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What Is the Five Wishes Advance Directive?

By CRYSTAL BAI •

What Is the Five Wishes Advance Directive?

The short answer: Five Wishes is a nationally recognized advance directive created by Aging with Dignity that goes beyond standard legal forms to express personal, emotional, and spiritual end-of-life preferences — including how you want to be comforted, touched, and spoken to, and what you want loved ones to know. It is legally valid in 42 states and is often called 'the living will with a heart.'

What Is Five Wishes?

Five Wishes is a nationally recognized advance directive document created by Aging with Dignity, a nonprofit organization, in 1997. Unlike standard state advance directive forms — which typically focus on legal and clinical questions — Five Wishes is written in plain English and invites people to express not only their medical treatment preferences but also their personal, emotional, and spiritual wishes for the end of life. It is sometimes called the "living will with a heart."

The Five Wishes

The document addresses five core areas:

  1. Wish 1 — The Person I Want to Make Care Decisions for Me When I Can't: Designates a healthcare agent (proxy) — the same function as a durable power of attorney for health care. Includes specific instructions for that person.
  2. Wish 2 — The Kind of Medical Treatment I Want or Don't Want: Documents preferences for life-sustaining treatment, CPR, mechanical ventilation, artificial nutrition, and comfort care — the same function as a living will, but in plain language.
  3. Wish 3 — How Comfortable I Want to Be: Expresses preferences for pain management, personal care, spiritual comfort, and specific comfort measures. This section goes beyond standard living will language to address quality of experience.
  4. Wish 4 — How I Want People to Treat Me: Covers personal care preferences — being touched, spoken to, prayed over, having music playing, having family present. Asks about privacy and dignity.
  5. Wish 5 — What I Want My Loved Ones to Know: Invites the writer to express what they want their family and loved ones to know — about forgiveness, love, and what matters most. This is the most personal and distinctive section of Five Wishes.

Why Five Wishes Is Different

Standard advance directives answer clinical questions about medical treatment. Five Wishes additionally asks: What do you want to feel like at the end of your life? How do you want to be treated as a person? What do you want the people you love to know? These questions produce a richer document that helps healthcare providers and family members understand the whole person, not just their medical preferences.

Five Wishes meets legal requirements for advance directives in 42 U.S. states when properly signed and witnessed. In states where it doesn't fully meet technical requirements, it can be used alongside the state's own advance directive form. The Aging with Dignity website maintains a current state-by-state legal status guide.

How to Complete Five Wishes

  1. Obtain the current version at agingwithdignity.org or from your hospice, hospital, or physician's office
  2. Read through all five wishes carefully before completing any section
  3. Consider discussing with your healthcare proxy and family before completing
  4. Complete all sections — the document is most valuable when fully completed
  5. Sign in front of two adult witnesses (check state requirements; most states require witnesses who are not your agent, healthcare provider, or direct beneficiary)
  6. Distribute copies to your healthcare proxy, primary care physician, and hospital

Five Wishes and Death Doulas

Death doulas frequently use Five Wishes as a starting point for advance care planning conversations. The document's personal and values-based questions create entry points into the kinds of conversations that death doulas specialize in facilitating. Renidy can connect you with a death doula who helps clients complete Five Wishes and build a comprehensive advance care plan.

Frequently Asked Questions

Is Five Wishes legally valid in all states?

Five Wishes is legally valid as an advance directive in 42 states. In the remaining states it may not meet all state technical requirements to serve as a standalone legal document but can be used alongside state-specific forms to express your wishes. Check Five Wishes' website for current state-by-state status.

How do I get a copy of Five Wishes?

Five Wishes documents are available through Aging with Dignity (agingwithdignity.org). They can be downloaded digitally or ordered in print. The cost is minimal — a few dollars for print copies. Many hospitals, hospice organizations, and community organizations provide them at no cost.

Can I use Five Wishes in addition to my state's advance directive?

Yes, and this is often recommended. Complete your state-specific advance directive for legal compliance, and complete Five Wishes for the additional personal and values-based guidance it provides. Healthcare providers and family members benefit from having both.

Does Five Wishes replace a POLST or DNR form?

No. Five Wishes is an advance directive that expresses your values and preferences. A POLST/MOST/POST is a physician-signed medical order for seriously ill patients that translates those wishes into immediately actionable clinical orders. Both serve different functions and may both be appropriate.

Can a death doula help me complete Five Wishes?

Yes. Death doulas frequently assist clients with completing Five Wishes and other advance planning documents. They can help you think through the values questions (Wish 2) and personal care preferences (Wishes 3, 4, 5) that make Five Wishes distinctive. Renidy can connect you with a death doula for advance care planning support.

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