The living will: putting your wishes about medical treatment in writing

It is the document that speaks for you when you cannot. The law precisely defines its two scenarios: terminal health condition (an incurable, irreversible, medically diagnosed illness that per medical judgment will cause death within no more than 6 months) and persistent vegetative state (unconsciousness with no cortical or cognitive function and no realistic possibility of recovery). "Medical treatment" in this law means what is administered with the sole potential of artificially prolonging the moment of death when death is imminent: cardiopulmonary resuscitation, diagnostic tests, dialysis, medications, ventilator, surgery, invasive diagnostics, transfusions. There are limits the law itself sets: you cannot prohibit pain relief or hydration and feeding (unless death is already imminent or the body cannot absorb them), the declaration is inoperative during pregnancy until the pregnancy ends, and the law expressly does not authorize euthanasia.

Any person of legal age — which for this law means having turned 21 — in full enjoyment of their mental faculties. It can be executed at any time: you need not be ill. To witness the declaration one must be a qualified witness under the Notarial Act, and in the before-a-physician mode, the two witnesses cannot be the declarant’s heirs nor participate in their direct care.

• Being 21 or older: the law defines "person of legal age" as someone who has turned twenty-one.Verified against the official source
• Being in full use of mental faculties at the time of declaring.Verified against the official source
• Making it in writing, signed and sworn: before a notary (by act or testimony), before a person authorized to authenticate signatures, or before a physician and two qualified witnesses who are neither heirs nor direct caregivers.Verified against the official source
• That the document record the authenticator’s and witnesses’ appreciation of the will, and the date, time and place of execution.Verified against the official source

• The declaration itself, with your orders on treatment and, if you wish, the agent designation. There is no official form in the law: the document is drafted and sworn with Article 4’s requirements.

1. 1

   Step 1: Decide what you want and who decides the rest

   The declaration can order abstention from any or a specific treatment that would only artificially prolong the imminent process of death, and it can also order the opposite: that it be administered. You can add any other order about your medical care, whose viability the physicians will evaluate. And you can name an agent to decide what the declaration did not foresee, per your values. If you name no one, the law designates the closest adult relative per the Civil Code succession order, with the spouse in first rank.

2. 2

   Step 2: Execute it through one of the three routes

   In writing, signed and sworn: (1) before a notary, by act or testimony; (2) before another person authorized to authenticate signatures in Puerto Rico; or (3) before a physician and two qualified witnesses who are neither your heirs nor part of your direct care. In all of them, the authenticator records having verified with you the voluntary character of the declaration, and the document captures date, time and place. The physician-and-witnesses route exists precisely so the document can be made without notary costs, even in a hospital.

3. 3

   Step 3: Notify it and put it in the record

   It is your responsibility to notify the declaration to your physician and the health institution, and give a copy to both; once notified, the physician immediately includes it in your record. If you can no longer communicate, one of the witnesses or your agent makes the notification. A declaration kept in a drawer nobody knows about protects nothing: give a copy to your agent and close family.

4. 4

   Step 4: Change or revoke it whenever you want

   Total revocation can be done at any time, in writing (with date, expression of the will to revoke and your signature) or even orally — the physician records it in the chart with a qualified witness present and date, time and place. Modifying it, by contrast, requires the same requirements as the original execution. The declaration does not affect your life or health insurance policies: the law says so expressly.

It is not filed with any agency: it is executed before a notary, a person authorized to authenticate signatures, or a physician with two qualified witnesses, and a copy is given to your physician and the health institution treating you.

• Believing a notary is required: the law equally accepts declaring before a physician and two qualified witnesses who are neither heirs nor direct caregivers.
• Executing it at 18: for this law, legal age means having turned 21.
• Not handing out copies: without notifying the physician and institution, the declaration never reaches the record and no one can honor it.
• Using as witnesses the children who will inherit or the relative who cares for you: the physician mode expressly excludes them.
• Thinking it prohibits pain relief or feeding: the law protects basic care — hygiene, comfort, pain relief, hydration and feeding — until the moment of death.
• Confusing it with euthanasia: the law expressly says it does not authorize it. It is refusal or acceptance of treatment, not causing death.

These are the government pages this guide is based on.

• Departamento de Salud de Puerto Rico

  Salud

  bvirtualogp.pr.gov