The Legal Characteristics of the Patient’s «Living Will»: Doctrine and Jurisprudence

Keywords: living will, refusal of medical treatment, patient’s rights, eutha- nasia, legal capacity.


The advance of medical technologies since the mid-20th century has enabled to prolong a patient’s life in critical situations, though not all patients would tolerate to undergo such treatment. Therefore, the legal question encompass- ing the problem was to resolve the issue of a patient’s refusal of life-sustaining treatment. Since most of such patients are usually irresponsive and lack legal capacity, a solution featuring a legal document akin to a testament or trust has been proposed in the early 70s. Upon the gist of this document, a patient having full legal capacity would anticipate his/her further incapacitation and command to conduct or refuse medical treatment. His/her will, which is reflected in a «living will» has to be notarized, and upon the jurisprudence of various countries worldwide, though not omnipresently, affirmed by a court in order to avoid fraud and satisfaction of the illegitimate interests of third parties.

Despite being introduced in the 1970s, living wills are still seldomly drafted by patients. In such case, when the patient lacking a living will falls incapaci- tated, his/her legal representatives and/or the healthcare institution commence civil proceedings so as to define the future fate of the patient using the concept of a substituted judgment, constructed by the courts upon the evidence of the past beliefs and habits of the said person, which requires extensive witness testimony. Resolving the presumed will of the patient is a very complicated issue, and in terms of lack of evidence, courts are not likely to authorize ter- minating the patient’s treatment, acting with a «negative» presumption to rule so. However, courts still may rule that futile treatment is not of the best interests of the patient (which is frequent in respect with minor patients who were born with major congenital ailments).

Therefore, a living will, if legitimately drafted, is considered as a firm evidence of the will of the incapacitated person to continue, or to terminate treatment. The «living will» is an entirely voluntary-drafted document and is void upon the fact of undue influence, like an ordinary testament. The intro- duction of such document into the national legislation requires adopting vari- ous legislative acts, and such document is not legally valid unless provided by appropriate legislation. A living will reflects the will of the patient, not his/her legal representatives, and may not be drafted by them. In rare exemptions, the patient, unable of writing, may dictate the will’s content to a duly authorized person (e.g., a guardianship judge, like in Italy). Thus, the approval of the living will execution is the compliance with the will of the patient concerned: his/her guardian expresses his/her will, and the court affirms it. The control- ling function of the courts is hereby apparent. All in all, the «living will» is a considerable institute of private law, enacted in various countries worldwide and has its legal prospects in Ukraine, as well.


Caso Englaro, Corte di Cassazione, Sezione I Civ., Sentenza n. 21748, del. 16 otto- bre 2007, para. 7.5-7.6, 8, 10 (originally p. 15–17 of the case report).

D.,M.A. s/Declaración de Incapacidad, Corte Suprema de Justicia de la Nacion, 7 de julio de 2015, CSJ 376/2013 (49-D), para. 8–10; 22.

Magyarország Alkotmánybírósága. 22/2003. (IV. 28) 22/2003. (IV. 28.) AB határo- zat, IX, para. 4.

Re Baby C (Withdrawal of Medical Treatment),(2015) EWHC 2920 (Fam), para. 28–33.

Rechtbank Zeeland-West-Brabant, 03.03.2014, 2660330 EJ VERZ 13-5801, section 3.1-3.2; 3.3-3.7.

In re Northern Manhattan Nursing Home, 32 Misc.3d 754, 756-757, 928 N.Y.S.2d 810, 2011 N.Y. Slip Op. 21247 (2011).

Ekstrenna medychna dopomoha: dohospitalnyi etap. Novyi klinichnyi protokol, p. 4.4. (s. 118–122), zatv. Nakazom MOZ Ukrainy № 1269 vid 5 chervnia 2019 r.

Vyrok Kyievo-Sviatoshynskoho raionnoho sudu Kyivskoi oblasti, № 40063829, 29.07.2014, sprava № 369/2104/14k.

Rishennia Lypovodolynskoho raionnoho sudu Sumskoi oblasti, № 77899139, 14.11.2018, sprava № 581/625/18.

Ministero Publico c. Joao Carlos Ferreira, Tribunal da Justiça do Rio Grande do Sul, 20 de novembro 2013, Apelação Civel No. Nº 70054988266 (N° CNJ: 0223453- 79.2013.8.21.7000), p. 3–7.

Kutner L. Due Process of Euthanasia: The Living Will: A Proposal, 44 Ind. L. J. 538 (1969).

Strand J. H. The Living Will: The Right to Death with Dignity? , 26 Case W. L. Rev. 485 (1976).

Alexander G. J. Death by Directive, 28 Santa Clara L. Rev. 67, 92–93 (1988).

Steinle S. J. Living Wills in the United States and Canada: A Comparative Analysis, 24 Case W. Res. J. Int’l L. 435 (1992).

Stanley B. Informed Consent and Senile Dementia, 1 B. Sc. & L. 57, 69 (1983).

Fang A. The Living Will of Dementia Patients, 1997 UCL J. Rev. 143 (1997).

Stephen R. Latham, Living Wills and Alzheimer’s Disease, 23 Q.P.L.J. 425, 427 (2009).

Lemmens Ch. End-of-Life Decisions and Demented Patients – What to Do if the Patient’s Current and Past Wishes Are in Conflict with Each Other, News and Views, 19 EJHL 177 (2012).

Myronova H. A. Living will – novyi instytut Yevropeiskoho pryvatnoho prava. Universytetski naukovi zapysky. 2012. № 3. S. 47–54.

Bundesgerichsthof. 2014.17.09. – XII ZB 202/13, para. 13, 15.

Bundesgerichtshof. 2017.08.02. – XII ZB 604/15, para. 14–15.

Bundesgerichtshof. 2018.14.11. Az.: XII ZB 107/18, para. 17–18.

Lytvynenko A. A. The Necessity of a Court Approval in Civil Proceedings on the Withdrawal of Life-Supporting Treatment for Terminally Ill Patients. 2020. Teisė, 1170. Р. 138–151.

Oberster Gerichthof, 2012. 08.10. 9 Ob 68 / 11g, para. 3.5; 2.3.

Serdiuk V. H., Korohod V. A., Kozodaiev S. P. Kontseptsiia dobrovilnoi informovanoi zghody: zatsikavlenyi pohliad iz boku patsiienta. Medychna informatyka ta inzheneriia. 2012. № 2. S. 15–25. PatVG, BGBl I Nr. 55/2006.

Tribunal administratif de Châlons-et-Champagne, 11 mai 2013, No. 1300740.

Tribunal administratif de Châlons-et-Champagne, 16 janvier 2014, No. 1400029, Dall. Et. juin 2015.

Komar T. S., Nikitenko O. L. Napriamy reformuvannia zakonodavstva Ukrainy shchodo zabezpechennia prav patsiientiv. Visnyk st. n.t. DonNU im. V. Stusa. 2020.

№ 2 (12). S. 181–184.

Matter of Baby K., 832 F. Supp. 1022, 1027 (E.D. Va. 1993) [Civ. A. No. 93-68-A].

Jehovah’s Witnesses of the State of Washington D.C. v. King County Hospital et. al., 278 F. Supp. 488, 495–496; 499–504; 505–508 (1967).

Satz v. Perlmutter, 362 So. (2d) 160, 162 (Fla. Dist. Ct. App. 1978) [Docket Nr. 78-1486].

Application of President and Directors of Georgetown College, Inc., 331 F.2d 1000, 1006–1010 (1964).

Mercy Hosp., Inc. v. Jackson, 62 Md. App. 409, 410; 489 A. 2d. 1130 (1986) [moot], див. фабулу справи.

In Re Osborne, 294 A. 2d. 372 (D.C. C. App. 1972), p. 373, 375–376.

Postanowienie Sądu Najwyższego z dnia 27 października 2005 r. III CK 155/05, OSNC 2006/7-8/137.

OLG Karlsruhe, 29.10.2001 – Az.: 19Wx 21/01, para. 18–30.

OLG Dusseldorf, 07.02.2009, I-25 Wx 25/09, para. 19–20; 22–23.

AG Garmisch-Partenkirchen, 06.02.1999. – XVII 43/99, para. 2–5; 13–19; 26–28

Tribunale di Pavia, Ordinanza di 24 marzo 2018, p. 5.

Truus Postma, Rechtbank Leeuwarden, 21.02.1973, NJ 1973, 183.

Rechtbank Rotterdam, 01.12.1981, NJ 1982, 63; 42. Rechtbank Utrecht, 21.12.1982, NJ 1983,264;

Hof Amsterdam, 17.11.1983, NJ 1984, 43 [case facts, para. 4–6]

Hoge Raad, 27.11.1984, no. 77091: Euthanasia Alkmaar, NJ 1985, 106, Section 4.2 para. 2.

E.D. Wiegman, Het levenstestament: wettelijke verankering gewenst en nodig?, Universiteit van Amsterdam, Nederlands., Juli 2014.

Gerehtshof Amsterdam, 13.06.2017; No. 200.206.621/01 NOT, sections 3; 6.

M. Eidenschink, Die Patientenverfügung in der öffentlichen Debatte: Die Akzente der neuen Discussion in Deutschland, ausgehend von dem Fall Theresa Schiavo, Lit Verlag Dr. Kopf, Berlin 2009.

G. Ferrando, Guido Alpa e il testamento biologico, Dialoghi con Guido Alpa. Unvolume offerto in occasione del suo LXXI compleanno (Uni. Roma), 179 (2018).

LG Arnberg, 23.03.2005, 2 T. 32/04, para. 13–14.

1, 2 wettelijke vertegenwoordigers van Ester t. Stichting Amphia Ziekenhuis, Rechtbank Breda, 26.09.2003, NJF 2004, 3; No. 124740 / KG ZA 03-492 (see case facts and judgment).

Rechtbank Hertogenbosch, 29.03.2011, No. 228385, KG ZA 11-213, section 2.7- 2.10; 3.1-3.2; 4.1-4.4.

1, 2, 3, 4 t. Stichting Nijmeegs Interconfessioneel Ziekenhuis Canisius Wilhelmina, Rechtbank Gelderland, 17.12.2018, No. C/05/346839, KG ZA 18-538, Section 3.1-3.3; 4.5- 4.7; 5.

Trib. de Modena , decreto 14 Maggio 2009, p. 1–2, 4–6; 7 of the original court report.

La Legge 22 dicembre 2017, n. 219.

Trib. de Cagliari, decreto del 16 luglio 2016, p. 3–6.

Άρειος Πάγος, 22 Μαρτίου 2007, Απόφαση 1123 / 2007 (Ζ, ΠΟΙΝΙΚΕΣ). (Supreme Court of Greece, Judgment of 22 March 2007, Case no. 1123/2007).

Audiencia Provincial de Tarragona, Sección 2ª, Sentencia 110/2009 de 25 Marzo de 2009, Recurso 3/2008, Sec. III-VI [Grounds].

Yokohama District Court, Judgment on March 28, 1995 (Judgment Hourly Report No. 1530, p. 28).

Bundesgerichtshof, 17.03.2003 – XII ZB 2/03, para. 36.

Golubchuk v. Salvation Army Grace Hospital, 2008 MBQB 49, 290 DLR (4th) 46; [2008] 8 WWR 229, Docket No. CI 07-01-5466 (see para. 7–11 and the litigants’ arguments)

In re Guardianship of Stein, 105 Ohio St.3d 30, 35 (2004).

Author Biography

A. A. Lytvynenko, Ivan Franko Lviv National University

PhD student in Law at the Department of International Law Ivan Franko Lviv National University, PhD student in Law at the Robert Gordon University of Aberdeen, PhD student in Law at the Legal Sciences Baltic International Academy

How to Cite
Lytvynenko, A. A. (2021). The Legal Characteristics of the Patient’s «Living Will»: Doctrine and Jurisprudence. Medicne Pravo, (1(27), 52-68.