The living will system in mainland China: legislative status quo, dilemmas and prospects

As the right of patients to make autonomous decisions about life-sustaining treatment has gained wider recognition, many countries have introduced legislation on living wills. Over the past two decades, mainland China has seen a gradual shift from voluntary advocacy by civil-society organizations to initial local legislation, culminating in the Shenzhen Special Economic Zone Medical Regulations (2023), the first statute to recognize the legal effect of living wills. Yet the emerging living will system continues to be hindered by multiple factors at both the legislative and implementation stages. This article identifies three main challenges: vague statutory definitions of key concepts; the lack of supporting mechanisms, particularly for registration and revocation; and tensions between the practice of living wills and traditional cultural understandings of death and filial piety. On this basis, it proposes reforms to clarify in legislation the qualifications of parties eligible to execute living wills and the scope of their application, to establish a unified and accessible registration–revocation system, and to reinterpret the normative foundations of the living will system in light of local cultural values. The analysis aims to provide a roadmap for strengthening institutional safeguards for patients' medical autonomy in China and to offer comparative insights for other developing countries considering similar legislation.