Why Have Dementia-Specific Advance Directives

Advance directives typically address scenarios such as an imminently terminal condition or a permanent coma. They generally do not address the more common scenario of gradually progressive dementia.

Although progress has been made developing video aids and conversation kits to facilitate discussions about advance care planning in dementia, many patients do not have access to a simple written document to express their wishes for care if they should develop dementia.  The Five Wishes is a legal document that currently meets the legal requirements for an advance directive in 42 states, including New York.  This easy to read, straight forward legal document is sure to reduce family anxiety about surrogate decision-making as well as the patient’s anxiety about future care.  Take a look at just how simple this is!

The Fives Wishes in Summary for Advance Directives

Wishes 1 and 2 are both legal documents.  Once signed, they meet the legal requirements for an advance directive in New York State.  Wishes 3, 4, and 5 are unique to Five Wishes, in that they address matters of comfort care, spirituality, forgiveness, and final wishes.

Planning your advance directives


Wish 1: The Person I Want to Make Care Decisions for Me When I Can’t

This section is an assignment of a health care agent (also called proxy, surrogate, representative, or health care power of attorney). This person makes medical decisions on your behalf if you are unable to speak for yourself.

Wish 2: The Kind of Medical Treatment I Want or Don’t Want

This section is a living will—a definition of what life support treatment means to you, and when you would and would not want it.

Wish 3: How Comfortable I Want to Be

This section addresses matters of comfort care. Discussing what type of pain management you would like, personal grooming and bathing instructions, etc. It will include whether you would like to know about options for hospice care, among others.

Wish 4: How I Want People to Treat Me

This section speaks to personal matters such as whether you would like to be at home, whether you would like someone to pray at your bedside, among others.

Wish 5: What I Want My Loved Ones to Know

This section deals with matters of forgiveness, how you wish to be remembered, and final wishes regarding funeral or memorial plans.

Signing and Witnessing Requirements

The last portion of the document contains a section for signing and having it witnessed.  Some states require notarization and are so indicated in the document.

The form for Five Wishes Advance Directive can be viewed at Here

For more information on Dementia-Specific Advance Directives, see the links below:

New York Times Health article

Jama Network Article


For more blog posts by Virginia Tortorici click here.

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