November 28, 2011

‘Tis the season for giving thanks and making wishes, making it the perfect time to spread the word about Five Wishes, the revolutionary "living will with a heart and soul."

Introduced in 1997 through the Tallahassee, Fla.-based Aging with Dignity foundation, 15 million copies of the Five Wishes document have been distributed through 23,000 organizations, mostly faith-based groups, as well as cancer centers, medical offices, hospitals, hospices, attorneys and financial planning officers, and individual employers.

Aging with Dignity founder Jim Towey found inspiration for Five Wishes in the wise philosophy of Mother Teresa, whom he served as legal counsel while volunteering in her service to the poor and dying. From those origins of spirituality and law, the list of supporters and shapers through the years has grown long and diverse, ranging from the Robert Wood Johnson Foundation to the American Bar Association.

Accepted as a legal document in 42 states and the District of Columbia, Five Wishes simply, in plain language (26 of them, actually, and Braille), offers a place for individuals to express their medical end-of-life choices, and to guide the construction of their personal legacy as well.

The Five Wishes are:

1. My wish for the person I want to make health care decisions for me when I can’t make them for myself.

2. My wish for the kind of medical treatment I want or don’t want.

3. My wish for how comfortable I want to be.

4. My wish for how I want people to treat me.

5. My wish for what I want my loved ones to know.

The questions raised by the document are deep and profound, but ultimately rewarding for most individuals, writes Susan P. Plummer, MSW, Ph.D., executive director of the Alliance for Living and Dying Well. Contemplating life’s meaning and death’s inevitability allows people to "feel more vividly the preciousness of life, what really matters, and experience a deeper sense of connection with the life around us," she says.

The document is used in the "My Choices My Wishes" advanced care planning program at the Greenwood Village, Colo.-based Rocky Mountain Cancer Centers, said Susan Ash-Lee, M.S.W., L.C.S.W.,  manager of psychosocial support services.

The Five Wishes-centered seminar offers patients and families more than a brief, pro forma advanced directives talk with a nurse, oncologist, or social worker, said Ms. Ash-Lee in an interview.

"We say, 'Let’s talk about who you are now, who you were before, and what worries you have for the future. Who are you and what do you value? How will we know when your values come up against medical treatment?' "

Many families ultimately welcome the idea of a forum for emotional meaning-making, legacy-building conversations that go far beyond a loved one’s desire to have (or reject having) a Do Not Resuscitate Order in place, she said.

As part of her training, Ms. Ash-Lee filled out the document herself and learned that "my family is just like the families we face everyday," with some members reticent to talk about the end of any family member’s life and unsettled by the idea that there are circumstances in which she would no longer want treatment.

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