Wills, Trusts & Probate
That's All We Do
Comprehensive Guide to DNR and Advance Healthcare Directives
Planning for serious medical events is an important part of any estate plan for residents of Lawndale, California. A Do Not Resuscitate order, commonly called a DNR, allows individuals to specify that they do not want cardiopulmonary resuscitation or other resuscitation measures if their heart or breathing stops. Creating a valid DNR requires attention to state law, careful documentation, and clear communication with healthcare providers and loved ones. This guide explains how DNR orders work in California, how they fit into broader advance healthcare directives, and practical steps to make sure your wishes are known and respected.
Many people find comfort in having written healthcare instructions that reflect their values and medical preferences. In Lawndale, a properly executed DNR can prevent unwanted emergency measures and reduce stress for family members making decisions in a crisis. Establishing a DNR sometimes involves conversations with physicians and preparation of specific forms to be included in medical records. This resource outlines the legal framework, the components of a DNR, and how to integrate a DNR with other documents like living wills and healthcare proxies to create a coherent plan that follows California law and supports your intentions.
Why DNR Orders Matter for Your Healthcare Plan
A DNR order serves several important purposes for individuals and families in Lawndale. It documents a clear preference to decline resuscitation in the event of cardiac or respiratory arrest, which helps medical staff act in accordance with the patient’s wishes. Having a DNR can prevent invasive interventions that a person would not want and can spare family members the burden of making immediate life-or-death choices without guidance. A well-documented directive promotes dignity, preserves patient autonomy, and reduces uncertainty during medical emergencies by ensuring that healthcare providers have access to explicit instructions.
About Our Lawndale Estate Planning Practice
LA Estate Plans serves individuals and families in Lawndale and throughout Los Angeles County, focusing on wills, trusts, probate, and healthcare directives such as DNR orders. Our team works with clients to document healthcare preferences clearly and to coordinate those directives with medical providers and medical records. We emphasize attentive communication, practical guidance, and adherence to California requirements so that documents are both effective and easily accessible when needed. Call our Lawndale office at 310-634-1006 to discuss how a DNR order can fit into your broader estate plan and help protect your healthcare wishes.
Understanding DNR Orders and Their Legal Role
A Do Not Resuscitate order is a legal instruction directed to medical personnel, indicating that cardiopulmonary resuscitation and other resuscitative measures should not be performed if a person’s heart stops or they stop breathing. In California, a DNR must be properly documented and typically signed by the patient and a physician to be recognized by healthcare facilities. It is important that a DNR be placed in the patient’s medical record and that treating providers are aware of it. Understanding how DNR orders operate helps individuals make informed choices about end-of-life care and how those choices interact with other documents.
Establishing a DNR often involves consultation with your physician to determine whether a DNR is appropriate for your medical condition and wishes. The process includes completing the required forms, ensuring the order is recorded in medical records, and sharing copies with relevant providers and family members. DNRs can be part of a broader advance healthcare directive or living will, which provide additional instructions about other types of medical treatment. Clear communication with designated decision makers ensures that your preferences are understood and followed if you cannot speak for yourself.
What a Do Not Resuscitate Order Means
A DNR order instructs healthcare professionals not to perform CPR or similar life-saving interventions if a patient’s heart stops or breathing ceases. It is intended for situations where resuscitation is inconsistent with a person’s wishes or medical goals. The DNR does not affect other types of medical care that support comfort, pain management, and dignity at the end of life. In California, creating a valid DNR involves specific documentation and communication steps so that emergency and in-hospital personnel can locate and honor the order promptly. Ensuring the order is accessible and properly recorded is essential.
Key Elements and Steps to Establish a DNR Order
Key steps to establish a DNR include discussing wishes with your physician, completing the appropriate California forms, and making sure the order is incorporated into your medical records. You should designate a healthcare proxy who can communicate your preferences if you are unable, and ensure family members and primary care providers have copies. The DNR form must be signed by the patient and the attending physician or another authorized medical professional. Regular review and updates are advised when health status or personal preferences change, and clear documentation helps prevent misunderstandings during emergencies.
Key Terms to Know About DNR Orders
Familiarity with terms used in medical and legal discussions about DNR orders helps individuals make more informed decisions. This glossary explains common phrases such as DNR, advance healthcare directive, CPR, and healthcare proxy. Understanding these terms clarifies how different documents interact, what powers designated decision makers hold, and how healthcare providers interpret written instructions. Knowing the vocabulary allows you to have more productive conversations with doctors, family members, and legal advisors when preparing directives that reflect your values and comply with California law.
Do Not Resuscitate (DNR)
A Do Not Resuscitate order is a written instruction directing medical staff not to perform cardiopulmonary resuscitation or advanced resuscitation measures if the patient’s heart or breathing stops. The DNR focuses specifically on resuscitation and does not necessarily limit other forms of medical treatment aimed at comfort or symptom control. In California, a DNR must be documented in the medical record and signed as required for it to be honored by hospitals and emergency responders. Maintaining clear copies and ensuring providers are aware helps ensure the DNR is followed when needed.
Cardiopulmonary Resuscitation (CPR)
Cardiopulmonary resuscitation is an emergency procedure that may include chest compressions, rescue breaths, and other life-saving interventions intended to restore heart and lung function. CPR is performed in situations of cardiac arrest or respiratory failure to attempt to restart breathing and circulation. A DNR order specifically declines these measures. Understanding CPR helps individuals weigh the benefits and burdens of resuscitation, consider how outcomes relate to underlying health conditions, and make informed decisions about including or excluding CPR in their healthcare directives.
Advance Healthcare Directive
An advance healthcare directive is a legal document that records a person’s preferences for medical treatment and can include DNR instructions along with broader decisions about life-sustaining care. It also often names a healthcare proxy empowered to make decisions when the individual cannot. Advance directives serve to communicate values and treatment goals to medical teams and family members, reducing uncertainty in emergencies. Creating an advance directive in California involves considering specific medical scenarios and ensuring that the document is accessible to treating providers and designated decision makers.
Healthcare Proxy
A healthcare proxy is an individual appointed to make medical decisions on behalf of another person if that person becomes unable to make or communicate decisions. The proxy is expected to act in accordance with the patient’s documented wishes and values, including any DNR orders or advance directives. Selecting a trusted and available proxy and discussing preferences with them is important so they can advocate effectively. Properly documenting the appointment of a proxy and sharing that information with medical providers reduces confusion and supports decision making aligned with the patient’s intentions.
Comparing DNR Orders with Other Healthcare Documents
A DNR order addresses a narrow and specific choice about resuscitation, while other documents such as living wills, advance healthcare directives, and healthcare powers of attorney provide wider guidance on medical treatment preferences and decision makers. Each document serves a different role: a DNR tells providers not to perform CPR, a living will can outline preferences about life-sustaining treatments more broadly, and a healthcare proxy designation names someone to make decisions. Combining these documents creates consistency and reduces ambiguity for medical staff and family members during critical situations.
When a Focused DNR Is an Appropriate Option:
Targeting Resuscitation Choices Only
For individuals who wish to address only the question of resuscitation without detailing other medical interventions, a DNR can be a clear and concise solution. This focused approach is particularly useful when the primary concern is avoiding CPR or other emergency resuscitation efforts, while leaving other treatment decisions open or to be handled through discussion with medical providers. A narrowly tailored DNR reduces the likelihood of confusion in an emergency and makes the patient’s resuscitation preference explicit to emergency responders and hospital staff.
Simplicity and Quick Recognition
A DNR is simple to implement and is easy for medical personnel to identify and follow, especially in time-sensitive emergencies. Because the instruction pertains directly to CPR and similar resuscitation measures, it can be quickly located in the medical record and acted upon by emergency teams. This clarity helps ensure that the specified preference about resuscitation is honored without ambiguity. For those who want a direct statement about resuscitation without broader instructions, a DNR offers an uncomplicated and accessible option.
Why a Broader Healthcare Plan May Be Advisable:
Handling Multiple Treatment Scenarios
A comprehensive approach addresses a range of treatment choices beyond resuscitation, helping to guide care in different medical scenarios such as prolonged illness, intensive care decisions, and life-sustaining treatments. Including a living will or advance healthcare directive allows individuals to specify preferences about feeding tubes, ventilators, and other interventions, providing clearer guidance when clinical situations extend beyond a simple resuscitation decision. This broader planning reduces ambiguity and helps ensure that care aligns with one’s values over a range of circumstances.
Appointing and Empowering Decision Makers
Designating a healthcare proxy within a comprehensive plan ensures someone trusted is authorized to make medical decisions if you cannot. A proxy can interpret your written preferences, speak with providers, and make timely decisions consistent with your wishes. This appointment helps avoid disputes among family members and supports continuity of care across different settings. Documenting both substantive treatment preferences and the identity and authority of a decision maker creates an integrated framework that guides medical teams and loved ones during stressful situations.
Advantages of a Full Healthcare Directive Package
Taking a comprehensive approach to healthcare planning in Lawndale helps ensure that your values and medical choices are clear across many possible situations. A full set of documents, including a DNR, advance healthcare directive, and proxy designation, reduces uncertainty for medical staff and family members, and helps align treatment with your preferences even when your condition changes. This coordinated planning supports clear communication, easier implementation of care, and a greater likelihood that decisions made on your behalf reflect your intentions and dignity.
A complete healthcare directive package can also facilitate smoother coordination between medical providers and family members by providing written guidance and named decision makers. That clarity can reduce delays in care, minimize disagreements about treatment choices, and help focus care on appropriate symptom management and comfort when curative measures are not desired. Overall, thorough planning provides peace of mind by documenting preferences and ensuring the people you trust know how to act on your behalf when necessary.
Clarity and Personal Control
A comprehensive set of healthcare directives helps you maintain control over important medical decisions by documenting specific preferences and instructions. This clarity makes it easier for clinicians to deliver care that aligns with your goals and reduces the likelihood of unwanted interventions. By taking time to record your choices and share them with loved ones and providers, you help ensure medical decisions reflect your values and priorities, even if you cannot communicate directly at the time of treatment.
Reduced Stress and Clear Guidance for Families
Providing written directives and naming a trusted decision maker eases the emotional burden on family members who might otherwise be forced to make urgent choices without guidance. Clear documentation reduces the potential for conflict and helps family caregivers feel confident in following the patient’s wishes. This practical benefit preserves family relationships and ensures medical teams have a reliable basis for treatment decisions, offering both emotional relief and practical direction during difficult circumstances.
Practice Areas
Top Searched Keywords
- DNR Lawndale
- Do Not Resuscitate California
- advance healthcare directive Lawndale
- healthcare proxy Los Angeles County
- living will California
- CPR refusal order
- end of life planning Lawndale
- medical directives Los Angeles
- estate planning DNR
Practical Tips for Managing Your DNR Order
Keep Your DNR Accessible
Make sure copies of your DNR order are placed in your medical record and shared with key individuals who may need access in an emergency. Provide a copy to your primary care physician, specialists, and any facility where you receive care, and give a copy to your designated healthcare proxy and close family members. Consider keeping a reduced version or wallet card indicating the presence of a DNR so that emergency responders can quickly identify your wishes. Accessibility helps ensure the order will be found and followed when time is limited.
Review and Update Regularly
Communicate Clearly with Family
Open conversations with family members and the person you name as your healthcare proxy help prevent confusion and disagreements in a crisis. Explain the reasons behind your choices and the circumstances under which you would want a DNR honored. Clear communication helps ensure that the people who may be involved in decision making understand and can advocate for your wishes. Sharing copies of written directives and discussing them in advance supports confident and consistent implementation when it is needed most.
Reasons to Consider Establishing a DNR in Lawndale
A DNR order may be appropriate for individuals who wish to avoid resuscitation in the event of cardiac or respiratory arrest, whether due to chronic illness, advanced age, or personal preferences about end-of-life care. Choosing a DNR can prevent medical interventions that do not align with a person’s values and can help focus treatment on comfort and quality of life. Having a written order reduces uncertainty for medical teams and loved ones and helps ensure that your resuscitation preferences are honored across care settings in California.
In addition to directing resuscitation preferences, a DNR can serve as an entry point for broader conversations about advance care planning. Establishing a DNR often leads to complementary documents such as a living will or healthcare proxy appointment, which together create a comprehensive plan for future medical decisions. Taking these steps proactively reduces the need for rushed decisions during emergencies and provides family members with clear guidance to follow, supporting consistent and respectful care during challenging times.
Common Circumstances Where a DNR Is Considered
DNR orders are commonly considered by people with progressive or terminal illnesses, older adults facing frailty, or individuals who prefer not to receive aggressive resuscitative measures under any circumstances. They may also be chosen by those who want to prioritize comfort care over life-extending interventions that do not improve quality of life. Each decision is personal, and the suitability of a DNR depends on an individual’s health status, values, and goals of care. Discussing options with medical providers and trusted decision makers helps determine the right approach.
Chronic or Terminal Illness
Individuals with progressive or terminal conditions often consider a DNR to avoid resuscitation that may prolong the dying process without meaningful recovery. A DNR can allow focus on comfort care and symptom management rather than invasive emergency measures. When such conditions are present, planning ahead by documenting preferences and discussing likely outcomes with physicians helps ensure that care remains consistent with goals and reduces the need for sudden decisions during emergencies. Clear documentation supports dignity in end-of-life care.
Advanced Age and Frailty
Older adults and those with significant frailty sometimes choose a DNR because resuscitation may be unlikely to restore prior quality of life and may carry substantial risks. A DNR can reflect a preference to avoid aggressive procedures that are inconsistent with personal goals at the end of life. Discussing how resuscitation outcomes relate to overall health and long-term prognosis with medical providers helps inform the decision. Proper documentation and communication with family ensure that these preferences are honored when urgent care is required.
Personal Preference for Medical Care
Some people choose a DNR based on deeply held personal or philosophical preferences about medical treatment, independent of specific health conditions. Documenting this choice ensures that resuscitation will not be performed in situations where the person would prefer comfort-oriented care. Clear instructions and a designated healthcare proxy ensure that care providers and family members understand and follow the person’s wishes, thereby protecting autonomy and providing peace of mind that care will reflect individual values.
We Are Here to Support Your Healthcare Planning
Why Work with Our Lawndale Team on DNR and Healthcare Planning
Choosing a local Lawndale legal partner for DNR and estate planning matters helps ensure your documents are prepared with attention to California law and local medical practices. Our approach emphasizes clear communication, careful documentation, and coordination with treating physicians so that directives are properly recorded and accessible. We assist clients in balancing medical realities and personal values to create directives that reflect true intentions and work in real-world clinical settings.
We focus on practical guidance to make sure DNR orders and accompanying documents are easy for providers to find and implement when needed. That includes helping clients place orders in medical records, providing copies to appropriate hospitals and clinics, and preparing wallet cards or notification strategies for emergency situations. These proactive measures improve the likelihood that directives are honored across care settings and reduce the administrative burden on families during stressful times.
Our team takes a client-centered approach, listening to individual preferences and helping translate those preferences into clear, legally effective documents. We guide clients through revocation, amendment, and periodic review so directives remain current. For people in Lawndale and the surrounding communities, this support helps ensure that both the letter and the spirit of their healthcare choices are preserved and communicated effectively to those who will act on their behalf.
Contact Our Lawndale Office to Discuss Your DNR
How We Handle DNR Orders and Related Documents
Our process for preparing DNR orders begins with a detailed conversation about your medical preferences and goals, followed by document preparation, review, and assistance with placing the order in medical records. We explain the legal requirements under California law and help you choose complementary documents to create a cohesive plan. Throughout the process we coordinate with your healthcare providers and designated decision maker to ensure the directives are accessible and understandable when they are needed most.
Initial Consultation and Information Gathering
The first stage focuses on gathering medical history, understanding values and treatment goals, and discussing relevant legal forms. During this conversation we clarify what situations you want the DNR to cover and whether additional documents are advisable. We collect necessary personal and medical information, identify the person you wish to appoint as a healthcare proxy, and outline how the DNR will be implemented within California’s legal framework so the plan is effective and practical.
Initial Consultation
During the initial consultation we ask about your health, treatment preferences, and any prior directives you may have. This meeting is a chance to explore the implications of a DNR and other advance directives, and to ensure that your choices are consistent with your values and medical realities. We also review the process for documenting a DNR in California and identify any follow-up steps needed to coordinate with medical providers and to file or place the order in the appropriate records.
Understanding Your Wishes
We take time to understand what outcomes and treatments are most important to you, including preferences about resuscitation, life-sustaining measures, and comfort care. This discussion helps craft clear language for documents and clarifies the role of a healthcare proxy. By aligning document language with your values and specific scenarios, we help ensure that written directives communicate practical and meaningful guidance to clinicians and loved ones under stressful circumstances.
Drafting, Reviewing, and Coordinating Documents
In the drafting phase we prepare the DNR and any complementary documents such as an advance healthcare directive or living will. We review drafts with you to confirm the language matches your intentions and provide guidance on signing and witnessing requirements. We also advise on how to share documents with medical providers and how to ensure the DNR is placed in electronic or paper medical records at relevant facilities to guarantee accessibility when urgent decisions arise.
Document Preparation
We prepare the required forms and review them with you line by line to ensure accuracy and clarity. Proper signatures, dates, and notations are all verified to satisfy California procedural requirements. Clear and unambiguous wording reduces the risk of misinterpretation by clinicians, and we provide guidance on where to store and how to distribute copies so the instructions can be located quickly in an emergency.
Coordination with Medical Providers
We assist in communicating with your treating physicians and other healthcare facilities to make certain the DNR is included in your medical records. Coordinating with providers helps ensure the order is recognized across care settings and by emergency teams. We recommend sharing documents with primary care physicians, specialists, and the staff at facilities you frequent so that the DNR is accessible and consistently applied when needed.
Finalizing and Implementing Your Directives
After documents are completed and signed, we help you implement them by distributing copies, confirming placement in medical records, and advising on practical measures for emergency accessibility. This stage includes guidance on notifying your healthcare proxy and family, preparing wallet cards or emergency alerts, and scheduling any necessary follow-up to update records. Ensuring documents are both valid and easy to find maximizes the likelihood that your directives will be followed when they matter most.
Execution of Documents
Proper execution includes signing, dating, and obtaining any required physician attestation so the DNR is legally effective in California. We review the execution process with you to avoid procedural errors that could compromise the validity of the order. Once executed, we advise on filing or placing the document in the appropriate medical records and on providing trusted individuals with certified copies or clear instructions about where to locate the DNR in an emergency.
Ongoing Support and Updates
Healthcare preferences can change over time, so we offer ongoing support to review and update your DNR and related documents as needed. This includes helping you amend or revoke directives, re-document decisions with updated physician input, and redistribute new copies to providers and designated decision makers. Maintaining current documents and open communication helps ensure your wishes continue to be honored as medical circumstances or personal choices evolve.
The Proof is in Our Performance
Frequently Asked Questions About DNR Orders in Lawndale
What is a DNR order and how does it work in California?
A Do Not Resuscitate order is a written instruction directing healthcare providers not to perform cardiopulmonary resuscitation or related resuscitative measures if a patient’s heart stops or breathing ceases. In California, a DNR must typically be documented in the medical record and may require the attending physician’s signature or notation to be enforceable. The order applies to emergency situations involving arrest of heart or breathing and is intended to prevent undesired resuscitation when it conflicts with a patient’s values or treatment goals. A DNR does not eliminate other aspects of medical care focused on comfort, symptom relief, or other medical treatments the patient wishes to receive. It is important to discuss a DNR with your treating physician and to make sure the order is recorded and shared with relevant providers. Proper documentation and communication help ensure that medical personnel can find and follow the order when urgent decisions arise.
How do I create a valid DNR order in Lawndale?
Creating a valid DNR order in Lawndale involves discussing resuscitation preferences with your physician and completing the required documentation so the order is placed in your medical record. The attending physician generally must acknowledge or sign the DNR, and the order should be recorded in the chart or electronic health record used by the facility where you receive care. Providing copies to your primary care provider and any clinic or hospital you use improves the order’s visibility. You may also want to include DNR instructions within an advance healthcare directive or living will and appoint a healthcare proxy to communicate your wishes if you cannot. Regular reviews with your medical provider and updates to records help keep the order current and effective, and sharing copies with key individuals ensures others are aware of your preferences.
Can I change or revoke my DNR order later?
Yes, you can change or revoke a DNR order as long as you have the capacity to do so. If you decide to revoke or alter the order, inform your treating physician so the change can be reflected in your medical record. It is also important to notify your healthcare proxy and family members about any revisions so they are aware of your current wishes and can convey them to providers if necessary. When a DNR is revoked, make sure the revocation is documented in your medical records and that providers at any facilities you visit receive updated information. If the order was placed in multiple locations, confirm removal or replacement across those records to avoid conflicting instructions during an emergency.
How does a DNR differ from a living will or advance directive?
A DNR specifically addresses whether resuscitation should be attempted in the event of cardiac or respiratory arrest, while a living will or advance healthcare directive provides broader instructions covering a range of life-sustaining treatments and end-of-life care preferences. A living will may explain whether you want interventions such as ventilators, feeding tubes, or dialysis in various scenarios, and an advance directive can appoint a decision maker to interpret and implement those preferences. Using multiple documents together can provide both the focused clarity of a DNR and the broader guidance of an advance directive. Naming a healthcare proxy alongside these documents ensures someone can make decisions consistent with your values when situations arise that are not explicitly covered by written instructions.
Who should receive copies of my DNR order?
Provide copies of your DNR order to your primary care physician, any specialists involved in your care, the medical records department of hospitals or clinics you use, and the person you have named as your healthcare proxy. Giving copies to close family members or caregivers who may be present during an emergency helps ensure that responders can quickly learn about your wishes. Keeping a copy with your personal medical information and sharing the location of the official document are practical steps to improve accessibility. You may also consider carrying a wallet card or medical alert that indicates the existence of a DNR and where a full copy can be found. Confirm that facilities you frequent have placed the order in your chart so emergency staff can easily locate it when time matters.
What happens if there is no DNR when a cardiac arrest occurs?
If there is no DNR order when a cardiac arrest occurs, medical personnel are typically required to initiate resuscitation efforts to attempt to save life. In many settings, emergency responders and hospitals will perform CPR and other interventions unless a valid DNR is present in the patient’s medical record or an authorized clinician has documented an order to withhold resuscitation. This default approach aims to preserve life in the absence of explicit instructions to the contrary. Because of that default, having a written and accessible DNR is the only reliable way to ensure that resuscitation will not be performed when it is inconsistent with your preferences. Preparing and recording the order in advance prevents automatic resuscitative measures from being applied contrary to your wishes.
Who can legally authorize a DNR in California?
In California, an individual can request a DNR for themselves while they are competent, and a legally appointed healthcare proxy can make decisions about DNR orders when a patient lacks capacity. Family members without legal appointment generally do not have the authority to impose or revoke a DNR unless they have been designated as a proxy or hold appropriate legal authority under state law. That is why naming a healthcare proxy in an advance directive is an important step in ensuring the right person can make decisions. If you anticipate needing a proxy, document that appointment clearly and provide the proxy with copies of any DNR or advance directives. Clear legal designation reduces potential disputes and ensures that someone trusted can act on your behalf in accordance with your documented wishes.
Will my DNR be recognized at different healthcare facilities?
DNR orders that are properly documented and recorded in medical records are generally recognized across healthcare facilities in California, but it is important to ensure the order is placed in the record at each facility you use. Communication between providers and confirmation that the order has been entered in charts or electronic health systems helps maintain consistency when care transitions between hospitals, clinics, and long-term care facilities. Because recognition depends on documentation and placement in facility records, proactively sharing copies, informing new providers, and requesting that the order be recorded at each site you visit improves the likelihood the DNR will be honored across different care settings. Periodic verification that records reflect the order is a prudent step.
How can I make sure my DNR is respected in an emergency?
To maximize the chance your DNR is respected, keep copies in your medical records, provide copies to your primary and specialist physicians, and give a copy to your healthcare proxy and close family members. Consider carrying a brief card indicating that a DNR exists and where the full document can be found. Confirm with hospitals and clinics you use that the order has been properly documented in your chart and that staff are aware of its presence. Open communication with your healthcare proxy and family about your preferences helps ensure that those who may be present in an emergency can inform responders and advocate for your wishes. Regularly reviewing records and confirming placement at facilities reduces the risk of the order being overlooked during critical moments.
What other documents should I consider alongside a DNR?
Alongside a DNR, consider preparing an advance healthcare directive or living will to provide broader guidance about life-sustaining treatments and end-of-life care, and appoint a healthcare proxy to make decisions if you cannot. These complementary documents together create a fuller picture of your preferences and designate someone to interpret your wishes when situations are not explicitly addressed by a DNR alone. Having this package reduces ambiguity and supports consistent decision making across various medical circumstances. Other useful steps include informing family members and providers, maintaining copies in medical records at facilities you use, and periodically reviewing and updating documents to reflect changes in health or preferences. A coordinated approach helps ensure that both the letter and spirit of your healthcare choices are honored.