A Document Built for Human Beings, Not Lawyers
Picture a scene many families know: a hospital room, a loved one on a ventilator, family members standing in a hallway disagreeing about what they would have wanted. The doctors are waiting. Nobody has the same answer. Nobody actually knows.
More than 65% of Americans have no advance directive in place. Which means that when the moment comes — and for most families, it comes without warning — decisions get made by people who are guessing, under pressure, at the worst possible time. The disagreements that result are one of the most painful things grief can add to death. Not because anyone is wrong, but because nobody knows.
Five Wishes exists to change that. It was designed not as a legal form, but as a human one — readable by anyone, completable by anyone over 18, and structured around what actually matters when someone is nearing the end of life: not just medical instructions, but comfort, dignity, and the things left to say. This guide explains what Five Wishes is, how it differs from a standard advance directive, what each of its five sections covers, and how to complete and share it in a way that actually protects the wishes of the person who fills it out. It also touches on digital legacy planning for families thinking about the full picture of what they leave behind.
What Is Five Wishes?
Five Wishes was created by Aging with Dignity, a Florida nonprofit, in collaboration with physicians, nurses, hospice workers, and lawyers. It was first published in 1997. Today, more than 18 million copies are in circulation across the United States, distributed through more than 35,000 organizations — hospitals, hospices, senior centers, healthcare systems, and faith communities. It is available in 27 languages.
Aging with Dignity describes Five Wishes as "the first living will that talks about your personal, emotional, and spiritual needs as well as your medical wishes." That description captures what makes it different: most advance directives are written in legal language and address only medical interventions. Five Wishes is written in plain English and addresses five distinct dimensions of care — hence the name. It functions simultaneously as a healthcare power of attorney and a living will, while adding three dimensions that standard directives omit entirely: how the person wants to be kept comfortable, how they want to be treated as a human being, and what they want their loved ones to know before they die.
For many people, Five Wishes is the first document that makes end-of-life planning feel like something they can actually do — not a legal chore to delegate to an attorney, but a personal act of care for themselves and the people they love.
Who Should Complete Five Wishes?
Five Wishes is designed for any adult 18 or older, regardless of age, health, or family situation. The document's designers are explicit: completing Five Wishes is not a statement about being near death. It's an act of planning — one that protects your wishes and reduces burden on family members who would otherwise have to guess. Per Aging with Dignity and the Samaritan hospice system: "the best time is before you need it."
Many people complete Five Wishes after a health scare — their own or a parent's. Others fill it out after watching a family member navigate a difficult death without clear guidance. Many complete it at a life milestone: becoming a new parent, turning 40 or 50, or simply taking stock of what would happen if something unexpected occurred. Any of these is the right time. The document can be updated at any point by completing and signing a new copy, so there is no risk in doing it now and revisiting it later.
How Five Wishes Differs from a Standard Living Will
A standard living will is a legal document focused primarily on medical interventions — it specifies what treatments the person does or doesn't want in terminal situations: ventilators, feeding tubes, resuscitation, artificial nutrition. It addresses the mechanics of medical care. It does not address who makes decisions when the person cannot, how the person wants to be treated as a human being, what comfort measures matter to them, or what they want the people they love to know.
Five Wishes incorporates the legal elements of both a living will and a healthcare power of attorney — and then adds three dimensions that standard directives never touch: the comfort of the body, the dignity of the person, and the closure of the heart. It covers the same legal ground while also addressing what actually makes end-of-life care feel humane or inhumane. For anyone who has watched a loved one receive medically competent but impersonal care — care that addressed every clinical need but missed the person entirely — that distinction is not abstract. It is the difference between dying well and dying alone in a room full of people.
Research published in the Journal of Palliative Medicine found that 95% of participants who reviewed Five Wishes described it as "helpful" or "very helpful" for end-of-life planning, with none finding it "stressful." That is not the experience most people have with standard legal advance directive forms. For broader context on the range of end-of-life care options, our guide to understanding hospice and palliative care covers the landscape families often need to navigate alongside these decisions.
The Five Wishes — What Each Section Covers
Wish 1 — The Person I Want to Make Care Decisions for Me
The first wish appoints a healthcare agent — sometimes called a healthcare proxy or durable power of attorney for healthcare. The person named here is legally authorized to make care decisions on your behalf when you can no longer make them independently. Wish 1 guides you to name both a primary agent and a backup agent, and to think carefully about what qualities matter in that person.
It's not about who loves you most. It's about who can advocate firmly and clearly with medical providers under pressure, without letting their own grief or preferences override yours. The right person for this role is someone who knows your values, can handle emotional pressure without losing sight of your wishes, and will speak for you rather than for themselves. The section also prompts you to discuss the appointment with the person you're naming before you finalize it — because carrying that responsibility unprepared is its own kind of burden, and the conversation itself often becomes one of the most meaningful ones the two of you will have.
Note that the healthcare agent named in Five Wishes carries significant legal authority in states where the document is recognized. This wish should be completed thoughtfully, with a conversation before the ink dries.
Wish 2 — The Kind of Medical Treatment I Want or Don't Want
Wish 2 is the living will component — the section that specifies your treatment preferences in several defined medical scenarios. The document walks through four situations: being close to death, being in a coma with no reasonable chance of recovery, having permanent and severe brain damage, and being in another specific condition you can define yourself. For each, the document provides clear options: some people want all life-sustaining treatment available; others specify that they do not want treatments that only prolong dying.
This section also includes space to write specific conditions or exceptions in your own words. "I do not want a feeding tube unless..." or "I would like all measures taken if there is any reasonable chance of recovery" — these refinements matter, and Five Wishes provides room for them rather than forcing a binary choice. The language throughout Wish 2 is direct but accessible. It walks the person through the choices without assuming medical knowledge.
If you feel uncertain about any of the options in this section, discussing them with your primary care physician is genuinely useful. Many doctors welcome this conversation; it helps them understand their patient as a person, not just a chart. If you have a family member currently navigating these decisions with medical providers, the experience of supporting a family member through hospice is one many families find both harder and more meaningful than they expected.
Wish 3 — How Comfortable I Want to Be
This is one of Five Wishes' most distinctive features — and one of the sections most likely to surprise people who've only encountered standard advance directives. Wish 3 moves beyond medical interventions entirely and into personal care: the things that make a person feel human and cared for, not just medically stable.
Examples from the document include: wanting pain medication even if it might shorten life; wanting warm blankets and clean sheets; wanting specific music played; wanting a pet present; wanting personal care routines maintained (hair, grooming, the things that made the person feel like themselves). These are not small things. For people in the final stages of life — and for the families and care providers sitting with them — these specifics are often the difference between care that feels like care and care that feels clinical. Wish 3 creates a record of the things that matter to this particular person, in their own words, that care providers can actually act on.
Wish 4 — How I Want People to Treat Me
Wish 4 addresses the interpersonal wishes — how the person wants to be spoken to, whether they want visitors and which ones, whether they want prayers or religious texts read aloud, whether they want physical contact and of what kind, what they do not want (the document includes options like "please do not talk about me as if I'm not in the room" and "please do not let my loved ones see me in distress").
This section also addresses who is and isn't present at the bedside — a meaningful element for families navigating complicated dynamics. Families with estrangements, second marriages, or other complexities often find that Wish 4 is the section that prevents the hardest conversations from happening in the worst possible moment. The person completing the document gets to make those calls while they still can, clearly and compassionately, in writing. The care providers and family members who receive those instructions don't have to guess or negotiate.
Wish 5 — What I Want My Loved Ones to Know
Wish 5 is unique among advance directives and, for many people, the most profound section to complete. It addresses matters of closure: forgiveness, love, things left unsaid, and messages for specific people. The document provides open space for the person to write in their own words. Some people write a sentence; others write pages.
Per the Hospice SLV guide: "Many people get very creative in Wish 5." That creativity is the point. This section can include instructions about memorial and burial preferences, reflections on a life lived, and direct messages to specific people — children, siblings, a spouse, a friend. For many families, what gets written in Wish 5 becomes more significant over time than the medical instructions in the sections that preceded it. It is, in many cases, the last clear statement of who a person was and what they wanted to leave behind.
Wish 5 can be the beginning of something larger — a legacy letter, a tribute that outlasts the document's legal function. It can also become the foundation for a deeply personal memorial service, a tribute book, or a family archive. The wishes expressed there belong to the person who wrote them — and they deserve to be honored.
Legal Validity — Where Five Wishes Stands in Your State
As of 2026, Five Wishes meets the legal requirements for an advance directive in 42 states and the District of Columbia, per Aging with Dignity and the American Bar Association's Commission on Law and Aging. In all 50 states, Five Wishes can be used as a personal guide to end-of-life preferences and as an expression of a person's values, regardless of statutory standing.
In four states — New Hampshire, Kansas, Ohio, and Texas — Five Wishes can be used as a guide and supplement but must be attached to the state's own statutory form to carry full legal weight. In Wisconsin, a notice statement must be attached (the statement is provided with the document). In Michigan and North Dakota, the named healthcare agent is required to sign an acceptance form. These aren't prohibitions; they're additional steps, and the document itself explains what's needed in your state. The practical implication: if you live in one of these states, complete Five Wishes and then ask Aging with Dignity or a local attorney whether a state form attachment is needed in your specific situation.
What Makes It Legally Binding?
Five Wishes becomes a legally binding advance directive when it is properly signed and witnessed according to the instructions inside the document. Requirements include: the person completing it must be 18 or older and mentally competent at the time of signing. The document must be signed in the presence of two adult witnesses who meet specific criteria: they cannot be the named healthcare agent, a family member, or a beneficiary of the person's estate. Some states require notarization in addition to witnesses — the document specifies state-by-state requirements.
Once properly executed, Five Wishes revokes any prior advance directive. If you've previously completed a living will or healthcare power of attorney and you complete Five Wishes, the earlier documents are superseded. Updating Five Wishes is simple — complete and sign a new copy, and the old one is replaced. Families who want to keep their wishes current can revisit the document after any significant health change or life event.
How to Get Five Wishes
Five Wishes is available from Aging with Dignity at fivewishes.org. The document is available in printed form (approximately $5 per copy for individuals), as a digital download, and through an online completion tool that walks users through the document interactively. For families who want multiple copies — one for the physician, one for the hospital, one for the named agent, one kept at home — purchasing a small supply makes sense.
Many hospitals, hospices, senior centers, and healthcare systems provide Five Wishes free of charge to patients and families. Ask your primary care physician, your hospital's patient services department, or a local hospice organization whether copies are available. Given that more than 35,000 organizations distribute the document, the odds are good that someone in your healthcare network already has it. If you're already engaged with a hospice or palliative care team, they almost certainly have it and can walk through it with you.
One important clarification: a generic "living will" form found on a legal website is not the same as Five Wishes. The version from Aging with Dignity is the one with documented legal standing, research backing, and the full five-section structure this article describes. Don't substitute a generic form and assume it covers the same ground.
How to Talk About It With Family
Completing Five Wishes is only the first step. The document's designers are consistent in emphasizing that the conversation it prompts matters as much as the paperwork — sometimes more. A Five Wishes document kept in a drawer that no one knows about is only partially useful. Sharing it, discussing it, and making sure the right people have copies is what gives it real power.
Starting that conversation can feel awkward. A few suggestions from families who've done it well: choose a low-stakes moment, not a holiday dinner or the middle of a health crisis. Frame it as a gift you're giving: "I've been working on Five Wishes, and I want you to understand what I want — so you never have to guess." Share the document with the person named in Wish 1 well before it's needed, and talk through it together. Give copies to your primary physician and ask them to put it in your chart. Tell close family members where the original document is kept. If you're admitted to a hospital, bring a copy with you.
Many families find that the conversations prompted by Five Wishes lead naturally to other important discussions — about values, about what matters most, about how the person wants to be remembered, about things that have gone unsaid for years. For families navigating the weight of anticipatory loss while a loved one is still present, these conversations are one of the most meaningful things that can happen. They're rarely regretted. If you're supporting a family member through a serious illness, our guide to anticipatory grief while caregiving offers compassionate framing for exactly this kind of experience.
Five Wishes and Tribute Planning
What gets written in Wish 5 — the messages, the memorial preferences, the things the person wants loved ones to know — often becomes the most lasting part of Five Wishes. Those words, written in a person's own hand while they were still fully themselves, carry an irreplaceable weight that no one else can provide after the fact.
For families supporting a loved one who has already completed Five Wishes, it is worth reading the document together while the person is still present to discuss it. Not just to understand the medical instructions, but to hear the person in those words — to honor what they wrote and, if there's time, to respond to it. The living wishes in Wish 5 can become the foundation for a deeply personal memorial service, a tribute book, or a legacy letter that carries who they were forward. The tributes built around who someone truly was — their values, their humor, their specific ways of loving — are the ones that matter most to the people left behind. Five Wishes, at its best, gives those people a map.
Sources
Aging with Dignity / Five Wishes. "Five Wishes Advance Directive." Official source: 18M+ copies; 35,000+ distributing organizations; 27 languages; ~$5 per copy. fivewishes.org; fivewishes.org/states/
Samaritan NJ Hospice. "Five Wishes: America's Most Popular Living Will." Legal validity in 42 states + DC; "the best time is before you need it." samaritannj.org/caregiver-support/caregiving-tips/advanced-planning/five-wishes/
American Bar Association Commission on Law and Aging. Legal standing analysis. Via liquisearch.com/five_wishes/meets_legal_requirements_in_42_states
Journal of Palliative Medicine (PMC). "Five Wishes in a Community-Based Palliative Care Program." 95% of participants found it helpful; 0% found it stressful. pmc.ncbi.nlm.nih.gov/articles/PMC2650081/
Hospice SLV. "Five Wishes Explained." Section-by-section description; "Many people get very creative in Wish 5." hospiceslv.org/wp-content/uploads/2019/05/Five-Wishes-Explained.pdf
University of Michigan Health-Sparrow. "Five Wishes Advanced Planning Guide." "First living will that talks about personal, emotional and spiritual needs as well as medical wishes"; for anyone 18+. uofmhealthsparrow.org/sites/default/files/2022-08/five-wishes-advanced-planning-guide.pdf