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Clinical implementation, however, faces ethical barriers shaped by traditional cultural norms, prevailing medical ethics, policy frameworks, healthcare resource allocation, and systemic constraints. A threefold strategy is proposed: strengthening public death literacy and autonomy education, improving legal procedures for establishing and implementing living wills, and creating a comprehensive national hospice care safeguard system to protect terminally ill patients’ rights and dignity.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/legislative-recognition-and-implementation-challenges-of-living-wills-in-china-research-open-access/457714/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/legislative-recognition-and-implementation-challenges-of-living-wills-in-china-research-open-access/457714.png","ImageObject",300,407,{"name":92,"@type":93},"awa","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-08","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What legal milestone did Shenzhen’s 2022 medical regulations introduce regarding living wills?","Question",{"text":112,"@type":113},"The 2022 revision marks China’s inaugural legislative recognition of “living wills” as legally binding instruments.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Which factors are identified as ethical challenges for implementing living wills in clinical practice?",{"text":117,"@type":113},"Challenges are influenced by traditional cultural norms, prevailing medical ethics standards, policy frameworks, healthcare resource allocation, and broader systemic constraints.",{"name":119,"@type":110,"acceptedAnswer":120},"What three measures does the study propose to advance end-of-life care and implementation of living wills?",{"text":121,"@type":113},"Enhance public education on death literacy and autonomy, improve the legal procedures for establishing and implementing living wills, and establish a comprehensive national hospice care safeguard system.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},457714,1790984880,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},3985747858093,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Chen Philosophy, Ethics, and Humanities in Medicine (2026) 21:1  \n[https://doi.org/10.1186/s13010-025-00208-9](https://doi.org/10.1186/s13010-025-00208-9)  \nPhilosophy, Ethics, and Humanities in Medicine  \nRESEARCH Open Access  \nLegislative recognition and implementation challenges of living wills in China  \nLong Chen1,2*  \nAbstract  \nThe 2022 revision of China’s Shenzhen Special Economic Zone Medical Regulations marks the nation’s inaugural legislative recognition of “living wills” as legally binding instruments. However, the implementation of living willsin clinical practice encounters significant ethical challenges, influenced by traditional cultural norms, prevailing medical ethics standards, policy frameworks, healthcare resource allocation, and systemic constraints. To advance this end-of-life care paradigm, we propose a threefold strategy: (1) enhancing public education on death literacy and autonomy, (2) improving the legal procedures for establishing and implementing living wills, and (3) establishing a comprehensive national hospice care safeguard system. These measures are critical to ensuring the protection of terminally ill patients’ fundamental rights and dignity.  \nKeywords Hospice, Live will, Medical autonomy, Personal dignity, Right of death  \nIntroduction  \nChina’s rapidly aging population – reaching 296.97 million adults aged ≥ 60 (21.1% of the population) by 2023, arise of >16 million year-on-year (National Bureau of Statistics, 2024)– intensifies urgent societal and policy challenges in safeguarding elderly welfare [1]. Against this backdrop, the formal recognition of living wills as legally binding instruments under Shenzhen’s revised Special Economic Zone Medical Regulations (June 2022) marks a pivotal advancement in end-of-life autonomy [2]. Yet this legislative milestone has simultaneously unveiled systemic ethical and practical challenges in clinical implementation, influenced by cultural traditions, professional norms, resource constraints, and policy frameworks [3].  \nThis study adopts a policy-analytic and normative ethical approach to examine the tensions arising from living  \n*Correspondence:  \nLong Chen  \n[0025131@zju.edu.cn](0025131@zju.edu.cn)  \n1Guanghua Law School Zhejiang University, Hangzhou, China 2Institute of Digital Jurisprudence, Zhejiang University, Hangzhou, China  \nwill adoption in China.We begin by defining key concepts: a living will refers to a legal document through which individuals, while mentally competent, specify their preferences for or refusal of life-sustaining medical treatments in the event of terminal illness or irreversible incapacity. End-of-life care encompasses medical, nursing, and psychosocial services provided to individuals in the final stages of life, while hospice care (or palliative care) is a specialized form of end-of-life care focused on relieving suffering and improving quality of life for terminally ill patients, rather than curing the underlying disease.While the aging population provides the broader demographic context, the primary target population for living wills in this discussion is terminally ill patients—a distinct subgroup often overlapping with, but not limited to, the elderly.  \nThis study examines the ethical tensions arising from living will adoption in China, analyzes their underlying determinants, and proposes pathways to strengthen implementation by improving the legal operational procedures of living wills and establishing a hospice care safeguard system. By integrating secondary data, legal  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not hav","cbCaivlKVnEtPhMY","https://ap.wps.com/l/cbCaivlKVnEtPhMY","pdf",651990,"English","# Abstract\n# Introduction\n# The definition of living will\n# Legislative recognition and implementation challenges\n# Proposed threefold strategy","[{\"question\":\"What legal milestone did Shenzhen’s 2022 medical regulations introduce regarding living wills?\",\"answer\":\"The 2022 revision marks China’s inaugural legislative recognition of “living wills” as legally binding instruments.\"},{\"question\":\"Which factors are identified as ethical challenges for implementing living wills in clinical practice?\",\"answer\":\"Challenges are influenced by traditional cultural norms, prevailing medical ethics standards, policy frameworks, healthcare resource allocation, and broader systemic constraints.\"},{\"question\":\"What three measures does the study propose to advance end-of-life care and implementation of living wills?\",\"answer\":\"Enhance public education on death literacy and autonomy, improve the legal procedures for establishing and implementing living wills, and establish a comprehensive national hospice care safeguard system.\"}]","Legislative recognition and implementation challenges of living wills in China - Research Open Access | PDF",1790750216,18]