Five Wishes, Next Step and Consumer’s Tool Kit for Health Care Advance Planning -Chapter 6

You may have heard about a document called "Five Wishes," which has received wide recognition from feature stories in the media. It is a document that combines the "Living Will," Power of Attorney for Health Care and C.P.R. directions but with more personal and detailed expressions of your wishes under various circumstances.

"Five Wishes" contains categories in which you state:

1. Whom you want to make your health care decisions

2. Your choice of medical treatment under various conditions

3. Details of how you want to be treated by caregivers

4. Instructions on care for your comfort

5. Final expressions of love for family and friends and how you wish to be remembered.

A volunteer who cared for Mother Teresa during her final illness, Jim Towey, developed "Five Wishes" based on his experience. He also founded the Commission on Aging with Dignity, a non-profit organization. The Commission and the American Bar Association Commission on Legal Problems for the Elderly worked together on this document to determine that it is valid under the health care statutes of 33 states, including Colorado.

"Five Wishes" helps people exercise their rights to decide the kind of medical treatment and care that they do or don't want when seriously ill.

Good Advance Planning is a Continuing Conversation
Advance planning for health care is always a work in progress. That's because circumstances change and lives change. One's values and priorities even change. As a sage remarked, "The world looks very different when you're horizontal rather than vertical."

Five Times to Re-Examine Your Health Care Wishes...
1. Before each annual physical exam.

2. At the start of each decade of your life.

3. After any major life change—such as birth in the family, marriage, divorce, remarriage and especially after the death of a loved one.

4. After any major medical change—such as being diagnosed with a serious disease or terminal illness. Or if such conditions worsen.

5. After losing your ability to live independently.

If your wishes change . . .

Make a new advance directive if your old one no longer reflects your wishes. Ask about the proper way to cancel or amend your existing directive in your state. If you change your advance directive, it is important to notify everyone who has copies of your old medical directive forms.

What to do With Your Advance Directive
1. Keep the original copy of your health care advance directive and these work sheets or other notes some place they can easily be found.

2. Give your chosen proxy a copy of the directive, plus any worksheets or notes. Make sure your proxy knows where to find the original.

3. Give your doctor a copy of your directive. Make certain it is put in your medical record. Make sure your doctor will support your wishes.

4. Carry an advance directive wallet card with you.

5. If entering a hospital or nursing home, take a copy of your directive with you and ask that it be placed in your medical record.

6. Some organizations offer to register advance directives electronically and enable health care institutions to access them electronically. Some churches and synagogues keep advance directives on file for members. You may wish to consider such a service.

If You Don't Want Emergency C.P.R., One More Step
After completing your advance directive, you may have to take one more step if you want to avoid C.P.R., or other life support when an ambulance (911) is called.

Some people with serious and irreversible conditions do not want an emergency medical team to give them C.P.R. if their heart stops. If this is your wish, ask how to get a D.N.R. (Do Not Resuscitate Order) that will be respected outside of hospitals. These are also called out-of-hospital D.N.R. orders, comfort-care-only orders or by other similar names. They usually require your physician's signature and your consent. You will get a special identifying bracelet or document that must be visible if you have a medical crisis. If the emergency medical team sees the proper bracelet or document upon arrival, you can expect to receive all necessary comfort care—but no life support.