Living wills in Latin America, legal and ethical dilemmas, and regulatory proposal for Ecuador [Testamento vital en Latinoamérica, dilemas legales y éticos, y propuesta normativa para Ecuador]

Abstract

Living wills constitute a legal and bioethical instrument that guarantees the autonomy and dignity of patients at the end of life. In Ecuador, the lack of specific regulations creates regulatory gaps, legal uncertainty, and ethical tensions in medical practice. This paper comparatively analyzes the Latin American experience with advance directives, particularly in Colombia, Argentina, Uruguay, Mexico, and Brazil, where regulatory models with varying scope have been implemented. Methodologically, a qualitative, descriptive, and comparative approach was used to examine the reality of living wills in countries in the region. The results show that the lack of regulations in Ecuador limits advance care planning, exposes physicians to legal liability, and weakens the right to a dignified death. It is concluded that the incorporation of a specific legal framework is urgently needed to harmonize constitutional and bioethical principles and international human rights standards.