I wrote yesterday about Atul Gawande’s book, Being Mortal. I’m following up with a post about an organization called Five Wishes, which helps families have conversations with their loved ones about the kinds of care and comfort they want as they approach the end of their lives.
When it became clear that my father was experiencing a gradual cognitive decline, I contacted a lawyer about drawing up a health care proxy and an advance directive. What came back may have been legally suitable, but it was so dry and dispassionate as to seem almost cold-blooded. I found I didn’t even want to show it to my parents. But by that time a friend of mine had shared with me an example of the Five Wishes document, and I was struck by how humane and empathetic it was. While it was entirely sound from a legal perspective, it was obviously written with a commitment to providing caring support and guidance. I discarded the documents I had paid my lawyer to draft and went with the Five Wishes document instead.
The Five Wishes document is designed to enable families to discuss and capture their loved one’s preferences in five categories:
- The person who will be empowered to make care decisions for them should they be unable to make such decisions themselves
- The kinds of medical treatment they want or don’t want
- How comfortable they want to be
- How they want people to treat them
- What they want their loved ones to know
You pay five dollars for a printed copy of the document pre-printed with the name and birthdate of the person for whom it’s intended. It contains a range of options for each aspect of end-of-life care. The idea is to go through the document with the person it’s intended for and record their wishes in each category. Alternatively, you can make these selections online and have the system generate a PDF document that has the desired options selected. (I recommend the former as it allows for finer customization.)
There are questions asking what kind of care the person wants under any of several hypothetical scenarios: if they are close to death, in a coma and not expected to wake up, or suffering from severe brain damage and not expected to recover.
But there are also selections that you wouldn’t find in an advance directive written strictly from a legal perspective. For example, the person can specify how they want others to treat them when it seems that death may come at any time — for example, whether they want to have visitors, be talked to, or be prayed for. They can also specify what they want their loved ones to know, such as that they are at peace with dying, or that they want their loved ones to seek counseling if they have trouble dealing with the person’s death. My mother, who is a churchgoer, was able to specify what kind of funeral service she wanted, and even one of the hymns she would want played.
Once the document is completed you get it signed and notarized. It legally serves as both an advance directive and a health care proxy designation.
My father died in April, and having talked through the choices in the document gave me confidence that I would be able to make decisions both before and after his death that were consistent with his wishes. I would recommend this exercise to anyone whose parents are getting older or who are getting older themselves. It’s all too easy to defer such discussions until it’s too late to have them, but the Five Wishes document makes it much easier to have these conversations and to do so in a caring and thorough manner.