中国生前预嘱法律规制的困境与立法完善

A Living Will is a statement of medical choices made in advance by an individual, while conscious, in response to a future medical condition in which he or she may lose decision-making capacity. In many countries, this system has formed a relatively comprehensive legal system to protect the autonomy of individuals at the end of life. However, in China, the legal regulation of advance directives is still in the initial stage of development, and the current legal framework does not yet fully cover the system, which is only partially recognised in the Medical Regulations of the Shenzhen Special Economic Zone. This paper first analyses the legal basis of living wills and its current situation in China, pointing out the lack of legislation and insufficient public awareness of the system. Secondly, it discusses the difficulties in the application of living wills in the Chinese legal system, including the definition of the scope of subjects, the uncertainty of the applicable circumstances and the lack of a registration system. Especially in practice, the implementation of living wills is often faced with ethical dilemmas of medical institutions, disagreements of patients’ families, and insufficient legal protection mechanisms. To address these issues, this paper proposes recommendations to improve the legal system of advance directives, including: (1) expanding the scope of application of advance directives to cover more medical decision-making scenarios; (2) strengthening the review mechanism of advance directives to ensure their legality and enforceability; and (3) setting up a unified registration system for advance directives toensure that the patient’s medical choices can be effectively implemented. In addition, drawing on foreign experience, such as South Korea’s Life-Sustaining Treatment Decision Act, a system of ethics committees for healthcare organisations has been introduced to promote transparency and fairness in medical decision-making. On balance, although China’s living will system is still in the exploratory stage, it holds great promise for development as legal research deepens and social demand grows. Through legal improvement, social publicity, and supporting reforms of the healthcare system, living advance directives are expected to become an important legal tool for safeguarding the dignity and autonomy of patients’ lives, thus promoting the further development of China’s medical ethics and legal system.