Five Wishes Advance Directive: What It Covers and When to Use It

Most advance directive forms read like legal contracts. Boxes to check. Clinical terminology. No room for what actually matters to your parent — whether they want music playing, who should be in the room, or how they define a life worth living.

Five Wishes takes a different approach. Created by the nonprofit Aging with Dignity, it's an advance directive that goes beyond the standard medical and legal checkboxes to address the personal, emotional, and spiritual dimensions of end-of-life care. It's written in plain language and structured around five questions that most clinical forms never ask.

What the Five Wishes Cover

Wish 1: The person I want to make care decisions for me when I can't. This is the healthcare proxy designation — functionally identical to a durable power of attorney for healthcare. The signer names a primary agent and an alternate.

Wish 2: The kind of medical treatment I want or don't want. This covers the standard living will territory: CPR, mechanical ventilation, feeding tubes, dialysis, and antibiotics in terminal situations. But it uses accessible language rather than clinical jargon, framing each option as a yes/no choice the signer can understand without medical training.

Wish 3: How comfortable I want to be. This is where Five Wishes diverges from standard forms. It addresses pain management preferences, bathing and grooming, being held or touched, and whether the person wants to be kept at home rather than hospitalized. Standard advance directives rarely cover comfort care at this level of detail.

Wish 4: How I want people to treat me. Preferences about dignity, privacy, and interpersonal care: being addressed by a preferred name, having personal grooming maintained, being read to, having someone present at all times (or being allowed solitude). These preferences matter enormously in practice but appear on virtually no state statutory form.

Wish 5: What I want my loved ones to know. Space for personal messages — forgiveness, gratitude, burial or memorial preferences, and the person's own words about what made their life meaningful. This section transforms a legal document into a personal legacy statement.

Legal Validity: Where Five Wishes Works

Five Wishes meets the legal requirements for an advance directive in 44 US states and the District of Columbia. In the remaining states — Alabama, Indiana, Kansas, New Hampshire, Ohio, and Oregon — it doesn't satisfy the state-specific statutory form requirements on its own. Families in those states can still complete Five Wishes as a supplement to the state-mandated form, attaching it to communicate preferences the official document doesn't cover.

Outside the US, Five Wishes is not a legally binding document, though it can serve as a values-clarification tool alongside the country's own advance directive framework (Lasting Power of Attorney in the UK, Representation Agreement in British Columbia, Personal Directive in Alberta).

The document costs $5 for a print copy or $7.50 for a digital download from Aging with Dignity. Bulk pricing is available for healthcare systems and hospice programs.

Five Wishes vs. State Statutory Forms

The appeal of Five Wishes is its emotional depth and readability. The limitation is that it can create a false sense of completion.

Five Wishes does not replace:

• A POLST or MOLST form. Five Wishes is a legal directive, not a medical order. Emergency responders cannot follow it. Seriously ill patients still need a clinician-signed portable medical order.
• A separate financial power of attorney. Five Wishes covers healthcare decisions only.
• State-specific requirements. Some states mandate specific statutory language, particular witness qualifications, or notarization that Five Wishes may not include in its standard template.

The strongest approach is to use Five Wishes as the values conversation tool — the document that captures what matters most to your parent in their own terms — and then ensure the clinical and legal requirements are met through the appropriate state forms and medical orders.

When Five Wishes Is the Right Starting Point

Five Wishes works best as the first document in a family's advance care planning process, particularly when:

• The parent is resistant to "legal" paperwork — Five Wishes reads like a personal letter, not a court filing, which reduces defensiveness
• The family hasn't had the values conversation yet — Wishes 3, 4, and 5 naturally prompt discussions that most families avoid
• Multiple siblings need alignment — sharing the completed Five Wishes document gives everyone the same reference point for the parent's preferences
• The parent is in early cognitive decline — the plain-language format is easier to understand and complete than dense legal forms

For families who've already completed state-specific healthcare proxy and living will forms, Five Wishes can still add value by documenting the personal comfort, dignity, and legacy preferences that standard forms leave blank.

How to Complete Five Wishes

1. Order the document from Aging with Dignity or obtain a copy through your parent's hospital, hospice, or faith community — many distribute them free
2. Go through it together in a calm setting, not during a medical crisis. Treat it as a conversation, not a form-filling exercise
3. Sign with proper witnesses — Five Wishes includes its own witness section, but verify your state's specific witnessing requirements
4. Distribute copies to the named healthcare agent, the parent's physician, and any care facility
5. Review annually or whenever the parent's health status changes significantly

The End-of-Life Conversations and Advance Care Planning Toolkit includes conversation scripts designed to walk families through the values discussion that Five Wishes is built around, along with worksheets that help organize treatment preferences before any formal documents are signed.