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HEN THE END came, all he wanted was for someone to hold his hand and listen to his war stories.
An 80-year-old veteran with cancer, he had been a Hospice Support Care patient for 18 months and was estranged from his family.
Judy Murphy, executive director of the Fredericksburg agency, persuaded him to fill out a Five Wishes advance directive.
"We had to make a judgment call because he did not have a primary caregiver," she said. "He did not have any relative who would take on this responsibility."
Murphy said her patient requested three things: He wanted to be pain-free, he didn't want life support used and he didn't want to die alone.
"He was looking for peace of mind," she said.
When the end came, Murphy arranged to have someone with the man at all times.
"That's why the Five Wishes is so helpful," she said. "Patients are allowed to direct what would be most comforting to them."
The Five Wishes document is a living will created by Aging with Dignity, a nonprofit organization that advocates for the elderly. It has five parts:
Wish 1 encourages patients to choose someone who will make health-care decisions for them if they are no longer able.
Wish 2 covers the kind of medical treatment the patient wants or doesn't want.
Wish 3 allows patients to request a level of comfort and ask to be kept pain-free and clean.
Wish 4 details how patients want to be treated, including whether they want family members at their bedside, and if they want to be talked to or have their hand held.
Wish 5 gives patients the opportunity to list things they want their family members to know, detailing everything from burial or memorial requests to asking for forgiveness for past wrongs.
Many local hospices and hospitals encourage their patients to fill out an advance directive like the Five Wishes. Bette Goglia, chaplain at Mary Washington Home Health and Hospice, gives incoming patients a Five Wishes form as part of their admissions packet. She takes copies of Five Wishes with her when doing community presentations.
"We spend so much time planning for a wedding and for the birth of a child," she said. "But when it comes to life and death, we would much rather deal with life."
Goglia said the Five Wishes form encourages patients to think about end-of-life scenarios and to discuss their wishes with their families.
"The Five Wishes encourages conversation," she said. "The necessary conversation."
Goglia advises her patients to discuss their wishes with their loved ones especially with whomever has been appointed primary caregiver.
"You cannot anticipate every scenario, and that's why you have someone to interpret your wishes," Goglia said.
Eileen Dohmann, director of Mary Washington Home Health and Hospice, said the Five Wishes form is beneficial for people of all ages, not just hospice patients.
"It's different for people, depending on their circumstances," Dohmann said.
Dohmann said the Terri Schiavo controversy raised public interest in Five Wishes.
"People were calling us and saying, 'What do I have to do so I never have to be in that situation?'" she said.
Terri Schiavo, a Florida woman, suffered brain damage in 1990 after collapsing into a coma caused by cardiac arrest. Schiavo remained in a persistent vegetative state, unable to speak for herself and without an advance directive.
A battle ensued between her husband and her parents, each side with different views as to what would be best for Schiavo. After numerous court battles, Schiavo's feeding tube was removed in March and she died 13 days later.
Dohmann uses the Schiavo case to increase public awareness of advance directives.
"We wanted to show people how they can avoid that situation, how they can avoid putting their families in that position," she said.
An advance directive, such as the Five Wishes, can be beneficial to those in charge of making health decisions.
"It's extremely helpful because it's more specific," added Dr. Rebecca Bigoney, co-chair of the ethics committee and director of ethics services at Mary Washington Hospital.
Bigoney said she has met patients who are reluctant to bring in a loved one's advance directive.
"They are afraid it would be used as an excuse not to provide them with care," she said. "But with [the Five Wishes] people can say they would want things that most of us do not want. It's not all about what we won't do but also what they do want done."
Bigoney instructs her patients to fill out a standard advance directive first, then to fill out the Five Wishes.
"A lot of people intend to do Five Wishes but it takes time," she said. "The state form is done more quickly."
A standard Virginia advance directive requires a person to list a primary caregiver and to state the treatment he or she would want. The advance directive must be dated, signed by the patient and by two witnesses.
"In Virginia, an advance directive doesn't need to be specifically worded," said Jay W. deBoer, the commissioner of aging in Virginia. "We specify that a specific form is not mandatory."
According to deBoer, the Five Wishes form fulfills the requirements for a living will in Virginia.
"The important part of the form is the formality of having it signed by two witnesses," deBoer said. "However, the more detail the better. It's your life."
