Five Wishes

So many people today face important decisions about medical care for ill or aging family members and recognize that it is best to plan for their own future health care while they are still healthy.

The booklet, Five Wishes® is an easy-to-complete legal document that allows you to plan for your own health care and that of your family. This advance directive (AD) states personal wishes for treatment and care in the event one is injured, ill or can no longer speak for oneself.

The Terri Schiavo case which involved a Florida woman who was in a persistent vegetative state for 14+ years, illustrates the unfortunate impact the lack of advance care planning can have on families and communities and the need for adults of all ages to document their wishes. (Terri was only 26 when she fell ill.)


will help you enhance your advance care planning process:

  1. Complete the Five Wishes® booklet.
  2. Sign the document in front of two witnesses.
  3. Make copies and give to your physician, agent(s), lawyer and hospital (for your chart).
  4. Keep your Five Wishes® advance directive in a place where it can be easily retrieved.

The Benefit? – Peace of mind for you and your loved ones knowing your wishes can be accessed in times of critical illness or medical emergency.

Five Wishes® is and Advance Directive that can be ordered for $5 (plus s/h) from Kōkua Mau and is legally valid in 40 states. Five Wishes® in produced and distributed by Aging with Dignity, based in Florida. Kōkua Mau offers this document as a service as long as supplies last, since it is legally recognized in Hawai‘i as an Advance Directive.

  • Download the order form for Five Wishes® here.
  • Download the order form for Five Wishes® as a writable pdf file here.