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Welcome Shriners |
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The Five Wishes document helps you express how you want to be treated if you are seriously ill and unable to speak for yourself. It is unique among all other living will and health agent forms because it looks to all of a person’s needs: medical, personal, emotional and spiritual. Five Wishes also encourages discussing your wishes with your family and physician.
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The Five Wishes costs only $5.00
To order Five Wishes please use our convenient shopping cart!

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Five Wishes lets your family and doctors know:
- Which person you want to make health care decisions for you when you can’t make them.
- The kind of medical treatment you want or don’t want.
- How comfortable you want to be.
- How you want people to treat you.
- What you want your loved ones to know.
Five Wishes is changing the way America talks about and plans for care at the end of life. Nearly FOUR MILLION COPIES of the document are circulating throughout the nation.
The document speaks to people in their own language, not in “doctor speak” or lawyer talk.” It can be use in the living room instead of the emergency room. And it helps families talk with their physician about a subject that before was too hard to face.
There are a few states in which Five wishes does not yet meet the legal requirements. These states either require a specific state form or that a person completing as advanced directive be read a mandatory notice or warning.
Answers to Questions About Five Wishes
What is Five Wishes?
Five Wishes is an easy-to-use legal document that lets you plan in advance for how you want to be cared for in case you become seriously ill. Some people refer to it as an “advanced directive” because when you complete Five Wishes you give direction to your doctor and family, in advance, on how you want to be treated. There are five wishes in this document:
Wish One lets you choose the person you want to make decisions for you when you can’t make them for yourself. Lawyers call it a “durable power of attorney for health care.”
Wish Two is a living will. It lets you put in writing the kind of medical treatment you want or don’t want if you become seriously ill and can’t communicate to anyone.
Wishes Three and Four let you describe in detail how you want to be treated so that your dignity can be maintained.
Wish five gives you a chance to tell others how you want to be remembered, and express other things that might be in your heart, like forgiveness.
Why should I fill out Five Wishes?
Without an advanced directive like Five Wishes, you may have no control over important medical care decisions that will be made if you ever get seriously ill—such as whether to give you life-support treatment or aggressively treat your pain. You may think your wishes are similar to those of other people and that your loved ones and doctors will automatically know what you want when you are very ill. That’s not true.
In reality, everyone has different wishes and yours won’t be followed unless you make them clear. For Example, your dying process could be artificially prolonged even though you may have wanted a natural death. Not expressing your wishes can put your family, friends and doctor in the difficult position of guessing what kind of treatment you want, which could lead to disagreements. Completing Five Wishes give you control over your care and peace of mind for you and your loved ones.
When do I need to use Five Wishes?
The best time to fill the Five Wishes is before you face a health crisis. The best place to fill out Five Wishes is at home—not a hospital. You never know when you are going to need Five Wishes, and many people put it off until it’s too late. If you are over the age of 18, you should complete Five Wishes now. If you are married, both you and your spouse need to fill out your own Five Wishes.
When does Five Wishes take effect?
You will always make your own health care decisions if you are able to talk with your doctor and understand what is being said. Five Wishes only takes effect when you are too ill to communicate. So if you have a stroke and can’t speak, or are in a coma, then your Five Wishes, and the person you choose to be your health care agent, can help direct your care with your doctor.
Is Five Wishes a legal document?
Yes. It is written with the help of the American Bar Association’s Commission on the Legal Problems of the Elderly. It meets legal requirements under the advance directive statues in most states (see list on page 3 of the Five Wishes document). Just follow the directions when you sign it.
How do I use Five Wishes?
Take the following steps to use Five Wishes:
- Review the document
- Fill it out
- Follow directions for signing it
- Discuss it with your health care agent and doctor and give each of them a copy
- Make sure a copy of your Five Wishes is placed in your medical file by your doctor.
- Discuss Five Wishes with your family and friends and give them a copy.
What if I don’t live in a Five Wishes state?
There are some states that require you to use their own legal forms to express your wishes and so you should use their forms and sign those forms. But you should also fill out Five Wishes because it can make clear to you r family, friends and doctor what you want.
Does filling out Five Wishes guarantee that my wishes will be followed?
Your doctor is required to follow your wishes according to the laws of your state. Each state has its own rules and conditions that a doctor must observe, and so your doctor has the final word on when your living will takes effect. To do all you can to have your wishes followed, make sure you do three things:
- Pick a health care agent (Wish One), tell him or her about your wishes and confirm they will speak for you if you ever get sick.
- Tell this person that hospitals, hospices and nursing homes have ethics committees that can help settle any disagreements with doctors or family members.
- Discuss your wishes with your doctor, family and friends before you get sick
What if I fill out Five Wishes and later change my mind?
You can change your mind any time you want. It is a good idea to review and update your Five Wishes at least once a year. You may want to do that more often if your health changes or you change your mind. When you make changes, be sure to inform your health care agent, family and doctor. Destroy all out-of-date copies of Five Wishes and distribute copies of your new Five Wishes.
If I am seriously ill, what can I do to make sure that I won’t be in pain?
Most people who are very sick want to be kept comfortable and alert, and surrounded by friends. Great progress has been made in our health care system to treat illnesses, but unfortunately there can be more attention paid to your treatment than your comfort. So make it very clear to your doctor, health care agent and family that you can’t want to be in pain.
Do I have to have my Five Wishes notarized?
Not unless you live in one of he states that is listed in the notarization section of Five Wishes. Simply follow the directions on the signature page of your Five Wishes booklet and you’ll be safe.
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| ORDERING THE FIVE WISHES |
The Five Wishes costs only $5.00
To order Five Wishes please use our convenient shopping cart!

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