Table 2.

Additional Items Elicited from Prior Clinical Work on EoL Issues

If I get very ill and cannot communicate my wishes, these are the treatments and/or procedures I would prefer to never experience again

This is where I want to be when the end of my life is near

These are the people I would like to be with me when the end of my life is near

Special ways I want to be remembered on my birthday by family and friends

How I would like to be remembered on specific holidays

The people who I would like to receive my belongings

Final Arrangements

I would like to be buried

I would like to be cremated

I would like for there to be a funeral/celebration of my life

Music/readings/schedule/decorations that I would like to be at my service

How I want my family to treat each other when the end of my life is near

The things I would like to accomplish/do or the places I would like to go

Note: The original Five Wishes^® document can be viewed at www.agingwithdignity.org.

EOL, end of life.