate how you wish people to treat you, if you want to be held etc.

Wish 5 asks you to tell your loved ones what you want them to know. This wish addresses matters of “closure.” You have the chance to offer love and forgiveness to those who have hurt you or who you hurt. There is also a place to list your favorite hymns that could be sung at your funeral or the celebration of your life.

How do I use the 5 Wishes Advance Directive?

Review and complete the document. Discuss it with your family. Sign it and have it witnessed or notarized if required.

Discuss your 5 Wishes with your health care proxy and doctor. Scan and provide electronic copies of your signed 5 Wishes to your doctor, healthcare proxy, and other loved ones and friends. Make sure your doctor includes a copy in your medical file. Store the original in an easily located place.

You can change your 5 Wishes Advance Directive at any time. Update it annually and when you experience significant life events like marriage, divorce, new children, or a major medical diagnosis. Inform your health care proxy, family, and friends of changes.

If the idea of discussing the 5 Wishes and other end of life matters is intimidating, consider consulting a nationally-certified End of Life Doula Giver Care Consultant who is trained to facilitate such conversations with individuals and families.

For further information, contact: TSP Family Office at (772) 257-7888 or