Advance Medical Directives in China: A Legal Pathway through Voluntary Guardianship

Against the backdrop of population aging and the growing imperative for human rights protection, voluntary guardianship and advance medical directives have emerged as key legal instruments for safeguarding the adult medical autonomy. Although advance medical directives directly embody patients' medical autonomy and have gained preliminary practical traction in China, they still operate without explicit legislative authorization. Article 33 of China's Civil Code, which establishes the voluntary guardianship system, empowers individuals to appoint medical agents and define the scope of their authority through agreement. This system aligns closely with advance medical directives in both its underlying philosophy and functional objectives, therefore offering an institutional pathway for the realization of advance medical directives. In detail, advance medical directives should be incorporated into voluntary guardianship agreements, with voluntary guardians authorized to act as medical agents in surrogate decision-making. Corresponding oversight mechanisms should also be established to ensure functional complementarity and systemic integration between these two instruments within China's existing legal architecture.