Five Wishes document

Five Wishes is an advance directive published by Aging with Dignity, a nonprofit. It is written in plain language, it covers ground statutory forms ignore, and it is sold, $5 for a paper copy, $7.50 for the digital version.

We do not sell it and we are not affiliated with it. What follows is what its publisher says, what we could verify, and what a free state form does instead.

What is in it

Five sections, which the publisher calls wishes:

1. My Healthcare Advocate: "Choose the person you trust most to make legal healthcare decisions and carry out your wishes when you can't do so yourself."
2. My Treatment Wishes: "Outline in your own words the medical treatments you want or don't want if you become seriously ill."
3. How Comfortable I Want to Be
4. How I Want People to Treat Me
5. What I Want My Loved Ones to Know

Mapped onto the legal instruments: Wish 1 is a healthcare power of attorney. Wish 2 is a living will. Wishes 3, 4, and 5 are comfort, personal treatment, and legacy, the material no statutory form covers.

That last part is the honest case for the document. A state form tells a hospital who decides and what treatment you refuse. It does not ask whether you want music in the room, or who you want told, or what you would like said. If those questions matter to you, Five Wishes asks them and a statutory form does not.

The publisher notes it "was written with the help of the American Bar Association's Commission on Law & Aging."

The legal validity claim, in three versions

Here the care is warranted, because the publisher does not say the same thing in the same place twice. All three of these are current, quoted from its own sites.

On agingwithdignity.org, the claim is unqualified:

Five Wishes is user-friendly, easy to understand, legally valid in all fifty states, and available in 32 languages plus Braille.

On the fivewishes.org homepage, a statistics block gives a different number:

46, States where it meets legal requirements

On the fivewishes.org FAQ, a third version, with a carve-out:

It meets legal requirements and is used in all 50 states ... As noted on page 3 of Five Wishes, only four states have additional requirements that may require the use of a state form.

Those four states are named elsewhere on the same site as New Hampshire, Kansas, Ohio, and Texas.

Fifty, forty-six, and fifty-minus-four are three different answers to the same question, published simultaneously by the same organisation. That is not evidence of a bad document. It is evidence that "valid in all fifty states" is a marketing sentence rather than a legal finding, and it is why we will not repeat the claim in our own voice.

We found no state statute that names Five Wishes. We did not search all fifty, so read that as what it is, we looked and did not find one, not proof that none exists.

What the "extra step" actually is

The publisher does not say. Its own wording is that you "may need to take an extra step" and "may require the use of a state form," and it refers readers to page 3 of the document itself, which is inside the product you have to buy.

We can show you what the problem looks like in one of the four states, from the statute directly.

Ohio law prescribes notice language that any printed health care power of attorney form distributed in Ohio must carry, including this sentence:

This document is not valid as a durable power of attorney for health care unless it is acknowledged before a notary public or is signed by at least two adult witnesses who are present when you sign or acknowledge your signature.

Ohio also requires certain provisions to appear in capitals, boldface, or larger type. That statute names no brand, it applies to any such form sold or distributed in the state. It is a concrete, checkable reason a generic national form may need supplementing in Ohio.

Kansas is stricter than most states on witnesses: a durable power of attorney for health care decisions must be "witnessed by two individuals of lawful age who are not the agent, not related to the principal by blood, marriage or adoption, not entitled to any portion of principal's estate and not financially responsible for principal's health care," or else acknowledged by a notary. Both witnesses must qualify, where Texas requires only one of two.

For New Hampshire and Texas, we could not verify what the extra step is, so we are not going to guess at it.

The limit the publisher states plainly

One answer in its own FAQ is worth quoting, because it is a straight concession and it matters for anyone using Wish 5 to record funeral preferences:

In Wish 5, I can indicate my burial/cremation wishes. Is that legally binding? No. You are only indicating your preferences.

That is correct, and it applies to every document of this kind. Recording a preference is not the same as appointing someone with authority to carry it out. Most states have a separate mechanism for designating who controls the disposition of your remains, and that is the document that binds.

The free alternative

The National Institute on Aging states the position plainly: "You can establish your advance directives for little or no cost. Many states have their own forms that you can access and complete for free."

In several states the official form is printed inside the statute itself, readable free at the state's own website:

• California: Probate Code § 4701 contains the complete Advance Health Care Directive form, on the state legislature's site.
• Kansas: Kan. Stat. Ann. § 58-632 prints the durable power of attorney for health care decisions in full.
• Texas: Texas Health and Human Services publishes the medical power of attorney, directive to physicians, out-of-hospital DNR, and declaration for mental health treatment together at fhb.hhs.texas.gov/forms/advance-directives.

For a state-by-state directory, CaringInfo, a program of the National Alliance for Care at Home, "provides free advance directives and instructions for each state that can be opened as a PDF." Its own caution is the right one to carry with you: "The states vary in their requirements for witnesses, notarization and other specifics so review the form and its instructions carefully."

The National Institute on Aging also suggests contacting your state attorney general's office or your local Area Agency on Aging, which you can find through the Eldercare Locator on 800-677-1116.

So should you use it

That is your decision, and both answers are defensible.

The case for it: it asks questions no statutory form asks, in language a family can actually read at a bedside. Wishes 3 through 5 are the part people say they are glad to have. Five dollars is not a serious obstacle.

The case against relying on it alone: the legal work, naming your agent and stating your treatment wishes in a form your state will honour without argument, is done by your state's form, for free, and the publisher's own validity claim comes in three versions.

What we would do: complete your state's free form for the legal appointment. If the personal sections appeal to you, use Five Wishes alongside it for wishes 3 to 5, and make sure the two documents do not contradict each other.

Whichever you use, the execution rules decide whether it works. Check who may witness in your state, whether a notary is required or merely allowed, and whether being in a nursing home adds a requirement. Then give copies to your agent, your backup, and your doctor.

A document nobody can produce at the moment it is needed does nothing, whatever it cost.

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The 72-Hour File has a medical section for recording which directive you completed, where the signed original is kept, and who already holds a copy. See what is inside