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Comprehensive Guide to Healthcare Directives
Planning ahead for medical decision making is one of the most important parts of estate planning. In Corte Madera, California, creating clear healthcare directives helps ensure your wishes are followed if you cannot speak for yourself. These documents allow you to appoint a trusted person to make medical decisions on your behalf and to state preferences about life-sustaining treatments, pain management, organ donation, and other critical healthcare choices. Working through the process early reduces stress for loved ones and clarifies your intentions for medical providers. Thoughtful directives are tailored to your values, updated as circumstances change, and coordinated with other estate planning documents.
Healthcare directives are practical legal tools that protect your ability to direct your own medical care. They provide a roadmap for family members and healthcare professionals so decisions are made in line with your priorities when you cannot communicate. In Corte Madera, residents benefit from directives that reflect California law and local healthcare practices, which helps prevent misunderstandings and conflict. Preparing these documents includes naming an agent, describing your treatment preferences, and specifying any conditions under which certain interventions should or should not be used. Regular review of directives keeps them current with changes in health, relationships, or personal views.
Why Healthcare Directives Matter in Corte Madera
Having healthcare directives in place preserves your decision-making authority even if you are unable to communicate. For Corte Madera residents, these documents reduce uncertainty and ensure that medical teams and family members follow your stated wishes. Directives can decrease emotional strain and potential disputes by making roles and preferences clear, especially around life-sustaining treatment decisions and comfort care. They also facilitate smoother interactions with hospitals and clinics by providing legally recognized instructions. Ultimately, a well-crafted directive promotes dignity and respect for your values while ensuring that the people you trust have the authority to act on your behalf.
About LA Estate Plans and Our Approach in Corte Madera
LA Estate Plans is focused on helping Corte Madera residents create clear, enforceable healthcare directives that reflect their values. Our team emphasizes careful communication, detailed document preparation, and compliance with California laws to ensure the directives will be respected when needed. We guide clients through naming appropriate agents, specifying medical preferences, and handling signing requirements so documents are ready for use. Our approach is practical and client-centered, prioritizing clarity and accessibility so you and your family can feel confident about the plan you put in place.
Understanding Healthcare Directives in California
Healthcare directives in California include several types of documents designed to communicate your medical preferences and authorize someone to make decisions if you cannot. These instruments commonly include advance healthcare directives, durable powers of attorney for healthcare, and living wills. Each serves a particular purpose: expressing preferences for treatments, naming an agent to act on your behalf, and documenting end-of-life decisions. Understanding the differences helps you choose which documents fit your situation. Preparing directives also involves practical choices such as who will receive copies, how to update the documents, and what instructions to provide for various medical scenarios.
The process of creating healthcare directives involves thoughtful conversation about values, anticipated medical situations, and preferences for interventions like life support and pain management. It also requires selecting an agent who understands and is willing to carry out your wishes. Proper execution under California law is important, including signing and witnessing, so that healthcare providers will accept and follow the directives. Maintaining and sharing up-to-date copies with your agent, family, and medical team ensures the documents are available when they are needed and reduces the risk of disputes or uncertainty during emergencies.
What Healthcare Directives Are and How They Work
A healthcare directive is a legal statement of your medical care preferences and a tool to appoint an agent to make medical decisions if you cannot. It typically covers preferences for life-sustaining treatment, pain management, organ donation, and other interventions, and it can be as broad or specific as you choose. In California, directives can include an advance healthcare directive that combines treatment instructions with a durable power of attorney for healthcare. These documents are designed to provide clear guidance, reduce family conflict, and ensure medical staff know which treatments you would accept or decline under specified circumstances.
Key Components and Steps to Prepare Directives
Creating a reliable healthcare directive involves several key elements: clarifying your treatment preferences, naming a trusted healthcare agent and alternates, specifying circumstances for particular interventions, and following California signing and witnessing requirements. The process commonly starts with a conversation about values, followed by drafting language that reflects your wishes clearly and unambiguously. After execution, distributing copies to your agent, family, and medical providers and storing originals safely ensures accessibility. Periodic review and updates help keep the directive aligned with changing health conditions, relationships, or personal choices.
Important Terms to Know About Healthcare Directives
Familiarity with common terms helps you make informed decisions when preparing healthcare directives. Key concepts include advance healthcare directive, durable power of attorney for healthcare, living will, healthcare agent, and life-sustaining treatment. Knowing what each term means and how it functions under California law reduces confusion and enables clearer conversations with your appointed agent and medical team. These definitions also help you determine which documents you need and how to phrase your instructions so they will be understood and honored when medical decisions arise.
Advance Healthcare Directive
An advance healthcare directive is a legal document that combines instructions about medical treatment preferences with the designation of an agent to make healthcare decisions if you cannot act for yourself. It can cover a wide range of scenarios, from preferences about life-sustaining interventions to requests for comfort-focused care. The directive should be written in clear language and executed in accordance with California requirements so medical staff and facilities will accept and follow your stated instructions. Sharing the directive with your agent and healthcare providers helps ensure it will be used appropriately.
Living Will
A living will is a component of healthcare planning that focuses on end-of-life treatment preferences, such as the use or withholding of life-sustaining procedures under certain conditions. It provides guidance to medical personnel and your appointed agent about the care you wish to receive or avoid when you are unable to express decisions yourself. In California, a living will may be incorporated into an advance directive or maintained as a separate document, and it should be drafted in plain language to clearly communicate the circumstances and types of treatment you accept or decline.
Durable Power of Attorney for Healthcare
A durable power of attorney for healthcare authorizes a person you choose to make medical decisions on your behalf if you are incapacitated. It remains in effect even when you lack the capacity to make decisions yourself. The document should name a primary agent and one or more alternates, and it can include instructions about how the agent should decide in particular situations. Proper execution and clear communication with the appointed agent are essential so they are prepared to represent your values and preferences when decisions must be made.
Healthcare Agent
A healthcare agent is the individual you appoint to make medical decisions for you if you cannot speak for yourself. This person should understand your values, be willing to advocate for your wishes, and be able to communicate with medical teams and family members during stressful situations. Selecting an agent involves considering their availability, temperament, and ability to carry out instructions faithfully. Naming alternates helps ensure someone is available to serve if your primary agent cannot act when needed.
Comparing Simpler Versus Comprehensive Directive Options
Choosing between a straightforward directive and a more comprehensive set of documents depends on your health status, preferences, and family dynamics. A basic directive may suffice for individuals with clear treatment priorities and a trusted agent, while those with complex medical conditions or nuanced preferences often benefit from more detailed instructions. Comprehensive planning can address contingencies, name successor agents, and include clear protocols for particular situations. Consider how much guidance your agent will need, the likelihood of disputes, and whether additional documents, such as a durable power of attorney for healthcare, should accompany a living will.
When a Simple Directive Works Well:
Clear, Uncomplicated Treatment Preferences
A limited directive works well when your wishes about medical care are straightforward and not subject to frequent change. If you have firm preferences about basic decisions—such as whether to accept life-sustaining measures under defined conditions—and you trust a close family member to follow them, a concise directive can provide the necessary guidance without excessive paperwork. This approach reduces complexity, encourages easier sharing with medical teams, and helps ensure your core choices are known and respected without extensive legal detail or multiple supporting documents.
Low Anticipated Medical Complexity
If you are generally healthy and do not anticipate complicated medical scenarios, a simpler directive often suffices to communicate your preferences. This can be true for adults in stable health who want to document their wishes about basic life-sustaining measures and designate a trusted decision-maker. The simplicity makes the document easy to review and update as needed. Even with a limited directive, it is important to discuss your choices with your agent and family so everyone understands your values and can act accordingly if circumstances change.
When a Comprehensive Directive Is Beneficial:
Complex Medical Conditions or Multiple Scenarios
Individuals with complex or chronic medical conditions often require more detailed directives to address a range of possible situations. Comprehensive documents can provide specific instructions for particular treatments, designate secondary decision-makers, and clarify how to proceed in ambiguous cases. This level of detail helps prevent misinterpretation and reduces stress for those charged with carrying out your wishes. Careful planning also ensures that directives integrate smoothly with broader estate planning, medical records, and treatment plans for a cohesive approach to future healthcare decisions.
Desire for Detailed Guidance and Contingency Planning
A comprehensive approach suits individuals who want to provide clear guidance across many potential medical scenarios and who prefer to set out fallback plans and alternate agents. Detailed directives reduce ambiguity and help your agent make decisions that align closely with your values when complex choices arise. This approach can also help families avoid disagreements by documenting intentions for uncommon but important situations. Investing time to articulate specific instructions yields greater clarity and confidence for your loved ones during stressful healthcare events.
Advantages of a Thorough Healthcare Directive
A thorough healthcare directive offers clear instructions that leave less room for interpretation, which helps medical staff and appointed agents act consistently with your wishes. It can address a wider range of scenarios, specify preferences for comfort and palliative care, and name successor decision-makers if needed. This reduces the likelihood of family disputes and supports quicker decision making in emergencies. By documenting nuanced preferences, a comprehensive directive can also assist healthcare providers in aligning treatment plans with your values and desired outcomes.
Comprehensive directives enhance peace of mind by ensuring your wishes are known and respected, and they can decrease the emotional burden on loved ones during difficult times. Detailed planning encourages conversations with family and agents that clarify expectations and prepare decision-makers for their responsibilities. Having legally valid, carefully drafted documents also makes interactions with hospitals and clinics more straightforward, reducing delays in care or uncertainty about which interventions to provide. Overall, the clarity provided by thorough directives promotes dignity and consistent decision making.
Clear Guidance for Medical Teams and Agents
Providing explicit instructions in your directive helps medical teams and your appointed agent interpret your wishes without guesswork. This clarity can prevent unnecessary treatments or interventions that do not align with your preferences. When your directives include detailed scenarios and specific choices, clinicians can more readily follow them and your agent can advocate effectively on your behalf. The result is a smoother decision-making process that respects your priorities and reduces the likelihood of conflict or delay during urgent medical situations.
Reduced Family Stress and Dispute Risk
Detailed directives help minimize conflict among family members by clearly documenting who is responsible for decisions and what those decisions should reflect. This documentation provides a reference that can be used to resolve disagreements and guide conversations during emotionally charged moments. When relatives and decision-makers understand the specific preferences you set out, they are better able to support your wishes without additional stress. Clear written instructions also make it easier for medical staff to follow your plan, avoiding delays or disputes over treatment choices.
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Practical Tips for Creating Healthcare Directives
Communicate Your Wishes Clearly
Open communication is a vital part of preparing healthcare directives. Discuss your medical values and specific treatment preferences with the person you plan to name as your healthcare agent and with close family members. Clarify why certain treatments matter to you and describe any circumstances where your preferences might change. These conversations help the agent make decisions that align with your values and reduce uncertainty when medical choices arise. Documenting these discussions in the directive itself can provide helpful context for decision makers and medical providers.
Review and Update Regularly
Choose a Trusted and Willing Agent
Selecting the right person to act as your healthcare agent is as important as the language of the directive itself. Choose someone who understands your values, can communicate effectively with medical professionals, and is willing to take on potentially difficult decisions. Discuss the role with them ahead of time so they know what you expect and feel comfortable representing your wishes. Naming alternate agents ensures there is a backup if your primary appointee is unavailable when decisions must be made.
Why Establish Healthcare Directives in Corte Madera
Establishing healthcare directives allows you to maintain control over your medical care and ensures that your wishes are honored when you cannot communicate them yourself. In Corte Madera, having formally executed directives helps coordinate care among local hospitals and clinicians and reduces the burden on family members who might otherwise face difficult choices without guidance. Directives also promote clearer conversations with your healthcare team about treatment goals and comfort measures so your medical care aligns with your priorities and values over time.
Healthcare directives can prevent delays and disputes by providing legally recognized instructions that medical staff and appointed agents can rely on. They also support advanced planning for serious diagnoses, planned surgeries, and changes related to aging or chronic illness. Putting directives in place complements other estate planning tasks and contributes to a comprehensive plan for your future care. Taking these steps ahead of time enhances peace of mind and ensures your wishes are documented and accessible when needed most.
Situations Where Healthcare Directives Are Especially Important
Healthcare directives are particularly important for individuals facing serious medical diagnoses, those undergoing major procedures, older adults, and people with chronic conditions that might affect decision-making capacity. They are also valuable for anyone who wants to avoid ambiguity about treatment preferences and reduce the likelihood of family disagreements. In all these situations, directives provide clear instructions and designate a trusted decision-maker so that your values guide medical care when you cannot personally make decisions.
Serious Medical Diagnosis
A serious diagnosis that could impair your ability to communicate or make decisions highlights the need for clear healthcare directives. These documents ensure your treatment preferences are known and followed, directing clinicians and your chosen agent about interventions you would accept or decline. Having directives in place before a medical crisis reduces confusion and helps ensure that your care aligns with your values during critical moments. Providing clear written instruction and discussing it with your care team supports consistent application of your wishes.
Planned Surgical Procedures
Before undergoing surgery or other significant medical treatments, documenting your healthcare preferences can help guide decisions if complications occur. A directive specifies the types of interventions you would want or refuse and names a decision-maker who can act when you are unable to. This reduces the potential for delays in care and confusion about your intentions. Informing your surgical team and ensuring copies are available in your medical record increases the likelihood that your wishes will be followed in urgent situations.
Advanced Age or Chronic Health Conditions
As health changes with age or chronic conditions progress, clear directives become more important for ensuring care matches your values. These documents document preferences for long-term management, emergency interventions, and end-of-life care. They also simplify decision making for caregivers and medical teams by setting expectations ahead of time. Regular review and communication with your agent and family help keep directives aligned with evolving circumstances so that your wishes remain clear and actionable.
We Are Here to Help Corte Madera Residents
Why Choose LA Estate Plans for Healthcare Directives
LA Estate Plans focuses on clear, accessible guidance for Corte Madera residents preparing healthcare directives. We emphasize careful listening and drafting to ensure documents reflect your personal values and meet California formalities. Our approach includes practical advice on agent selection, distribution of documents, and steps to maintain the directive’s validity over time. Clients receive personalized attention that aims to make planning straightforward and helps family members understand the choices that have been recorded.
We help clients navigate the technical aspects of execution and storage so directives are ready for use when needed. This includes explaining signing and witnessing requirements, advising on notarization when appropriate, and recommending distribution strategies for copies to agents, family, and medical teams. Clear documentation and proper handling increase the likelihood that your directives will be recognized and followed by healthcare providers in Corte Madera and across California.
Our process supports ongoing review and updates so your directives remain relevant as health status, relationships, or personal preferences evolve. We provide guidance on how to modify or revoke directives in a legally effective manner and how to communicate changes to those who need to know. This attention to maintenance helps ensure your healthcare plan continues to reflect your intentions over time and reduces uncertainty for decision-makers.
Contact LA Estate Plans to Discuss Your Healthcare Wishes
How We Handle Healthcare Directives at LA Estate Plans
Our process begins with a careful conversation about your values and medical preferences, followed by drafting documents that clearly express your wishes and designate a trusted agent. We explain California rules for signing and witnessing, assist with execution, and advise on distribution and storage of final copies. After documents are completed, we recommend sharing them with your healthcare providers and keeping copies accessible so they can be used when needed. We also encourage periodic review to maintain accuracy and relevance over time.
Initial Consultation and Needs Assessment
The first step is a detailed consultation to gather information about your health, values, and the kinds of medical decisions you envision. During this meeting we discuss who you trust to act as your healthcare agent and whether you want detailed instructions for specific scenarios. We also cover practical matters such as existing medical conditions, upcoming procedures, and preferences for comfort versus aggressive treatments. The information collected forms the basis for drafting directives tailored to your circumstances and priorities.
Discussing Medical Values and Treatment Preferences
We spend time exploring your values around medical care, what outcomes you consider acceptable, and which interventions you would want to avoid. These conversations help translate personal principles into concrete instructions that medical teams and agents can follow. By clarifying the reasons behind your choices, we can incorporate language that guides decision-makers in complex scenarios. This step ensures the final documents reflect thoughtful consideration of the kinds of care you prefer in different circumstances.
Choosing Your Healthcare Agent and Alternates
Selecting an appropriate healthcare agent involves assessing trustworthiness, availability, and ability to make difficult decisions under pressure. We discuss naming a primary agent and one or more alternates to ensure coverage if the primary is unavailable. We also review what you should communicate to your chosen agent so they understand your wishes and feel prepared to act. Naming alternates provides continuity and reduces the chance of delays when decisions need to be made.
Drafting the Directive Documents
Drafting involves translating your preferences into clear, legally acceptable language that medical staff and agents can interpret. We prepare documents that specify conditions for life-sustaining treatment, comfort care instructions, organ donation choices, and agent authority. The drafting stage also addresses contingencies and provides guidance for situations that may not be straightforward. Clear drafting reduces ambiguity and makes it easier for agents and providers to follow the plan during stressful or time-sensitive circumstances.
Detailing Medical Treatment Preferences and Scenarios
We work with you to describe the types of treatments you would prefer or decline in specified situations, including preferences about resuscitation, ventilation, feeding, and pain management. Documenting scenarios with practical language helps clinical staff apply your choices appropriately. Where useful, we include examples or conditional statements that clarify your priorities across different stages of illness or recovery, enabling your agent to interpret and implement decisions consistent with your values.
Including Agent Authority and Successor Instructions
The documents set out the scope of your agent’s decision-making authority and name alternates who can step in if needed. We ensure the directive makes clear whether the agent’s authority is limited to specific decisions or is broader to handle unforeseen circumstances. Including alternate agents and fallback provisions prevents gaps in decision making and provides a practical plan if the primary appointee cannot serve, ensuring continuity of care aligned with your documented preferences.
Execution, Distribution, and Ongoing Maintenance
After drafting, we guide you through proper signing and witnessing procedures required in California so the directives will be recognized by healthcare providers. We also advise on distributing copies to your agent, family members, and medical facilities and on secure storage of originals. Finally, we recommend a schedule and process for reviewing and updating directives as circumstances change, ensuring the documents remain current and continue to reflect your wishes over time.
Signing and Witnessing Requirements
We explain the signing and witnessing steps necessary to make the documents valid under California law. Proper execution typically requires your signature and one or more witnesses, and in some cases a notary may be advisable. Following these formalities reduces the risk that a directive will be questioned by medical providers and helps ensure it will be honored in clinical settings. We help coordinate these details so the documents are completed correctly and ready for use.
Distribution, Storage, and Sharing with Providers
Once finalized, distributing copies to your chosen agent, family members, and medical providers helps ensure the directive can be located and used when needed. We recommend keeping the original in a safe, accessible place and providing clear instructions about where copies are stored. Sharing the directive with your primary care physician and any specialists, and including it in your medical record when possible, reduces the chance of delays or uncertainty during emergencies and supports consistent application of your wishes.
The Proof is in Our Performance
Healthcare Directives — Frequently Asked Questions
What is a healthcare directive and why do I need one?
A healthcare directive is a legal document that records your preferences for medical treatment and designates someone to make healthcare decisions on your behalf if you cannot do so. It serves to guide medical teams and appointed decision-makers about choices like life-sustaining treatments, comfort measures, and organ donation. Having a directive ensures that your wishes are known and reduces the need for family members to make decisions without clear guidance, improving consistency between your preferences and the care you receive. Preparing a directive also makes it easier for clinicians to follow your plan in urgent situations. Creating a directive in advance helps prevent uncertainty and conflict during stressful medical events. It allows you to consider and document what matters most to you in different scenarios, and to choose a person who understands and will represent your wishes. Sharing the directive with your agent, family, and doctors increases the likelihood that it will be located and followed when needed, and it complements other parts of your estate plan.
How do I choose the right person to be my healthcare agent?
Selecting a healthcare agent involves choosing someone you trust to interpret and carry out your wishes when you cannot speak for yourself. Consider someone who understands your values, can remain calm under pressure, and is willing to communicate with medical teams and family members. It is often helpful to name alternates to ensure decision making continuity if your primary appointee is unavailable. Discuss the role with your chosen person so they understand your preferences and are ready to act when needed. When evaluating candidates, think about availability and proximity, their relationship with family members, and their ability to advocate on your behalf in clinical settings. You should also consider whether the person can navigate difficult conversations and weigh complex medical information in light of your stated priorities. Preparing your agent in advance by sharing the directive and outlining specific scenarios will help them execute your wishes accurately.
Can I change or revoke my healthcare directive later?
Yes, you can update or revoke your healthcare directive at any time while you have the capacity to make decisions. Revisions typically involve creating a new document that explicitly supersedes previous versions, and distributing copies of the updated documents to your agent, family, and medical providers. It is a good practice to note the date of the most recent version so that those who rely on the document know which one is current. Major life events, a change in health status, or alterations in relationships are common reasons to review and modify directives. Communicating changes to your agent and relevant family members reduces the chance of confusion. Properly executed updates with clear distribution ensure the most recent instructions are followed when medical decisions arise.
What decisions can a healthcare directive cover?
Healthcare directives can address a wide range of decisions related to medical treatment, such as preferences about resuscitation, use of ventilators, artificial nutrition and hydration, pain management, and organ donation. You can also include instructions for comfort-focused care and specify circumstances under which certain interventions should or should not be used. The more clearly you describe these preferences, the easier it will be for your agent and clinicians to follow them. Directives can also empower an appointed agent to make decisions on your behalf when unforeseen situations arise, giving them the authority to consult with doctors and choose options consistent with your stated values. Including both specific instructions and general guidance about your priorities helps the agent navigate complex decisions aligned with your goals for care.
How does a living will differ from a durable power of attorney for healthcare?
A living will primarily focuses on end-of-life treatment preferences, documenting the types of interventions you would accept or refuse under particular conditions. It explains your wishes about life-sustaining measures and comfort care in scenarios where recovery is unlikely. A durable power of attorney for healthcare, by contrast, appoints a person to make medical decisions for you when you cannot do so yourself, granting them authority to act based on your best interests and stated preferences. Both documents work together to create a comprehensive plan: the living will provides direct instructions for specific circumstances, while the durable power of attorney authorizes a trusted person to make decisions in situations that may not be explicitly covered. Combining these tools offers clear guidance and flexible decision-making authority when circumstances require someone to act on your behalf.
What happens if I do not have a healthcare directive?
If you do not have a healthcare directive, medical decisions may be made by family members or medical providers under California’s default rules, which might not reflect your personal wishes. This can lead to delays, disputes among loved ones, and treatments that you would not have chosen. Without clear written instructions, decision makers may struggle to determine what aligns with your values when urgent choices must be made. Preparing a directive helps avoid these outcomes by documenting your preferences and appointing a decision-maker you trust. This reduces burden on family members and provides medical staff with legally recognized guidance, improving the likelihood that care will proceed in a manner consistent with your priorities and comfort.
Will my healthcare directive be valid in Corte Madera and elsewhere in California?
Healthcare directives executed according to California law are generally valid within the state, including for residents of Corte Madera. Proper signing and witnessing procedures help ensure that hospitals and clinics will accept and follow your directives. When traveling or receiving care outside California, recognition of the document can vary, so it is advisable to carry copies and confirm local acceptance when possible. Keeping updated copies with your agent and providers, and noting any jurisdictional considerations if you spend extended time elsewhere, helps ensure your wishes are accessible and more likely to be followed. Consulting with legal counsel or your care team can clarify how to maximize the directive’s effectiveness both in California and beyond.
Can I name a family member as my healthcare agent?
Yes, naming a family member as your healthcare agent is common and often practical because family members tend to understand personal values and history. If you choose a family member, make sure they are willing and able to take on the responsibility, and that they can advocate effectively with medical professionals. Discuss your preferences openly with them so they are prepared to act in accordance with your wishes when needed. If family dynamics are complex or multiple relatives have differing views, you may still name a family member but consider naming alternates and documenting clear instructions to reduce the potential for conflict. Ensuring that others know who the appointed agent is and where the directive is stored also helps facilitate timely decision making.
What should I do if family members disagree about my care?
If disagreements arise among family members about your care, clear written directives are the best tool to resolve conflict by providing the agent and clinicians with documented instructions to follow. Including detailed language and naming a decisive agent reduces ambiguity. Encourage open communication among family members after you create the directive so everyone understands the choices you have made and why they reflect your values. If disputes cannot be resolved informally, medical providers or courts may become involved to determine appropriate care consistent with the law and your documented wishes. To minimize the chance of intervention, it helps to communicate your intentions clearly, name alternates, and provide context within the directive about the reasoning behind key decisions.
How often should I review my healthcare directive?
Review your healthcare directive periodically and especially after major life events such as a new diagnosis, a change in relationships, relocation, or significant shifts in your health status. Regular review, for example every few years or after important changes, ensures the document continues to reflect your current values and circumstances. Updating the directive when needed avoids reliance on outdated instructions that may no longer align with your wishes. When you make changes, execute a new directive that clearly supersedes earlier versions and distribute copies to your agent, family, and healthcare providers. Communicating updates to those who rely on the directive reduces confusion and helps ensure that the most recent instructions are available during medical decision-making.