Advance Directives Chile (Voluntades Anticipadas)

Advance Directives Chile (Voluntades Anticipadas) is a legal document governed by Article 16 of Ley N° 20.584 — the Ley sobre Derechos y Deberes que tienen las Personas en Relación con Acciones Vinculadas a su Atención en Salud — enacted on 24 April 2012 and published in the Diario Oficial on 24 April 2012, under the supervision of the Ministerio de Salud (MINSAL) and the Superintendencia de Salud. The document records a person's specific healthcare wishes, including the right to refuse extraordinary life-sustaining treatments, when the person is no longer capable of expressing their will due to illness, injury, or cognitive decline.

Article 16 of Ley N° 20.584 recognizes the right of every person with full legal capacity (mayor de edad con plena capacidad legal) to record in advance their wishes regarding medical interventions, including the right to decline treatments that prolong life artificially when the patient is in a terminal phase of a disease, is in an irreversible vegetative state, or lacks consciousness without reasonable expectation of recovery. The Reglamento de la Ley N° 20.584, aprobado por Decreto Supremo N° 31 de 2012 del Ministerio de Salud, establishes the procedural requirements for these declarations.

The voluntades anticipadas document operates within a constitutional framework: Article 19 N° 1 of the Constitución Política de la República de Chile guarantees the right to life and physical integrity, while the Tribunal Constitucional de Chile has affirmed in Sentencia Rol N° 2.867-15-INA that the autonomy of the patient includes the right to make medical decisions consistent with their personal values and dignity (dignidad humana). The Código Sanitario (DFL N° 725 de 1967) and its regulations establish the licensing and standards framework for hospitals, clínicas, and centros médicos where these directives are applied.

The declaration must be executed in writing before a notary (ante notario) or a competent civil officer (oficial civil competente), according to Article 16 inciso 4 of Ley N° 20.584. MINSAL maintains a voluntary national registry of voluntades anticipadas to facilitate access by treating physicians and healthcare establishments (establecimientos de salud) — both those belonging to the Sistema Nacional de Servicios de Salud (SNSS) managed by FONASA, and those of the private Instituciones de Salud Previsional (ISAPRE) supervised by the Superintendencia de Salud.

Healthcare providers — including hospitals administered by the Red Asistencial del SNSS, clínicas privadas accredited by the Superintendencia de Salud, and médicos tratantes registered with the Colegio Médico de Chile — are legally bound to respect the recorded wishes of the patient under Article 16 of Ley N° 20.584, subject to the limitations on extraordinary treatments and the prohibition on euthanasia (eutanasia activa) under Chilean law. The document does not authorize euthanasia but protects the right to a dignified death (muerte digna) by refusing disproportionate treatments (tratamientos desproporcionados).

A voluntades anticipadas declaration in Chile is needed whenever an adult with full legal capacity wishes to record their healthcare preferences in advance, ensuring those preferences are respected if they later lose the ability to communicate them due to serious illness, accident, or progressive cognitive decline such as Alzheimer's disease or dementia.

Patients diagnosed with terminal illnesses — including advanced cancer (cáncer en etapa avanzada), end-stage organ failure, or progressive neurological conditions — should execute voluntades anticipadas to specify whether they consent to artificial ventilation (ventilación mecánica), cardiopulmonary resuscitation (resucitación cardiopulmonar — RCP), enteral or parenteral nutrition (nutrición enteral o parenteral), dialysis (diálisis), or other intensive care interventions managed by hospitals within the Red Asistencial del SNSS and private clínicas.

Elderly persons enrolled in either FONASA or an ISAPRE-contracted health plan who have family members likely to disagree about end-of-life care should execute voluntades anticipadas to prevent the family conflict that commonly arises in ICU (Unidad de Cuidados Intensivos — UCI) or emergency settings. The Colegio Médico de Chile and clinical ethics committees (comités de ética clínica) of hospitals recognize voluntades anticipadas as the clearest expression of patient autonomy under Ley N° 20.584.

Persons who have experienced a stroke, cardiac event, or serious accident and recovered should execute voluntades anticipadas while they have full capacity, specifying their wishes for a potential recurrence. The Superintendencia de Salud supervises compliance by ISAPRE-contracted providers and reports persistent violations to MINSAL.

Adults with progressive degenerative conditions — Parkinson's disease, multiple sclerosis, or amyotrophic lateral sclerosis (ELA) — should execute voluntades anticipadas early in their diagnosis, before capacity may diminish, specifying their wishes about tracheostomy, feeding tubes, and other long-term interventions common in the management of these conditions in Chilean neurology centers.

Any adult who simply wishes to ensure their healthcare values — religious convictions, cultural practices, or philosophical views on medical intervention — are documented and respected should execute voluntades anticipadas regardless of their current health status. Evangelical Christian, Catholic, and indigenous (pueblo mapuche, aymara, and others) communities in Chile have recognized the document as a way to incorporate spiritual values into end-of-life care.

A valid voluntades anticipadas declaration under Article 16 of Ley N° 20.584 and its Reglamento (DS N° 31/2012, MINSAL) must contain the following essential elements:

Declarant's Full Identity: The full legal name, RUT, nationality, date of birth, domicile, and marital status of the declarant (declarante). The declarant must be a legally competent adult (mayor de edad con plena capacidad legal) at the time of execution. Mental competency should be confirmed by the notary or an attending physician if there is any doubt.

Declaration of Full Capacity: An express statement that the declarant is executing the document with full mental capacity (plenas facultades mentales) and free will (libre voluntad), without coercion from family members, healthcare providers, or insurance companies. The Superintendencia de Salud has issued guidelines warning against healthcare providers pressuring patients to execute or modify voluntades anticipadas.

Specific Healthcare Wishes: Clearly articulated wishes regarding specific interventions, which may include: (a) Rechazo de resucitación cardiopulmonar (RCP) — refusal of CPR; (b) Rechazo de ventilación mecánica artificial; (c) Rechazo de nutrición e hidratación artificiales (alimentación por sonda nasogástrica, gastrostomía, o vía parenteral); (d) Rechazo de diálisis y soporte renal sustitutivo; (e) Rechazo de antibióticos o quimioterapia con intención puramente curativa en fase terminal; (f) Solicitud de sedación paliativa (sedación terminal) para control del dolor y el sufrimiento, which is expressly permitted under MINSAL clinical guidelines on palliative care.

Scope of Application: Whether the wishes apply in all circumstances of incapacity (incapacidad para expresar voluntad) or only in specific clinical situations — terminal illness (enfermedad terminal), permanent vegetative state (estado vegetativo permanente), advanced dementia (demencia avanzada), or irreversible loss of consciousness (pérdida irreversible de conciencia). The clinical situations should be described with reference to the criteria used by treating physicians.

Designation of Healthcare Representative (Representante de Salud): An optional but strongly recommended provision designating a trusted person — family member, close friend, or civil partner under Acuerdo de Unión Civil (Ley N° 20.830) — who is authorized to communicate the patient's wishes to the treating team when the document needs interpretation or when situations arise not covered explicitly. The representative's RUT and contact information must be included.

Religious and Cultural Preferences: Any spiritual, religious, or cultural values that should inform the care provided — last rites (últimos sacramentos), presence of spiritual advisors (capellán hospitalario), indigenous healing practices under the Programa de Salud Intercultural del MINSAL, or specific preferences about the setting of death (domicilio, hospice, or hospital).

Organ Donation Wishes: A statement of whether the declarant confirms or modifies their organ donation status under Ley N° 19.451 on Trasplante y Donación de Órganos (as amended by Ley N° 20.413 and Ley N° 21.145 establishing presumed consent — presunción de donación). MINSAL and the Instituto de Salud Pública (ISP) administer the national organ donor registry.

Notarial Authentication: The declaration must be executed before a notary (notario público) who certifies the identity and competency of the declarant, or before a competent civil officer (oficial civil) under Article 16 inciso 4 of Ley N° 20.584. The notary's RUT, name, office address, and date of authentication must be recorded.

Registration with MINSAL: Although registration is voluntary, MINSAL's Registro Nacional de Voluntades Anticipadas provides the most reliable mechanism for ensuring the document is accessible to treating teams in any establishment within the Red Asistencial del SNSS or contracted ISAPRE facilities nationwide. The original signed document should also be kept by the declarant, the designated healthcare representative, and provided to the primary care physician (médico de cabecera).

Forms-legal.com provides this voluntades anticipadas template as a reference document. Given the deeply personal and medically complex nature of these decisions, persons are encouraged to discuss their wishes with their médico tratante, a palliative care specialist (especialista en cuidados paliativos), and a legal professional (abogado) before execution.