What it is
The advance directive ("instrucciones previas", "voluntades anticipadas" or "testamento vital", depending on the region) is recognised in Law 41/2002 on patient autonomy. In it, an adult with capacity records their wishes about the care and treatment they want if a situation arises in which they can no longer express them, and about what should happen to their body or organs. Health professionals are obliged to take it into account.
It is not only for the end of life. It also applies to an acute complication (sepsis, an intensive care admission, a coma) you may recover from, and says how you want decisions made in the meantime.
What it can include
- Treatments you accept or refuse in specific situations: cardiopulmonary resuscitation, mechanical ventilation, dialysis, artificial nutrition, chemotherapy once it can no longer cure, intensive care admission, transfer to hospital or staying at home.
- Your values and priorities: what quality of life means to you, which situations you would not want prolonged, where you would prefer to be cared for.
- Palliative care and sedation in the dying phase if needed to control suffering.
- A representative: the person who will interpret your wishes and speak with doctors if you cannot. This is the most useful part of the document; choose someone who knows your wishes and can stand up for them.
- Organ and tissue donation, donating your body to science, and burial or cremation wishes.
- Spiritual or religious preferences, and whether or not you want to be given all the information.
It cannot include instructions contrary to the law or to good clinical practice.
How to make one
Each region has its own procedure and template (you can use the official form or write it freely). The usual routes are:
- Before the staff of your region's advance directives register (health department), by appointment. Free and the simplest.
- Before a notary, without witnesses.
- Before three adult witnesses (at least two with no family or financial ties to you), then filed with the register.
Once filed with the regional register, it is automatically passed to the National Register of Advance Directives of the Ministry of Health, which doctors in any Spanish hospital can consult. Keep a copy for yourself and give one to your representative and your GP; it should also be noted in your medical record.
It can be changed or cancelled at any time
The document can be amended, replaced or revoked at any time by the same procedure, and what you say in person always prevails while you can express yourself. You lose no rights and will not be denied treatment for having signed one.
Why do it early
It is hard to sit down and think about this while on treatment with curative intent, and it is precisely the best time: without urgency, with a clear head and in conversation with your family. People who do it usually describe relief, not defeat: it spares the family from guessing, avoids conflict and lets the medical team know where they stand. Many sign one and never need it.
Advance care planning with your team
The document is the written part of something broader: advance care planning, an ongoing conversation with your oncologist and your palliative care team (who can be involved from diagnosis, not only at the end) about what matters to you, what you expect from treatment and where you draw the lines. You can ask explicitly for this conversation. In metastatic cancer, guidelines recommend having it early and revisiting it at each change of situation.
And euthanasia
Since 2021, Organic Law 3/2021 regulating euthanasia (LORE) recognises the right to request assistance in dying in narrowly defined situations (serious incurable illness, or serious, chronic and disabling condition, with intolerable suffering), through a safeguarded procedure lasting several weeks. It is a separate legal framework from advance directives, although the document can record your wishes on this for the case where you cannot express them. If you want information, your doctor is obliged to give it neutrally.
What to ask at your appointment
- Can we talk about what would happen if treatment stopped working and what options I would have?
- Can you refer me to palliative care for symptom control and planning, even while I am on active treatment?
- Will my advance directive be noted in my medical record?
- If I cannot decide, will you speak with the person I have named as my representative?
- Where is the register in my region and what do I need to bring?