Legislative recognition and implementation challenges of living wills in China

The 2022 revision of China’s Shenzhen Special Economic Zone Medical Regulations marks the nation’s inaugural legislative recognition of “living wills” as legally binding instruments. However, the implementation of living wills in clinical practice encounters significant ethical challenges, influenced by traditional cultural norms, prevailing medical ethics standards, policy frameworks, healthcare resource allocation, and systemic constraints. To advance this end-of-life care paradigm, we propose a threefold strategy: (1) enhancing public education on death literacy and autonomy, (2) improving the legal procedures for establishing and implementing living wills, and (3) establishing a comprehensive national hospice care safeguard system. These measures are critical to ensuring the protection of terminally ill patients’ fundamental rights and dignity.