Patient's Five Wishes

Instructions

Review the Five Wishes Sample Download Five Wishes Sampledocument. Then, choose a family member or friend as a patient and complete the Patient's Five Wishes Download Patient's Five Wishes document.

Initial Post

Provide a summary of the individual, including any healthcare concerns, and upload your Patient's Five Wishes document for peer review. Include your thoughts regarding any wishes that you feel would be difficult to uphold as the family member/friend.

DO NOT include any personal identifiers in the document.

Citation: Aging With Dignity. (2011). Five wishes.

Response Prompts

• Identify at least one "wish" that may need to be discussed with the patient and family or expanded upon. How would you educate the patient and family?
• What is your role in advocating for this patient's wishes?
• Assume the medical provider or family did not want to follow the wishes. How would you handle this situation? Explain.

FIVE WISHES Template WISH

1: The Person I want to make health care decisions for me when I can't make them for myself: The person I choose as my health care agent is:

________________________________________________________ OR ________________________________________________________

Please specify any health care decisions you DO NOT want your health care agent to make that is listed on page 5 of the Five Wishes Sample document provided in the activity instructions on canvas.

WISH 2:

My wish for the kind of medical treatment I want or don't want: What life-support treatment means to me:

Close to death

___ I want to have life-support treatment.

___ I do not want life-support treatment. If it has been started, I want it stopped.

___ I want to have life-support treatment if my doctor believes it could help. But I want my doctor to stop giving me life support treatment if it is not helping my health condition or symptoms.

Permanent and Severe Brain Damage and NOT expected to recover:

___ I want to have life-support treatment.

___ I do not want life-support treatment. If it has started, I want it stopped.

___ I want to have life-support treatment if my doctor believes it could help. But I want my doctor to stop giving me life-support treatment if it is not helping my health condition or symptoms.

In a Coma and NOT expected to wake up or recover:

___ I want to have life-support treatment.

____ I do not want life-support treatment. If it has started, I want it stopped.

____ I want to have life-support treatment if my doctor believes it could help. But I want my doctor to stop giving me life-support treatment if it is not helping my health condition or symptoms.

In a condition under which I DO NOT wish to be kept alive

-

WISH 3: My wish for how comfortable I want to be:

Please specify any health care decisions you DO NOT agree with that are listed on page 8 of the sample.

-

WISH 4: My wish for how I want people to treat me: Please specify any wishes you DO NOT agree with that are listed on page 8 of the sample.

-

WISH 5: My wish for what I want my loved ones to know:

Please specify any wishes you DO NOT agree with that are listed on page 9 of the sample.

-

My body or remains should be put in the following location:

-

The following person knows my funeral wishes: If anyone asks how I WANT to be remembered, please say the following about me:

-

If there is to be a memorial service for me, I wish for this service to include the following (list music, songs, readings, or other specific requests you have):

-

Please list any other wishes you have:

-