Have you completed an advance directive, by itself or as part of a living will or trust?
It’s a good idea to review your forms every few years and sometimes you may want to add details that weren’t in your original document.
Using the Five Wishes Advance Directive
Described as “Living Will with Heart and Soul”, the Five Wishes advance directive was created by non-profit group Aging With Dignity, in 1996. The inspiration for Five Wishes came, when the founder Jim Towey had visited Mother Theresa’s home for the dying. He saw how people were treated with compassion and love. The agency worked on combining a living will and health care power of attorney in addition to addressing matters of comfort care and spirituality. They worked with the American Bar Association to assure that forms were legal. Many people, to be exact 25 million people have used Five Wishes to put their wishes on paper.
According to analysis by the American Bar Association’s Commission on Law and Aging, Five Wishes currently meets the legal requirements for an advance directive in 46 states and the District of Columbia, including California. In the remaining 4 states, (KS, NH, OH, TX) a statutory form is required, and one must attach the state document if one wishes to use the Five Wishes document as a guide.
How is Five Wishes advance directive different from a traditional living will?
The people who started Five Wishes, found that most people’s first response to those questions is to say they want their family or friends nearby. Or they say they want to be at home or to have their spiritual needs be attended to. These things are not part of most living trusts or wills.
So, Five Wishes’ goal was to provide a tool that addresses a person’s needs in his or her own words. Traditional living wills are written in terms intended for doctors or lawyers to address issues related to life support and Durable Power of Attorney, but they don’t cover things people say when you ask questions about end-of-life decisions. You can obtain a copy of Five Wishes at their website for a small fee: fivewishes.org.
Five Wishes Advance Directive will help your loved ones make decisions for your care, based on your wishes. You are giving your family or friends a gift by telling them what you want and do not want. This makes it easier for them to support you. If your wishes change, you can change your Advance Directive.
1. CHOOSING YOUR HEALTH CARE AGENT
We all would make our own decisions for care as long as we are mentally able. If a time comes and you are unable to talk or make decisions, your health care agent would make decisions based on the wishes your put down in this form.
It’s best to choose someone who knows you well, who you trust to honor your views and values… and someone who is able to make difficult decisions in stressful situations. Also, it helps to have an agent that will understand what the doctor is saying and someone who lives in your geographic area. Once you choose your health care agent, take the time to talk over your views and treatment goals and make sure they are willing to act as your decision maker.
You include who you want as your Health Care Agent-Primary Agent, First and Second Alternate Agent, and Powers of My Health Care Agent. There is space to put additional comments.
2. YOUR VALUES: WHAT MATTERS MOST TO YOU
Some may want to write about their religious or spiritual traditions, what a good day looks like or what matters most to them.
3. MY HEALTH CARE INSTRUCTIONS: My Choices, My Care
In this section, you can choose your wishes for treatment – to be followed if you become very ill and are not able to speak for yourself. Most of us don’t want to think about becoming seriously ill. With all the medical interventions, medicine and preventive procedures, more people are living longer. This means more of us face decisions about different kinds of medical treatment than in the past.
#1: You are asked to consider a situation if you had a sudden accident or stroke. Doctors say you have a brain injury, you are unable to recognize yourself or others. Doctors have told your agent/ family that you are not expected to recover these abilities. Life-sustaining treatments, such as ventilator or feeding tube, are needed to keep you alive. In this situation what would you want?
You can choose:
- I would want to STOP life-sustaining treatment. I realize this would probably lead me to die sooner than if I were to continue treatment. or
- I would want to continue life-sustaining treatments.
There is space to give additional instructions. Some people write in a certain time period that they would want to be kept alive if there were no improvement to their health.
#2. Addresses CPR (Cardiopulmonary Resuscitation)
The event given is that your heart and breathing stop, what would you want?
- I would want CPR attempted
- I never want CPR attempted, but rather permit a natural death, or
- I want CPR attempted unless the doctor treating me determines any of the following: I have an incurable illness or injury and am dying; I have no reasonable chances of survival if my. Heart or breathing stops; I have little chance of survival if my heart or breathing stops and the process of resuscitation would cause significant suffering.
4. YOUR HOPES AND WISHES (optional)
This is where you can spell out your hopes and wishes for end-of-life care. It addresses spiritual needs and organ donation. It addresses what things would bring you comfort at end of life.
5. THIS IS HOW WE MAKE THE DOCUMENT LEGAL.
In California, an Advance Directive is legal when it has been signed by two witnesses or notarized. If witnesses are chosen, one witness cannot be related to you (by blood, marriage, or adoption), or be entitled to any part of your estate. Your primary agent and Alternate agents cannot be witnesses.
When you are with witnesses or notary, sign your form on the last page. Be sure to make copies, one sent to your health plan, copies to your primary and alternate agent, and keep the original.
- How do you feel about this subject?
- How many of you have talked about care planning with your family or friends?
- Would you agree that this can be an emotion-laden topic?
- This is a process and sometimes we need time to complete or update our wishes. Treatments and technology may change and that could affect our decisions on care.
- By you talking about your individual wishes for care, you also help your loved ones continue have these important conversations. Do you agree?
Summary of presentation given at Stroke Support Association meeting by Gretchen Phillips, SSA Board President and retired social worker.