[Practical foundations and construction pathways of China's living will system: a comparative law perspective]

Living wills serve as an institutional link connecting medical self-determination, respect for life's dignity, family care ethics, and palliative care. China's existing law already provides a normative foundation through provisions on the right to life, informed consent, emergency rescue, voluntary guardianship, and medical quality management. These rules, however, remain fragmented and are insufficient to address the preservation of patients' authentic wishes, the boundaries of relatives' participation, the liability risks faced by medical institutions, and dispute resolution. A China-specific living will system should take the priority of the patient's own directive as its core rule and confine family involvement to a procedural mechanism for confirming, interpreting, and supporting the patient's wishes. Specifically, building on existing normative resources, the system should clarify the priority effect of living wills over medical decisions and limit their scope to major medical matters in specified serious life-threatening conditions; improve the rules on making, modifying, and revoking living wills; and safeguard implementation through physician review, ethics review, medical record documentation, and liability allocation. In this way, living wills can be embedded in China's existing health law system, yielding an institutional arrangement that is both locally adaptable and clinically operational.