The holiday season can make people contemplative. And quite often, it can also inspire them to accomplish one of life’s many “Shoulds” — getting affairs in order such as completing advance health care directives and final arrangements. But for many, those tasks seem daunting. Or confusing. Or just plain not fun.

Until now.

The Coda Alliance, a group with the stated mission of “giving guidance in sharing experiences for both embracing life and for end-of-life planning,” has converted the potential pain into play: The GoWish Game.

How to Play

Players are given 36 cards, each imprinted with a simple wish, and asked to sort them into three piles, ranking them as: “very important to me,” “somewhat important to me,” and “not important to me.” Some of the wishes seem aimed at specific end of life care, such as “Not being connected to machines” and “To be free from pain.” Some, such as “To be able to help others” and “To have human touch” are deeply personal. And a few — including “To keep my sense of humor,” “To be kept clean,” and “Not being short of breath” may be potential wishes that hadn’t occurred before.

Each deck also comes loaded with a Wild Card, which players are encouraged to use to signify anything important to them that does not appear on the other cards; examples given are “I want to go white water rafting” and “I want to be able to recognize my family and friends.”

Those playing are then directed to focus on the pile they have designated as “very important” and winnow it down to 10 cards, ranking those from most to least important. Those 10 cards can become the kickstarter for a conversation with a friend, family member, or healthcare provider who can see what concerns are ranked as important and hear why. Surprising leanings can also be revealed in discussing the wishes a player has deemed “not important.”

Players can indulge in GoWish introspection by playing the game alone, or use two decks to help foster a dual conversation with a family member or friend. That setup can be particularly useful with people being considered as health care agents to supervise and lobby for stated medical wishes for those who become unable to do so.

While the originators initially envisioned the game to be used with family members and friends, it has also taken off with health care providers who want to inspire their patients, caregivers interested in delivering the most fitting care, and those deemed “The Unprepared” — who have not yet honed in on their wishes. They pitch the game as perfect for those struggling to initiate conversations about final care and other end of life issues, but say it can also be used just to clarify and underscore what an individual feels is most important in life.

Lessons Players Learned

The GoWish website offers a number of testimonials from diverse players lauding the game’s unexpected revelations.

• A gay couple in a longterm relationship was moved to play GoWish when one of their parents became gravely ill — prompting them to realize they had never had any conversations about end-of-life wishes with any of their parents. The couple went through the cards individually with each of their four parents and learned some assumption-busting information about their health care wishes. And playing was prescient, as shortly after that, one of their mothers was hospitalized and became unable to speak for herself. Knowing her wishes helped her newly-informed relatives direct her medical care as she expressly wanted.
• A family — an elderly couple and their two sons — was prompted to play by a palliative care social worker after the woman in the family was diagnosed with a form of leukemia that resisted treatment. As the woman’s condition worsened, the social worker left the cards in her room for the family to review together when she felt well enough to talk. All reported they felt grateful to be able to discuss important topics that long-held family roles and behavior patterns had previously prevented. Those breakthroughs also enabled them to ensure that the wishes the woman valued most — to have family around and to be able to help others — were honored in her last weeks of life.
• One of the doctors who helped pilot the The GoWish Game found out at a Thanksgiving family feast that he had been named as the alternate agent in a relative’s health care directive; the woman had named her daughter as her primary agent. He asked the mother to sort through the cards and select her top 10 concerns, then asked the daughter to pick out what she thought her mother’s top 10 concerns would be. The daughter easily picked out 8 of her mother’s top 10 — and the two then had a deep conversation about the remaining two mismatched cards. Playing the game assured them all that the daughter was a good choice as her mother’s advocate.
• An elderly man, seemingly without close friends or family members, admitted himself into a nursing home after suffering from a number of medical conditions as well as a history of poor self-case practices. Though diagnosed with mild dementia, he was able to understand that his life expectancy was likely to be only a few months and to understand and rate the simple and direct statements on the GoWish cards as the facility physician read them to him. Though the man had long held himself out to be a loner in life, his play through the cards uncovered the surprise that his most precious thoughts were to have an advocate who understood his values and to have help in sorting out financial matters and in planning his final arrangements. Hospice workers were summoned and assigned as he wished.

More About GoWish

The GoWish Game is available from both the Coda Alliance and the learning company Reach and Teach.

It is offered in English and Spanish and through partnerships with other groups, has been translated into eight other languages.

Printed decks are available for $26 for a pack of two, with instructions included. It is also possible to play online free of charge, where sound has been added for those who wish to hear each card read, then email preferences and explanations to others they specify.