Five Wishes Advance Directives

five wishes Hope provides information and tools for people to talk comfortably about their end-of-life wishes with family, friends and healthcare providers.

The Five Wishes are simple forms that are records of your choices, goals and instructions for your future medical care in the event you become unable to speak for yourself.  Five Wishes has several components, including:

  • A health care power of attorney or surrogate that allows you to name a person you trust to make your health care decisions if you cannot make them yourself.
  •  A living will – a statement about your desires to have or not to have your life prolonged by extraordinary measures if you have a terminal or incurable illness or if you are in a vegetative state.
  • A declaration of an anatomical gift, allowing you to make a gift by will, organ donor card or other document.

"This is much more than simply getting your records in order,” says Samira K. Beckwith, Hope President and CEO. “This is one of the greatest gifts that a person can give to their family. Dying is inevitable, but leaving your family with difficult, heartbreaking decisions is not. Planning ahead will save them from a heavy burden and will give them peace of mind when they need it most."

50,000 Wishes: Hope has set a goal to have 10,000 individuals in our community complete the Five Wishes booklet by National Healthcare Decisions Day, to be observed on April 16. Everyone in the community is invited to participate in this community project of 50,000 Wishes for Hope. You can provide peace of mind for your loved ones by joining in the project :

If you would like the booklet mailed directly to you, please call Sherri Holly at 855-454-3105.

To print the form from your computer or to complete an electronic copy online, please visit the link below: