Five Wishes Advance Directives

five wishes Hope provides tools for people to talk comfortably about their end-of-life wishes with family, friends and healthcare providers.

Five Wishes is a simple form that documents your instructions for your future medical care in the event you become unable to speak for yourself. The booklet has several components, including:

  • A health care power of attorney or surrogate that allows you to name a person you trust to make your health care decisions if you cannot make them yourself.
  •  A living will - a statement about your desires to have or not to have your life prolonged by extraordinary measures if you have a terminal or incurable illness or if you are in a vegetative state.
  • A declaration of an anatomical gift, allowing you to make a gift by will, organ donor card or other document.

"This is much more than simply getting your records in order,” says Samira K. Beckwith, Hope President and CEO. “This is one of the greatest gifts that a person can give to their family. Dying is inevitable, but leaving your family with difficult, heartbreaking decisions is not. Planning ahead will save them from a heavy burden and will give them peace of mind when they need it most."

If you would like the booklet mailed directly to you, please call 855-454-3104.

To print the form from your computer or to complete an electronic copy online, please visit the link below:

five wishes