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Publication #FCS2262

Final Wishes: End-of-Life Decisions1

Martie Gillen and Carolyn S. Wilken2

“If only I knew what Mother would want, it would be easier to decide,” Sarah told her family after a conference with her mother's doctors. The doctors had explained that her mother's cancer had caused so much damage that she would need the help of several machines to keep her alive. They told Sarah there was almost no chance that her mother would wake up from the coma she was in. They suggested perhaps it was time to unhook the machines and let her mother die.

The doctors asked Sarah what she wanted them to do. They asked what her mother's wishes would be.

Sarah has just joined the growing number of people who are faced with the most difficult decision of their lives. Should she agree to let the machines keep her mother alive? Or should she “allow” her mother to die?

“How can anyone make that decision?” she asked.

Sarah's mother never had to make such a decision for her own mother forty years ago. But Sarah lives in a different time, and, medically speaking, in a different world. Now, Sarah has been asked to decide.

Final Wishes

What would you do if you were Sarah? If you were in this situation, what would your final wishes be? Who knows about your final wishes?

Families face these decisions every day, and not only with elderly family members. Car crashes, drug overdoses, and accidents can cause brain damage, coma, or a persistent vegetative state in people of any age.

How can you be sure that you would know what to do? How can you protect your own family from the decision Sarah had to make?

Fortunately, easy-to-use legal documents are available to help you express your final wishes.

Figure 1. 

As you grow older, it is important to discuss your final wishes with your family members so that they will know what type of medical care you will want. A living will is one way to express those wishes.


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Five Wishes®

The Five Wishes® materials were developed to help people express their final wishes in five important areas:

1. Who Will Be My Health Care Agent

2. Medical Treatment I Do or Do Not Want

3. Expectations for Comfort Care

4. How I Want People to Treat Me

5. What I Want My Loved Ones to Know

Five Wishes® booklets offer detailed explanations of each of these wishes. These booklets will guide you through the process of completing a document to express your final wishes. Once that document is signed and witnessed, it will meet the legal requirements for an advance directive in 42 states (including Florida) and the District of Columbia. Cinco Deseos® is the Spanish language version of Five Wishes®.

An online version was introduced in 2011, called Five Wishes Online, which allows individuals a way to complete Five Wishes using a computer and then print out a personalized document immediately. The website is https://fivewishesonline.agingwithdignity.org/.

Once you have completed and signed the document and obtained the witness signature, be sure to give a copy to your health care surrogate, family members, and doctors. Keep the original document and make sure family members know where to locate the original. If you are admitted to a hospital or nursing home, take a copy with you for your medical file.

All Five Wishes® materials can be ordered toll-free at 1-888-5WISHES (1-888-594-7437) or online at http://www.agingwithdignity.org/catalog/. You can also contact Five Wishes, Aging with Dignity, P.O. Box 1661, Tallahassee, FL, 32302. Single copies of Five Wishes® or Cinco Deseos® cost $5, with discounts for large purchases. Twenty-five copies cost $1 each. (Prices are subject to change.)

Examine Your Personal Belief System

Today, medical advances often exceed our ability to resolve life and death issues. Each of us must use our own beliefs and values to decide what to include in a living will. Before you complete your Five Wishes® document, take time to consider your personal belief system.

Use the following exercise to think about your own opinions and beliefs. Your answers will help you to more closely examine your feelings.

How I Feel about Life and Death

This is a three-step activity. Complete the first two steps in private. The third step asks you to share this paper with the most important people in your life.

Step 1: Quickly read each statement and write down the first response that comes to mind.

Step 2: Reread each statement. Look at your first response and then think through each statement. Change your response if you need to.

Step 3: Talk with the most important people in your life about these questions.

1) I know I can depend on my family and friends to make the medical decisions I'd want if I could not make them for myself.

Yes No Not Sure

2) My religious faith helps me to think of life as...

_________________________________________________________________________________________________________________________________________________________________________

3) My family members do not always agree on philosophical issues.

True False

4) It is important to me to stay independent and in control in all situations.

True False

5) I feel strongly about using or not using medical machines to keep me alive.

Yes No Not Sure

6) I believe that there might be times when I would prefer death over life.

Yes No Not Sure

7) When someone talks about organ donation, I think about...

_________________________________________________________________________________________________________________________________________________________________________

8) My religious faith helps me to think about death as...

_________________________________________________________________________________________________________________________________________________________________________

9) The people in my life who understand most about my beliefs and needs are...

___________________________________________________________________________________________________________________________________________________________________________

10) Thinking about my own death makes me feel...

___________________________________________________________________________________________________________________________________________________________________________

11) I will share my answers with the following people:

___________________________________________________________________________________________________________________________________________________________________________

For More Information

This is one of six publications in a series on caregiving and aging. The other publications in this series are:

FCS2257: Long-Term Care: Places to Call Home (http://edis.ifas.ufl.edu/fy869)

FCS2258: Caregiver’s Contacts: How to Get the Help You Need (http://edis.ifas.ufl.edu/fy870)

FCS2259: Puzzled by Your Care Receiver’s Refusal of Services? (http://edis.ifas.ufl.edu/fy871)

FCS2260: Balancing Work and Caregiving: Tips for Employees (http://edis.ifas.ufl.edu/fy872)

FCS2261: Balancing Work and Caregiving: A Guide for Employers (http://edis.ifas.ufl.edu/fy873)

Footnotes

1.

This document is FCS2262, one of a series of the Department of Family, Youth and Community Sciences, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. First published November 2006. Revised August 2012. Please visit the EDIS website at http://edis.ifas.ufl.edu.

2.

Martie Gillen, assistant professor and Family and Consumer Economics for Older Adults specialist, Department of Family, Youth, and Community Sciences; and Carolyn S. Wilken, emeritus associate professor, Department of Family, Youth and Community Sciences; Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL 32611. Appreciation is given to Kathleen Luzier-Bogolea, MAHS, and Jennifer A. Wells, regional Extension agent/Auburn University, for suggestions and comments.


The Institute of Food and Agricultural Sciences (IFAS) is an Equal Opportunity Institution authorized to provide research, educational information and other services only to individuals and institutions that function with non-discrimination with respect to race, creed, color, religion, age, disability, sex, sexual orientation, marital status, national origin, political opinions or affiliations. For more information on obtaining other UF/IFAS Extension publications, contact your county's UF/IFAS Extension office.

U.S. Department of Agriculture, UF/IFAS Extension Service, University of Florida, IFAS, Florida A & M University Cooperative Extension Program, and Boards of County Commissioners Cooperating. Nick T. Place, dean for UF/IFAS Extension.