Five Wishes Document Explained

The Five Wishes document is a comprehensive advance directive widely used across the United States, combining elements of a living will, healthcare power of attorney, and personal wishes into a single form. Unlike standard living wills, which typically address only life-support decisions, Five Wishes covers broader end-of-life preferences and is designed to be emotionally accessible, making it popular among individuals seeking to communicate values to family and healthcare providers.

What Five Wishes Is (and Is Not)

Five Wishes is an advance directive—a legal document that communicates your healthcare wishes before you’re unable to express them. It’s published by Aging with Dignity, a nonprofit, and has become one of the most widely recognized advance-directive templates in America.

Unlike a dry legal living will, Five Wishes is written in plain language and organized around five core questions, encouraging reflection rather than rote checkbox-filling. The emphasis on personal values and spiritual wishes distinguishes it from purely medical directives.

Five Wishes is not a will (which distributes property and assets); nor is it a power of attorney (which grants broad financial decision-making). Rather, it’s narrowly focused on healthcare and end-of-life care.

The Five Wishes Sections

The document is structured around five core prompts:

Wish 1: The Person I Want to Make Care Decisions if I Can’t

You designate one or more healthcare agents (proxies) empowered to make medical decisions if you become incapacitated. You can specify an order of succession (if the first agent is unavailable, the second takes over). Many people choose a spouse, adult child, or trusted friend.

This section also allows you to define what “incapacitated” means to you—loss of consciousness, advanced dementia, terminal illness, or other criteria.

Wish 2: The Kind of Medical Treatment I Want or Don’t Want

Here you specify preferences for life-sustaining treatment in specific scenarios:

• Resuscitation and CPR if your heart stops
• Breathing machine (ventilator) use
• Feeding and hydration via tubes
• Antibiotics for infection
• Pain management and comfort measures

Rather than simple yes/no boxes, Five Wishes allows narrative explanation. You might write, “I do not want CPR if I have advanced dementia and cannot recognize my family,” or “I want aggressive treatment as long as there’s a reasonable chance of meaningful recovery.”

Wish 3: How Comfortable I Want to Be

This section addresses symptom management and pain relief. You can specify that comfort and dignity matter more than extending life, or conversely, that you want aggressive treatment despite side effects. You might prioritize being alert over being pain-free, or vice versa.

Wish 4: How I Want to Be Treated

This addresses personal dignity and psychological comfort. You might request:

• Who should be present at the end
• Whether you want to die at home, hospital, or hospice
• Religious or spiritual practices important to you (last rites, prayer, specific rituals)
• Preferences for music, lighting, or personal touches
• Whether you want your body to be an organ or tissue donor

Wish 5: What I Want My Loved Ones to Know

A freeform section for a personal message: your hopes, regrets, forgiveness, love, or final thoughts you want family to understand. This turns the document into a letter, not just a medical directive.

Legal Validity by State

Five Wishes is recognized as a valid advance directive in 42 U.S. states and the District of Columbia. The states where it is not specifically recognized by statute are:

• Alabama
• Delaware
• Georgia
• Idaho
• Kansas
• Louisiana
• Mississippi
• Missouri
• New Hampshire
• North Carolina
• South Carolina
• Texas
• Utah
• Wisconsin
• Wyoming

Even in these states, Five Wishes may still be considered persuasive evidence of your wishes, though it lacks the same legal presumption. Many hospitals and healthcare systems accept it nation-wide as a practical matter, even in non-statutory states.

For complete legal validity in these holdout states, residents should supplement Five Wishes with a state-specific statutory living will or power of attorney form, available through state bar associations or the Secretary of State’s office.

Signature and Witness Requirements

Five Wishes requires:

• Signature by the person (principal) creating the document, dated and witnessed.
• Two adult witnesses (not the healthcare agent, not immediate family in most states, not the patient’s physician or hospital employees).

Notarization is not required by law in most states but is recommended, as it adds an extra layer of legal presumption if the document is ever challenged. Many notaries will notarize Five Wishes for a small fee ($10–25).

The witness process should be taken seriously. Witnesses are testifying that you appeared mentally competent, acted voluntarily, and understood the document. If disputes arise (e.g., a family member claims you lacked capacity), witnesses may be called to testify.

How Healthcare Providers Use It

Once signed, copies should be:

• Given to your primary care physician (for placement in the medical record)
• Shared with your healthcare agent
• Distributed to close family members
• Brought to the hospital if you’re admitted
• Kept in an accessible location at home (not a safe deposit box, which may be locked after death)

Healthcare providers treat Five Wishes as a binding advance directive (in states where it’s recognized) or as strong evidence of intent. When you’re unable to communicate, the healthcare team consults the document and your designated agent to make decisions aligned with your wishes.

In practice, good advance directives prevent conflict. When a dying patient’s wishes are clearly documented, families experience less grief and guilt, and medical teams avoid ethically fraught guesswork.

Comparison with Other Advance Directives

Living will vs. Five Wishes: A living will addresses only life-sustaining treatment (breathing machines, feeding tubes) in terminal conditions. Five Wishes is broader, covering pain management, organ donation, spiritual wishes, and personal messages.

Healthcare power of attorney vs. Five Wishes: A POA appoints an agent but doesn’t detail specific medical wishes. Five Wishes combines agent appointment with detailed preferences, reducing the agent’s burden of guessing.

POLST or MOLST form vs. Five Wishes: A Physician Orders for Life-Sustaining Treatment (POLST) form is a medical order (not an advance directive) used in clinical settings, signed by a doctor. It translates advance directives like Five Wishes into actionable medical orders. Many states now recognize Five Wishes as a valid input to POLST conversations.

For most people, Five Wishes alone is sufficient. For complex medical situations or those living in non-statutory states, combining Five Wishes with a state-specific power of attorney is prudent.

Common Pitfalls

Not distributing copies: A signed Five Wishes document gathering dust in a drawer is useless. Make sure your healthcare agent, doctor, and family know where it is and have copies.

Vague or conflicting wishes: “I want everything done but I don’t want to be a burden” is contradictory. The clearer and more specific your wishes, the better providers can honor them.

Appointing a conflicted agent: Designating someone geographically distant, unlikely to survive you, or emotionally unable to make end-of-life decisions creates problems. Choose someone trustworthy and local.

Forgetting to update it: If your wishes change due to illness, marriage, divorce, or shifting values, revise the document. Old documents can create confusion if they conflict with your actual current wishes.

Using an outdated or unsigned version: Five Wishes forms are updated periodically. Ensure you’re using the current version and that it’s properly witnessed and dated.

State-Specific Supplements

For residents of non-statutory states, many healthcare providers and bar associations offer state-specific living will or healthcare power of attorney forms. These should be used alongside Five Wishes to ensure legal validity. For instance, a Texas resident might:

1. Complete Five Wishes (for its comprehensiveness and personal value)
2. Complete the Texas Directive to Physicians (state statutory form)
3. Ensure the healthcare agent is designated in both

This belt-and-suspenders approach maximizes legal certainty and clarity.

See also