Five Wishes in New Hampshire: Does It Meet RSA 137-J Requirements?

Five Wishes is one of the most widely distributed advance directive documents in the United States, created by the nonprofit Aging with Dignity. Its approachable, non-legal language has made it popular with families who find traditional statutory forms intimidating. But popularity and legal sufficiency are two different things.

If you're using Five Wishes in New Hampshire, here's what you need to verify — and where the document may leave gaps in your planning.

What Five Wishes Covers

The Five Wishes document organizes advance care planning around five categories:

1. Who you want to make healthcare decisions for you (agent designation)
2. What kind of medical treatment you want or don't want (treatment preferences)
3. How comfortable you want to be (pain management and comfort care)
4. How you want people to treat you (dignity and personal care preferences)
5. What you want your loved ones to know (personal messages and spiritual preferences)

Wishes 3, 4, and 5 go beyond what most statutory advance directive forms address. They cover emotional, spiritual, and comfort-related preferences that the legal framework doesn't require but that families often find valuable.

Does Five Wishes Meet NH Legal Requirements?

Five Wishes is designed to meet the legal requirements of most states, and Aging with Dignity lists New Hampshire among the states where it is legally valid. However, "valid" requires proper execution.

Under RSA 137-J:14, any advance directive in New Hampshire — including Five Wishes — must be executed with either:

• Two qualified witnesses (with the disqualification rules: no agent, spouse, heir, estate beneficiary, or more than one healthcare provider employee), or
• A notary public or justice of the peace

If you complete Five Wishes but don't follow New Hampshire's specific execution requirements, the document may not be recognized by a hospital's legal department during a crisis. The content of the form matters less than the execution formalities.

What Five Wishes May Not Cover

While Five Wishes addresses general treatment preferences, it was designed as a national document. It may not address several New Hampshire-specific elements:

The 2021 SB 74 default authority expansion. Five Wishes predates the SB 74 amendments that broadened the default authority of healthcare agents in New Hampshire. Your agent now has automatic authority to request a POLST, access medical records, and authorize facility transfers unless you specifically restrict these powers. Five Wishes' agent designation language may not reflect this expanded framework.

The Dartmouth Dementia Directive. New Hampshire has a locally recognized supplement specifically designed for progressive cognitive decline. Five Wishes addresses end-of-life preferences generally but does not include the staged, milestone-based planning that the Dartmouth Dementia Directive provides.

The Living Will Burdens addendum. RSA 137-J:20 allows you to attach a custom addendum listing specific conditions or treatments you consider "excessively burdensome." This structured addendum is part of the state's statutory form but is not part of Five Wishes.

Organ donation. New Hampshire's statutory advance directive includes an optional organ donation section. Five Wishes does not address anatomical gifts. If you want to document organ donation preferences alongside your advance directive, you'll need a separate document or the state's statutory form.

POLST coordination. Five Wishes does not explain how your advance directive connects to active medical orders (POLST and Portable DNR). In New Hampshire, this coordination is critical — especially the distinction between planning documents (which express future wishes) and medical orders (which give immediate instructions to emergency responders).

Using Five Wishes Alongside the State Form

Some families use Five Wishes as a values-clarification exercise and then complete the New Hampshire statutory form for legal enforceability. This is a practical approach: Five Wishes helps you think through comfort, dignity, and personal preferences (Wishes 3-5), while the statutory form ensures your agent designation and treatment instructions meet all RSA 137-J requirements.

If you choose this route, make sure the two documents don't contradict each other. Your healthcare agent should have copies of both and understand which document controls for legal purposes.

Honoring Care Decisions

New Hampshire's hospital systems — particularly Dartmouth Hitchcock — participate in the "Honoring Care Decisions" framework, which emphasizes integrating advance care planning conversations into clinical practice. Whether you use Five Wishes, the state statutory form, or a comprehensive planning kit, the key step is getting your documented preferences uploaded to the electronic medical records at your preferred hospital.

The New Hampshire Advance Directive & Living Will Kit provides the full NH statutory form with step-by-step guidance, the SB 74 expanded authority framework, and supplemental planning tools that Five Wishes does not include — all in one document set designed specifically for New Hampshire law.

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