Final Wishes: Good to plan now

If you had five wishes, what would they be? Not the kind you'd seek from a genie, but wishes you would like granted at the end of your life.

Five Wishes is an advance-directive document created by the nonprofit Aging With Dignity that can be used to help you ensure that your desires are communicated and, ultimarely, carried out. (https://www.agingwithdignity.org/five-wishes/about-five-wishes).

Nathan Kottkamp, a health-care attorney with McGuireWoods in Richmond, Va., and founder of the National Healthcare Decisions Day movement, notes, "I'd say 80 percent of people want to die at home, but 80 percent of them die in institutions. If there's a generation likely to demand change, boomers are the one."

Lack of planning "can be so traumatic. And it doesn't have to be complicated, it can be written down on sheets of paper," he said. Guides for end-of-life planning are downloadable online, such as  the LastingMatters.com Organizer, available for $20 ($29 for a print version).

Robert Louis, estate-planning lawyer with Saul Ewing in Center City, calls Five Wishes "a bit of a gimmick, but it's a great way to get started."

Louis prefers six documents: a medical power of attorney; a living will (how you'll be treated at the end of your life); a HIPAA (Health Insurance Portability and Accountability Act) authorization; a financial power of attorney; a letter of instructions, (i.e. bury, cremate, funeral, no funeral); and a will disposing of your assets.

"In most cases, the first three documents can be combined," said Louis.

"Many people forget about the HIPAA authorization, which can make it difficult to find out a person's medical condition. The letter of instructions is a good idea, but whoever receives it should have it before the writer dies, to avoid steps being taken that are contrary to your instructions." Even the tiniest details - say, about tube feeding and hydration - can be included, he said.

Caringinfo.org, a program of the National Hospice and Palliative Care Organization, offers ideas for those who want to set down their wishes. Here are a few to get you started:

Talk to your family and friends. Ask permission to have this conversation because people cope with end-of-life issues differently. Tell them exactly what your choices for treatment would be if you were faced with a life-limiting illness.

Pick a health-care decision maker. Tell everyone who that person is who will act as your agent. Talk to your health-care providers about your wishes, and what medical treatment you want and don't want at the end of life.

Ask that person: Are you willing to do this and make medical decisions for me when I am no longer able? Will you be able to make decisions for me if they are what I want? If they are not, what you would choose for yourself or if you don't agree with my choices? Will you be able to make a medical decision and change it later if the treatment is not having the intended benefit? Will you seek out information about my disease, advance directives, your role as caregiver, and what to expect as I near the end of life?

Make copies of advance directives. Give copies to your health-care decision maker and your doctors. Keep the original documents in a safe and accessible place (not a safe-deposit box), and tell others where you put them.

Pose questions to doctors. Will they talk openly and candidly about your illness? What will they do if you have pain or other uncomfortable symptoms? How will they help you find professionals when you need them - for example, medical, surgical and palliative-care specialists, social workers? Will they support you in getting hospice care? If you reach a point where you are too sick to speak for yourself, how will they make decisions about your care? Will they still be available when you're close to the end of your life?

Ask spiritual advisers: If you have negative feelings like frustration, sadness, despair, or anger at God or at death, will they listen empathetically? Will they continue to visit even if you get very sick or can no longer respond? Will they help your family with their spiritual concerns about your illness? Will they just sit and be with you, even if you don't want them to or you can no longer respond?

earvedlund@phillynews.com

215-854-2808@erinarvedlund