Advance directives (instrucciones previas): what to write and how it is found

Key rules

• Three steps: Formalise it in a form your region accepts, register it, and make sure treating doctors can see it.
• Regional rules: Accepted forms, witness rules and registration steps differ by region, so check with your regional health service first.
• Moving: A registered directive should be available across regions, but check it is visible after you move.

What an advance directive does

Instrucciones previas is a written record of your medical wishes for the time when you can no longer express them. To count, it must be formalised in a form accepted in your region, registered in your regional registry (which is linked to the national one), and visible to the doctors treating you. A document that only sits in a drawer may never be seen.

Who can make one

You must be an adult, have the capacity to decide, and act freely. It must be in writing.

Choose how to sign it

Each region sets its own accepted forms. The usual options are:

• Before a notary. The notary records and signs it with you.
• Before three witnesses. Two of them must not be related to you by blood or marriage up to the second degree (parents, children, grandparents, grandchildren, siblings), and must have no property link with you.
• Before an official of your regional registry or health service.

Witness rules and registration steps differ by region. Ask your regional health service which forms and model documents it accepts before you sign.

What to write

Say clearly which treatments you do and do not want, and what matters to you. You can also name a representative to speak with the doctors for you. Use your region's model form if it has one, because doctors and registry staff know it.

Get it registered

After signing, the document is entered in your regional registry. The region then sends the entry electronically to the national registry. Changes and revocations are passed on in the same way, so a directive made in one region can be consulted in another.

The registry can be consulted by:

• health professionals treating you;
• you;
• authorised people, such as your named representative.

The exact procedure for you and your family to request access is set by each region. Ask your regional registry.

Make sure doctors will see it

In most regions, a registered directive is linked to your electronic health record (historia clínica), so treating doctors can see it. How this works varies. Some regions show an alert in the record. In others, the doctor must look in the registry separately. Because of that, give a copy to your family doctor or health centre, and tell your representative and family that it exists.

If you move to another region, check that your directive is visible there. The checklist below sets out where to keep your documents and what to ask.

Where to keep capacity and end-of-life documents so they are found

Lodge your documents where they will be found

• Register your advance directive with your region's registry of instrucciones previas, so doctors in any region can find it through the national registry.

• Ask your regional health service whether the registered directive appears in your health record (historia clínica) or whether doctors must query the registry separately.

• Keep a copy of the directive in your health record by giving it to your family doctor or health centre.

• Ask the notary who signed your preventive power of attorney to confirm it was notified to the Registro Civil, where it is recorded as a support measure.

• Keep the notary's authorised copy of the power of attorney in a safe place, and ask the notary for extra copies when you need them.

• Give copies of the directive and the power of attorney to the person you named as your representative and to close family.

• Tell your representative and family where the originals and the registry confirmation are kept.

Frequently asked questions

Who can make an advance directive, and how must it be signed?

Any adult who is capable and acts freely can make one, and it must be in writing. Depending on your region, you sign before a notary, before three witnesses, or before an official of the regional registry or health service. If you use witnesses, two must not be related to you up to the second degree and must have no property link with you.

Who can look at my registered directive?

The health professionals treating you, you, and authorised people such as your named representative can consult it. Regional registries send new entries, changes and cancellations to the national registry, so a doctor in another region can also see it. How the public asks for access is set by each region.

Will my doctor automatically see my directive once it is registered?

Not always, because it depends on your region. In most regions a registered directive is linked to your electronic health record, and some show an alert there. In others, the doctor has to search the registry separately.