What is a living will and how do you make one?

What is a living will and how do you make one? A living will is a legal document, formally known in Spain as an Advance Healthcare Directive or Advance Instructions Document, in which an adult with full legal capacity freely sets out the medical care and treatments they wish or do not wish to receive if they find themselves in a situation where they are unable to consciously express their wishes. It also allows you to make decisions regarding the disposal of your body or organ donation after death.

Planning your future healthcare is an act of responsibility, both personally and towards your family. In everyday clinical practice, complex situations arise, such as irreversible illnesses, persistent vegetative states or terminal stages of disease, in which medical decision-making becomes critical.

If you have not formally recorded your wishes, the emotional burden of deciding which treatments should be administered or withdrawn falls directly on your loved ones and the medical team. A living will removes this uncertainty and ensures that your personal autonomy is respected until the very end.

What is a living will: legal scope and content of the document

To fully understand what a living will is, it is essential to consider which matters can be regulated through it. It is not simply a question of making decisions about the end of your life, but of establishing a clear framework for the healthcare professionals treating you. Spanish legislation protects this right, ensuring that your instructions are binding on medical professionals, provided that they do not contravene the law or accepted clinical practice.

The most common provisions included in this document include the following:

• Medical treatments and care: you can specify limitations on therapeutic intervention, the refusal of life-support techniques or the artificial prolongation of life (such as mechanical ventilation or haemodialysis), and the administration of pain relief to alleviate suffering even if this may shorten your life.

• Organ and body donation: you can state whether you wish to donate your organs for therapeutic purposes or whether you prefer to donate your body for scientific research and teaching.

• Funeral arrangements and disposal of remains: you can provide instructions as to whether you prefer cremation or burial, as well as any religious or secular rites you wish to be observed after your death.

• Appointment of a representative: you can appoint a trusted person (and a substitute) to act as your representative in dealings with the medical team and ensure that the provisions set out in your living will are faithfully followed.

How to make a living will: requirements and ways of formalising your wishes

In Spain, the legal basis for living wills is set out in Article 11 of Law 41/2002. Furthermore, since 2007 there has been a National Register of Advance Instructions (RNIP), which is overseen by the Ministry of Health and Consumer Affairs and ensures compliance with the provisions contained in living wills registered with the regional authorities, as responsibility for this area, like healthcare as a whole, has been transferred to Spain's autonomous communities.

In this regard, you have two options when drafting your living will: you can use the official templates provided by the health authorities in each region or draw up a personalised document with the advice of a lawyer specialising in civil law. You also have three alternatives for formalising it:

• Before a notary: this is the option that provides the greatest legal certainty. The notary certifies your legal capacity and identity and is responsible for submitting the document to the corresponding register. No witnesses are required and the cost is approximately €60.
• Before healthcare administration staff: each autonomous community has an advance healthcare directives register where you can sign the document before an authorised official from the relevant health authority or assigned healthcare centre.
• Before three witnesses: you can execute a private document before three adults with full legal capacity, at least two of whom must not be relatives up to the second degree by blood or marriage, nor have any financial relationship with you.

An example of an effective living will

Imagine the case of a person diagnosed with the early stages of a neurodegenerative disease such as Alzheimer's disease. While they still retain full cognitive capacity, they execute a living will before a notary, stating in writing that if the disease progresses to an advanced stage involving unconsciousness or an inability to communicate, they refuse invasive life support intended to prolong their life artificially.

In their living will, they also request palliative care focused on preventing suffering and appoint their spouse as their legal representative. When that critical moment arrives, the medical team consults the document registered within the public healthcare system and immediately follows the person's wishes, relieving the family of the distress of having to make such complex decisions and ensuring that their wishes are fully respected.

How to make a living will: registration, consultation and amendment

A living will is neither a static nor an irrevocable document. Throughout your life, your personal or family circumstances or moral convictions may change. For this reason, the law allows you to amend, update or revoke it at any time by following the legally established procedure again. If several versions have been registered, only the most recently executed version will be legally valid.

Furthermore, the regional registers are interconnected with the RNIP. This means that if you experience a medical emergency outside your autonomous community, healthcare professionals anywhere in Spain will be able to access your records electronically and follow the instructions you set out in the document.