The living will system constitutes a crucial method for resolving dilemmas in end⁃of⁃life medical decision⁃making and safeguarding patients' right to autonomous decision⁃making. Shenzhen is the first city in China to legislate living will, and then pilot programs have been initiated in multiple provinces (municipalities directly under the central government) including Jiangsu and Beijing, and exploratory practices are progressing steadily nationwide. Nevertheless, in actual implementation of living will system, the supporting operational guidelines and the clinical response mechanisms of medical institutions remain underdeveloped, preventing the system from being fully realized in clinical practice. Currently, the promotion and application of living will system are jointly constrained by high barriers to textual comprehension, insufficient integration into medical workflows, and weak coordination mechanisms among multiple stakeholders. These constraints collectively point to a crucial bottleneck: during the concrete implementation process, the diverse actors involved patients, family members, medical teams, and relevant legal and ethical bodies, have yet to form a stable consensus on the functional positioning of living wills, on decision⁃making relationships, on clinical applicability criteria, and on pathways for collaborative handover and coordination. Based on this, future policy optimization should focus on the construction of the implementation system, strengthen the mechanism connection between professional interpretation, consultation support and clinical feedback, and promote the transformation of living wills from legislative confirmation to effective governance.

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