Five Wishes

How We Advise Clients About “Five Wishes”

You probably have bumped into the “Five Wishes” document before. It is widely promoted, and viewed favorably by most professionals and users.

You can order a paper copy of the Five Wishes workbook and form for (as of this writing) $5.00. Or, for $15.00, you can get an electronic version that lets you complete the form, print it out and sign it — and go back to make changes as your thinking evolves. The electronic version even tells you that you can sign it digitally, though we recommend caution if you decide to pursue that option.

But the ubiquity of the form and the low cost begs the real question: is the form any good? Is it a substitute for your Arizona health care power of attorney and/or living will? Are the various documents even compatible? Do we recommend the form to our clients? These are some of the questions our clients frequently ask about the Five Wishes document:

Where does The Five Wishes even come from?

If you were around in the 1990s you may recall a lot of discussion about advance directives. Usually the discussion centered on the “living will” — but that’s just one of several types of advance directive.

The federal Patient Self Determination Act of 1991 (the PSDA) really kick-started the discussion. Of course there had been concerns and suggestions before that, but the PSDA declared national support for patients being able to direct their own care. About the same time legislatures in Arizona and many other states created, formalized or even improved their advance directive laws.

In that milieu, the group Aging With Dignity set out to set out to create a universal advance directive. That effort ultimately became the Five Wishes project. The founder of the group was an attorney, and they sought input from lawyers, doctors, health care providers and public relations folks — all aimed at making their form useful, useable and universal.

Is the Five Wishes form legally valid in Arizona?

Yes. But keep reading.

If you complete and sign the Five Wishes document, you will have created a valid advance directive under Arizona law. Or at least, you will have if you get the necessary witnesses (or notarization). But you might also have revoked — or superseded — your existing advance directives. That might not be what you want to do.

For that matter, you might later revoke your Five Wishes document by signing a new advance directive at a lawyer’s office, or online. We frequently see clients signing the advance directive form offered to them at hospital intake, or at their doctor’s office. They may have forgotten that they have already signed perfectly valid (and probably more comprehensive) advance directives in our office.

Even if the Five Wishes is not signed, though, it is a useful document. It can help document your wishes, and your thought processes. Because it was designed with lay people in mind, it is easier to navigate and clearer than many other, less comprehensive, forms you might see.

So do we recommend the Five Wishes to clients?

Yes, but with this caveat: we think it’s a great tool to get you thinking about your wishes. But don’t sign it unless you mean it to be the final word on the subject. There’s nothing that prevents you from going through the process, filling out the form, and giving it to your health care agent (from the form we prepared for you) with a note that it should help them make the right decision for you.

We particularly like married couples to go through the Five Wishes process together. It can spark and lead discussions about difficult and complex subjects. It can help each partner better understand their spouse’s wishes.

Is the form you signed at Fleming & Curti better?

It’s not so much that our health care power of attorney and living will is “better” than the Five Wishes. It’s more that we’ve included things that you might not have thought of on your own, and that we’ve probed into a couple of the difficult questions with you.

For example: our usual health care power of attorney automatically includes language about mental health care issues. It also touches on your driving, your status as an organ donor (or not), your wishes for burial (unless you have told us that you do not have strong preferences). We also have talked with you about circulating your advance directives, notifying your agent(s), and reviewing your documents periodically. In short, we have done a better job of customizing your documents for your circumstances. And then we’re available to answer your questions, and give you after-the-signing assistance.

Are there quirks in Arizona law that affect this?

Well, yes, of course there are. Arizona is never quick to get on national bandwagons, and we’ve gone our own way a little bit, at least.

One key difference: no other state has a specific document like our “Prehospital Medical Care Directive.” Sometimes called “the orange form” (because it is supposed to be on orange paper), the form is a patient’s declaration that he or she would not want to be resuscitated outside the hospital or in an emergency room. The Five Wishes document does not help with that peculiarly Arizona provision.

That doesn’t mean that everyone in Arizona should sign a Prehospital Medical Care Directive. Far from it. But if you are a candidate for this type of form, you’ll need to get the Arizona-specific document and (probably) a little advice about what it means.

Note (because it’s a pet peeve of ours) that the Arizona Prehospital Medical Care Directive is not a “do not resuscitate” (DNR) order. That kind of medical order is entered by your physician (or qualified medical provider). The Arizona orange form is signed by the patient and directed to paramedics, EMTs, and emergency room physicians. The DNR is signed by a physician and is directed to hospital staff (usually) and other providers.

This all gets complicated by the spreading use of “Physician’s Orders on Life Sustaining Treatment” (POLST) forms. They are similar to DNR orders, and share some common points with Arizona’s orange form. But this kind of confusion is exactly why we’d rather you get advice about all of your advance directives. We can help you make sure your wishes are clear and enforceable.

So what’s the bottom line for Five Wishes? Good or bad?

Good. Unqualifiedly good. But as a process more than as a form.

We encourage clients to get the document, read through the directions, and answer the questions. But don’t sign it if you already have valid advance directives. Give the completed but unsigned form to your health care agent (and alternates). Make sure they know you’ve thought through the options, and encourage them to join in conversation with you and other family members about the concepts.

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