Five Wishes vs Living Will in Arizona

As you’re getting started with advance care planning, you’ll need to think about the specific advance planning documents you use. For a Living Will, you might turn to the form offered by your state government or perhaps make your own. But, there’s also Five Wishes, which is a powerful option for many people.

Whether you’re familiar with Five Wishes or just hearing about it, this article will step you through the details of the document, plus how it compares to the state-offered Living Will in Arizona. If you’re not in Arizona, no worries. Most of the principles we’re talking about will apply to the form in your state as well.

The Basics of Five Wishes

Five Wishes is a unique advance planning program with a few key features:

• The same form can be used throughout the nation (although four states require some additional paperwork).
• It includes a Living Will and Healthcare PoA, plus wishes for comfort, spiritual, and emotional needs. These last three needs aren’t found in other Living Wills.
• It relies on everyday language, making it easier to understand than other advance directives.
• You can add or strike out information in many places to make the information fit your needs.

Notably, Five Wishes contains a Living Will, but it’s also much more than that. It’s an all-in-one document that hits all your basic advance care planning needs in one go.

As a legal advance directive, Five Wishes will replace any Living Will and Healthcare PoA that you previously signed. If this isn’t what you want, you’ll need to leave Five Wishes unsigned and use it as a guide only.

Five Wishes vs a Living Will

Where They’re Found

The Five Wishes form can be purchased on the Five Wishes website, unless you receive it during an advance planning workshop. It’s an inexpensive form that’s well worth the price, especially as you can get a digital or physical version and the paperwork has been translated into 30 different languages.

Arizona’s state-created form can be found on the site of the Arizona Attorney General. You can find other documents here too, including a POLST form, Health Care Power of Attorney, and Mental Health Care Power of Attorney.

What They Contain

Despite having the same general goal, Five Wishes and the Arizona form vary considerably in the options they give you and how these are presented. In the next sections, we’ll show you what to expect.

Five Wishes

The Living Will part of Five Wishes is under Wish 2: My Wish for the Kind of Medical Treatment I Want or Don’t Want. It contains the following sections:

What You Should Keep In Mind As My Caregiver

This section provides a few brief paragraphs about what caregivers should consider, like not wanting to be in pain and wanting to be offered food.

What “Life-Support Treatment” Means To Me

This section allows you to define what life support treatment means. More specifically, you can restrict the definition of life support to match your values.

Medical Treatment

This section contains the following three scenarios:

• Close to Death
• Permanent and Severe Brain Damage and Not Expected to Recover
• In a Coma and Not Expected to Wake Up or Recover

For each of the scenarios, you can choose between:

• 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.

There’s also a section called: In Another Condition Under Which I Do Not Wish to be Kept Alive. Here, you can specify other conditions not covered in the previous sections.

Five Wishes contains three additional wishes that consider emotional, spiritual, and comfort needs. These can help guide family and medical staff, but they don’t have the same legal weight as the Living Will.

Arizona’s Living Will

Arizona’s Living Will mostly consists of a single page. There are five sections here, each with specific details. In brief, they are:

• “If I have a terminal condition, I do not want my life to be prolonged…”
• “If I am in a terminal condition or an irreversible coma or a persistent vegetative state that my doctors reasonably feel to be irreversible or incurable, I do want the medical treatment necessary…” (can provide further details)
• “Regardless of other directions… if I am known to be pregnant, I do not want life-sustaining treatment withheld or withdrawn…”
• “I want my life to be prolonged to the greatest extent possible.”

You can also attach additional special instructions about any other end of life wishes.

When They Come Into Effect

Both documents come into effect when the signee is very ill or loses decision making capacity. This is phrased slightly differently depending on the document.

• Arizona Form: “Use this form to make decisions now about your medical care if you are ever in a terminal condition, a persistent vegetative state, or an irreversible coma.”
• Five Wishes: “When the time comes that I am very sick and not able to speak for myself…”

The conditions here are similar for Arizona’s PoA form and the PoA part of Five Wishes. As such, the Living Will and PoA often come into effect simultaneously.

PoAs can be written to come into effect upon signing, which allows for joint decision making while the principal has capacity. You can’t do this with the forms we’ve discussed, so you may need to create your own PoA with a lawyer if you want this effect.

Their Strengths

Five Wishes

• Accessibility. The language of Five Wishes makes it easier to understand and suitable for more people than other Living Wills.
• More Languages. Five Wishes is available in 30 languages, which isn’t true for most other Living Will forms.
• Saves Time. Five Wishes gives you a single straightforward document. This is much faster than navigating a Living Will and then a separate PoA form.
• Can Be Expanded. You’re not limited to the specifics in Five Wishes. You can add extra information to ensure the document perfectly reflects your wishes.

Arizona’s Living Will

• Ability to expand. You can attach a separate page to the Living Will, which contains additional instructions for your wishes. This allows you to expand the information to cover anything you feel is missing in the original information.
• Designed for Arizona. Five Wishes aims to be a nationwide tool, while the Arizona forms focus on Arizona. As such, the features and wording on Arizona’s form are a closer match to Arizona’s requirements. This difference is helpful if there’s a risk of conflict concerning the Living Will.

Their Weaknesses

Five Wishes is basically a simplified and streamlined version of traditional advance directives. The approach is powerful in many situations, but any form of simplification also creates challenges. That’s why it’s so important to think about the best type of document for your needs.

The Limits of Five Wishes

Acceptance May Be Delayed

Some family members report that their Five Wishes document wasn’t accepted initially, with staff not believing it was a legitimate Living Will and PoA.

Five Wishes is getting increasingly well-known and is legally valid, so the issue should be rare. If this does happen, you should be able to resolve things by educating staff members on the form or talking to someone with more authority.

To avoid the issue, talk to staff members early, long before the document is needed. This way, you can get everyone on the same page without time pressure.

Issues with acceptance aren’t exclusive to Five Wishes. They also happen with other advance directives and can occur for many reasons.

Doesn’t Cover All Situations

The sections, language, and apparent simplicity of Five Wishes can be limiting in some situations. In particular:

• Some health conditions won’t fit into any of the categories offered. This is particularly true for people who no longer have decision making capability, but are not near death.
• Some terms are not well defined, potentially leading to confusion or conflict. For example, ‘permanent and severe brain damage’ may be interpreted differently depending on the individual.
• There are no options for choosing some life extending treatments and not others. For example, a person with dementia may not want complex and risky procedures, but may still wish for ones that have few risks and high rewards.
• You cannot choose more aggressive treatments. The Arizona document includes this option “I want my life to be prolonged to the greatest extent possible”. Five Wishes has no options like this.

Thankfully, you can write in extra instructions, giving you the chance to be as specific as you like. Doing so would be crucial if the current options don’t meet your wishes.

The Limits of Arizona’s Living Will

• Can be difficult to understand. The language used here is more complex than Five Wishes. Some people may need terms interpreted before they understand what the questions are asking.
• May feel impersonal. The clinical language of this document may make it unappealing to some people.
• It’s state-specific. Arizona’s document may not meet Living Will requirements in every state, which can cause problems if a senior begins living in a different state.
• It mostly considers medical perspectives. There’s no scope for personal and emotional wishes.

When is Five Wishes Best?

Five Wishes is essentially a simplified version of Living Will and PoA documents. It’s especially powerful:

• In straightforward situations, particularly for seniors nearing the end of life.
• For people with limited education and those who simply don’t want to fill out advance planning documents.
• When time is of the essence. Often, it’s simply important to get some paperwork completed and Five Wishes is certainly the fastest.
• For anyone who wants to talk about emotional, spiritual, and comfort wishes. Other advance directives don’t cover these.
• When health changes can be anticipated. For example, if someone is sick and near the end of their life, it’s easier to know which of the presented categories they’re likely to fall into and what types of care they’d want.

When is Arizona’s Form Best?

• For earlier advance planning. Arizona’s form provides more options than Five Wishes. This is powerful if you’re young, as you have no idea how your life is going to unfold. Plus, if you’re planning early, you can take your time with the form and ensure you fully understand each aspect.
• If pregnancy is possible. Arizona’s form has a specific option for pregnancy – something that’s not found in Five Wishes.
• If conflict is likely. Arizona’s form is more recognizable and precise than Five Wishes, which makes it easier to defend if there are any challenges. This is especially important in conflict-laden families, where family members have different views about the best type of care.

While Arizona’s document might help in cases of family conflict, it doesn’t guarantee smooth sailing. Realistically, conflict can make things tricky regardless of the advance directive you choose.

What About Another Living Will?

You could also turn to a completely different Living Will. This could be another form found online or locally, or something you create yourself.

It’s best to work with a lawyer here, as other forms may not fully meet the requirements in Arizona. A lawyer can also help ensure that the Living Will meets your needs and actually means what you want it to.

This approach is most relevant if you’re not satisfied with either of the Living Wills we’ve discussed. But, in most cases, you can simply choose one of the forms and attach extra instructions to make it fit your needs.

Final Thoughts

Five Wishes has some major advantages over the state-provided form, plus a few minor limitations. The best choice ultimately depends on your situation. Five Wishes is the way to go if you’re looking for something streamlined and easy to understand. If you need to be more specific or are worried about conflict – stick with Arizona’s form instead.