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Five Wishes We All Should Make

By Walter L. Guertin, CFP®, CPA/PFS, CSA
Senior Vice President, Financial Planning

The debate over the care of Terri Schiavo made very public an issue that most individuals are reluctant to discuss: What decisions need to be made in the event of an incapacitating illness? An important component of any estate plan (you do have an up-to-date one, don't you?) is a Health Care Proxy. A Health Care Proxy permits an individual to name a legal representative who has the authority to direct your medical care if you become incapacitated or comatose. It may also contain language that directs the legal representative to make decisions on your behalf. However, such guidance is left to the discretion of the legal representative and may, or may not be, what you had in mind.

Fortunately, there is now a document that addresses the shortcomings of a Health Care Proxy. It is called Five Wishes. You may have heard of it since it has been increasingly gaining prominence, particularly during the Schiavo controversy. In simple terms, Five Wishes is the first living will that talks about a person's personal, emotional, and spiritual needs as well as medical wishes. In addition to letting you choose the person whom you would like to make health decisions on your behalf if you are not able to make them for yourself, it lets you express exactly how you wish to be treated if you get seriously ill. It was written with the help of The American Bar Association's Commission on the Legal Problems of the Elderly, and the nation's leading experts in end-of-life care. It was inspired by a gentleman named Jim Towey who worked closely with Mother Teresa and, for a year, lived in a hospice that she ran in Washington D.C. Mr. Towey felt that there had to be a better way for patients and their families to cope with serious illness. From this, the Five Wishes document was developed.

Thirty-five states and the District of Columbia have determined that the Five Wishes can be considered a legal document under their laws. In New England, these states are Connecticut, Maine, Massachusetts and Rhode Island. If you already have a living will or a durable power of attorney, the Five Wishes document can supersede them. Here they are:

 

Wish 1

THE PERSON I WANT TO MAKE HEALTH CARE DECISIONS FOR ME WHEN I CAN'T MAKE THEM FOR MYSELF.

Similar to a health care proxy, this wish names the person who is authorized to make health decisions for you. The person will make this health care choice if the attending physician finds that you are no longer able to do so AND another health care professional agrees that this is true. This person can then make choices based on your wishes which, depending on what you decide in this document, may or may not include:

  • Requesting, taking away or not giving medical treatments;
  • Arranging for admission to a hospital, hospice or nursing home;
  • Making the decision to request, take away or not give medical treatments to keep you alive;
  • Authorizing or refusing any medication or procedure to help with pain;
  • Donating usable organs or tissues, as permitted by law.

 

Wish 2

MY WISH FOR THE KIND OF MEDICAL TREATMENT I WANT OR DON'T WANT.

This wish focuses on caregiver instructions regarding pain management, whether you wish to be offered food and/or fluids and also lets you describe in your own words what "Life Support Treatment" means to you under various circumstances such as when you are:

  • Close to death;
  • In a coma and not expected to wake up or recover;
  • Not expected to recover because of permanent and severe brain damage;
  • In any other condition that you might describe in this document.

The next three wishes focus on personal, spiritual and emotional issues.

 

Wish 3

MY WISH FOR HOW COMFORTABLE I WANT TO BE.

The document provides a list of "comfort" items and asks you to cross out anything that you don't want, such as:

  • Being pain free, even if it means being drowsy;
  • Having a cool moist cloth put on your head if you have a fever;
  • Being massaged with warm oils;
  • Having your favorite music played when possible until the time of your death;
  • Having religious readings and well-loved poems read aloud when you are near death.

 

Wish 4

MY WISH FOR HOW I WANT PEOPLE TO TREAT ME.

Some of the choices here include whether:

  • You wish to have people with you when you are near death;
  • You wish to have your hand held and be spoken to, even when it appears that you are not responsive;
  • You wish to have members of your church or synagogue told that you are sick and be asked to pray or visit you;
  • You wish to have pictures of your loved ones near your bed;
  • You want to die at home, if possible.

 

Wish 5

MY WISH FOR WHAT I WANT MY LOVED ONES TO KNOW.

This contains a long list of potential wishes and there is space provided to add more. These include:

  • Wishing to have family and friends know that you love them;
  • Wishing to have family and friends remember you after death like you were before you became ill;
  • Having family and friends and caregivers respect your wishes, even if they don't agree with them;
  • Having family and friends look at your dying as a time of personal growth for everyone, including yourself;
  • Whether you wish to be buried or cremated;
  • Whether you wish any or all parts of your body to be donated;
  • How you wish to be remembered;
  • If there is a memorial service for you, what you wish the service to include, such as music, songs, readings or anything else.

This is a very comprehensive document that covers all aspects of dying. While it is never pleasant to think about these things, as the saying goes, it is the one thing besides taxes that we all know is inevitable. Now is the time to answer these questions so your loved ones know your wishes.


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