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Living Will Template — Advance Healthcare Directive · South Africa
South Africa has no Living Will statute — yet the National Health Act 61 of 2003 informed-consent framework, the Constitution's sections 10 (dignity) and 12 (bodily integrity), the landmark Clarke v Hurst NO 1992 (4) SA 630 (D) Durban judgment and the South African Medical Association's ethical endorsement together give a properly executed Living Will substantial practical force in clinical decision-making. Our free template generates a comprehensive Advance Healthcare Directive covering triggering conditions (terminal illness, PVS, advanced dementia, irreversible coma), treatment refusals (CPR, ventilation, artificial feeding, dialysis, antibiotics), palliative care preferences, healthcare proxy designation and organ donation.
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LIVING WILL — ADVANCE HEALTHCARE DIRECTIVE
Thandi Nkosi · Republic Of South Africa · 20 May 2026
Declarant SA ID: 8003150000087
Healthcare Proxy: Sipho Mthembu
I, Thandi Nkosi, South African Identity Number 8003150000087, of 22 Fredman Drive, Sandton 2196, born 15 March 1980, being of sound mind and of full legal capacity, do hereby declare this Living Will (also known as an Advance Healthcare Directive) to communicate my wishes regarding medical treatment in the event of incapacity. I make this declaration voluntarily, free of duress, with full understanding of its meaning, in line with my rights under sections 10 (dignity) and 12 (bodily integrity) of the Constitution of the Republic of South Africa, 1996, and the principles of informed consent under the National Health Act 61 of 2003, and on the common-law authority of Clarke v Hurst NO and Others 1992 (4) SA 630 (D). Executed at Sandton, Johannesburg.
1.
TRIGGERING CONDITIONS
This Living Will shall come into operation if I am no longer able to communicate my wishes AND a qualified medical practitioner has diagnosed that:
(a) I am diagnosed with a terminal illness with no reasonable prospect of recovery
(b) I am diagnosed as being in a persistent vegetative state (PVS)
(c) I have advanced dementia with irreversible loss of cognitive function
(d) I am in an irreversible coma
(a) I am diagnosed with a terminal illness with no reasonable prospect of recovery
(b) I am diagnosed as being in a persistent vegetative state (PVS)
(c) I have advanced dementia with irreversible loss of cognitive function
(d) I am in an irreversible coma
2.
TREATMENTS — WITHHOLD, WITHDRAW OR PROVIDE
In the circumstances set out in Clause 1, I direct my treating healthcare practitioners as follows:
Cardiopulmonary Resuscitation (CPR): WITHHOLD / WITHDRAW
Mechanical Ventilation (Life Support): WITHHOLD / WITHDRAW
Artificial Nutrition and Hydration (Feeding): WITHHOLD / WITHDRAW
Dialysis: WITHHOLD / WITHDRAW
Antibiotics for Serious Infections: WITHHOLD / WITHDRAW
Cardiopulmonary Resuscitation (CPR): WITHHOLD / WITHDRAW
Mechanical Ventilation (Life Support): WITHHOLD / WITHDRAW
Artificial Nutrition and Hydration (Feeding): WITHHOLD / WITHDRAW
Dialysis: WITHHOLD / WITHDRAW
Antibiotics for Serious Infections: WITHHOLD / WITHDRAW
3.
PALLIATIVE CARE AND PAIN RELIEF
I REQUEST full palliative care including pain relief, comfort care, emotional and spiritual support, regardless of whether life-prolonging treatment is being withheld or withdrawn.
Pain relief: I request pain-relieving medication at the maximum medically appropriate dose to relieve my suffering, even if such treatment may have the secondary effect of shortening my life (the doctrine of double effect).
End-of-life setting: Where reasonably possible, I wish to spend my final days in my home, with hospice or home palliative-care support.
Pain relief: I request pain-relieving medication at the maximum medically appropriate dose to relieve my suffering, even if such treatment may have the secondary effect of shortening my life (the doctrine of double effect).
End-of-life setting: Where reasonably possible, I wish to spend my final days in my home, with hospice or home palliative-care support.
4.
HEALTHCARE PROXY
I appoint the following person to enforce this Living Will and to make any necessary healthcare decisions on my behalf when I am unable to do so:
Primary Healthcare Proxy: Sipho Mthembu (SA ID 7807205009088), Spouse / Life Partner, contactable at +27 83 333 4444.
Alternate Healthcare Proxy: Bongani Nkosi (sibling, SA ID 7805245009086) — +27 82 555 6666.
My Healthcare Proxy shall have full authority to consult my treating healthcare practitioners, to receive all relevant medical information about my condition, and to make decisions consistent with the wishes expressed in this Living Will. The Healthcare Proxy's authority is in the nature of a durable power of attorney for healthcare under the proposed National Health Amendment Bill 2019 and the common-law principles of agency / mandate.
Primary Healthcare Proxy: Sipho Mthembu (SA ID 7807205009088), Spouse / Life Partner, contactable at +27 83 333 4444.
Alternate Healthcare Proxy: Bongani Nkosi (sibling, SA ID 7805245009086) — +27 82 555 6666.
My Healthcare Proxy shall have full authority to consult my treating healthcare practitioners, to receive all relevant medical information about my condition, and to make decisions consistent with the wishes expressed in this Living Will. The Healthcare Proxy's authority is in the nature of a durable power of attorney for healthcare under the proposed National Health Amendment Bill 2019 and the common-law principles of agency / mandate.
5.
SPECIFIC CLINICAL SCENARIOS
In addition to the general directions in Clauses 1 and 2, I direct as follows in the following specific scenarios:
Scenario 1: If I am diagnosed with Alzheimer's and reach a stage where I no longer recognise my immediate family members for a continuous period of 6 months, withhold all treatment for serious infections (other than oral antibiotics that do not require hospitalisation). Scenario 2: If I suffer a stroke leaving me unable to communicate or feed myself, and this state persists for 90 days with no medical prospect of meaningful recovery, withdraw artificial nutrition and hydration. Scenario 3: If I am diagnosed with end-stage cancer with less than 6 months' life expectancy, withhold all curative-intent treatment; provide palliative care only.
Scenario 1: If I am diagnosed with Alzheimer's and reach a stage where I no longer recognise my immediate family members for a continuous period of 6 months, withhold all treatment for serious infections (other than oral antibiotics that do not require hospitalisation). Scenario 2: If I suffer a stroke leaving me unable to communicate or feed myself, and this state persists for 90 days with no medical prospect of meaningful recovery, withdraw artificial nutrition and hydration. Scenario 3: If I am diagnosed with end-stage cancer with less than 6 months' life expectancy, withhold all curative-intent treatment; provide palliative care only.
6.
RELIGIOUS AND CULTURAL WISHES
I am a practising Christian (Methodist). I wish to be visited by a Methodist minister for last rites if death is imminent, regardless of the day or time. I wish to be buried (NOT cremated) in accordance with Methodist tradition. My family may sing hymns at my bedside.
7.
FAMILY COMMUNICATION
All my immediate family members (spouse, children, siblings) may visit at any time. My medical information may be shared with my Healthcare Proxy and my adult children. News of my impending death may be communicated to my family by my Healthcare Proxy in the manner he deems appropriate. I prefer to die surrounded by family, conscious or unconscious, with quiet music playing.
8.
ORGAN AND TISSUE DONATION
In accordance with section 62 of the National Health Act 61 of 2003, I direct as follows regarding organ and tissue donation: All organs and tissue.
I consent to the donation of any and all of my organs and tissue suitable for transplantation, research or therapeutic use, including but not limited to heart, lungs, liver, kidneys, pancreas, corneas, skin, bone, heart valves and connective tissue.
Specific instructions: No specific exclusions. All donations subject to my Healthcare Proxy's confirmation at the time of death and compliance with my religious beliefs (Methodist Church).
I consent to the donation of any and all of my organs and tissue suitable for transplantation, research or therapeutic use, including but not limited to heart, lungs, liver, kidneys, pancreas, corneas, skin, bone, heart valves and connective tissue.
Specific instructions: No specific exclusions. All donations subject to my Healthcare Proxy's confirmation at the time of death and compliance with my religious beliefs (Methodist Church).
9.
FUNERAL WISHES AND LAST WILL CROSS-REFERENCE
Funeral wishes (high-level): I wish to be buried (not cremated) in accordance with Methodist tradition. Burial at Heroes Acre Cemetery, Soweto (family plot). Service: Methodist Church, Sandton. Specific funeral arrangements (pallbearers, hymns, readings) are set out in my Last Will and Testament dated 15 January 2025.
Last Will and Testament cross-reference: My Last Will and Testament is dated 15 January 2025, executed before Notary Public André van Heerden of Cape Town, and is kept in the safe at Standard Bank Sandton City branch (safe deposit box 234). My executor is Sipho Mthembu (spouse).
Last Will and Testament cross-reference: My Last Will and Testament is dated 15 January 2025, executed before Notary Public André van Heerden of Cape Town, and is kept in the safe at Standard Bank Sandton City branch (safe deposit box 234). My executor is Sipho Mthembu (spouse).
10.
REVOCATION AND LEGAL STATUS
This Living Will may be revoked or amended by me at any time while I retain legal capacity, by written notice signed by me in the presence of two competent witnesses. The Declarant acknowledges that, until the National Health Amendment Bill 2019 is enacted, Living Wills in South Africa do not enjoy direct statutory recognition. However, the Constitution of the Republic of South Africa, 1996 (sections 10 and 12), the National Health Act 61 of 2003 (informed consent framework), the common-law authority of Clarke v Hurst NO and Others 1992 (4) SA 630 (D), and the ethical endorsement of Living Wills by the South African Medical Association (SAMA), together provide strong support for healthcare practitioners to give effect to this Living Will in the best interests of the Declarant.
DECLARANT
Thandi Nkosi
SA ID 8003150000087
Declarant
Date: ____________________
WITNESS 1
Lerato Naidoo
SA ID 8511125009089
Witness
Date: ____________________
WITNESS 2
Pieter van der Merwe
SA ID 7505105009087
Witness
Date: ____________________
HEALTHCARE PROXY
Sipho Mthembu
Spouse / Life Partner
Healthcare Proxy
Date: ____________________
Available as a print-ready PDF or an editable Microsoft Word (.docx) file.
What Is a Living Will?
A Living Will — also known as an Advance Healthcare Directive — is a written document in which a person of sound mind sets out, in advance, the medical treatment they wish to receive (or refuse) if they later become unable to communicate their wishes. The most common scenarios are terminal illness with no prospect of recovery, persistent vegetative state (PVS), advanced dementia, and irreversible coma. The document typically directs healthcare practitioners to withhold or withdraw life-prolonging treatment (CPR, mechanical ventilation, artificial nutrition and hydration, dialysis, antibiotics for serious infections) while continuing palliative care for comfort.
A Living Will is conceptually distinct from a Last Will and Testament. The Last Will deals with the distribution of the Declarant's estate AFTER death and is governed in South Africa by the Wills Act 7 of 1953. The Living Will deals with medical treatment BEFORE death, while the Declarant is still alive but incapacitated, and is governed by the common-law principles of informed consent, the National Health Act 61 of 2003 and the Constitution. The two documents are complementary — every adult should have both, ideally with the same nominated representative (executor + healthcare proxy) for continuity.
South Africa's position on Living Wills is paradoxical: there is NO statute specifically recognising or regulating them (the National Health Amendment Bill 2019 would have done so but has not yet been enacted), yet the underlying legal and ethical framework strongly supports their enforcement. The Durban judgment in Clarke v Hurst NO and Others 1992 (4) SA 630 (D) authorised the withdrawal of artificial feeding from a patient in PVS on a "best interests" test, expressly noting that the patient's prior wishes (including any Living Will) were a relevant factor. The South African Medical Association (SAMA) ethical guidelines endorse Living Wills as a valid expression of the patient's right to refuse treatment. DignitySA and the Voluntary Euthanasia Society of Southern Africa advocate for formal statutory recognition. In practice, a properly executed Living Will signed before two witnesses, communicated to the patient's family and treating doctors in advance, and accompanied by a Healthcare Proxy designation, is routinely respected by SA healthcare practitioners.
What's Covered in This Template
Eight sections covering every typical Advance Healthcare Directive element + expert-tier healthcare proxy, specific clinical scenarios and organ donation.
Declarant Details
Full name, SA ID, address, date of birth, declaration date and place.
Triggering Conditions
Terminal illness, persistent vegetative state (PVS), advanced dementia, irreversible coma — Declarant elects each.
Treatments to Withhold / Withdraw
CPR, mechanical ventilation, artificial nutrition and hydration, dialysis, antibiotics — each separately elected withhold / provide / conditional on Proxy.
Palliative Care Preference
Full palliative care including pain relief, comfort care, emotional and spiritual support — regardless of withholding life-prolonging treatment.
Pain Relief Priority
Maximum (double-effect doctrine — pain relief even if it shortens life) / Balanced / Minimal (preserve consciousness).
End-of-Life Setting
Home (with hospice / home palliative care) / hospice facility / hospital / no preference.
Witnesses (Two Required)
Two competent witnesses — neither a beneficiary under the Declarant's Last Will nor the Healthcare Proxy.
Healthcare Proxy / Durable POA (Expert)
Primary Healthcare Proxy + alternate. Authorised to enforce the Living Will and make any necessary medical decisions on the Declarant's behalf.
Specific Clinical Scenarios (Expert)
Removes ambiguity beyond generic withhold/provide — specific scenarios for Alzheimer's, stroke, end-stage cancer with named decision-points.
Religious & Cultural Wishes (Expert)
Critical for SA: Christian, Islamic, Hindu, Jewish, traditional African end-of-life practices vary significantly.
Family Communication Wishes (Expert)
Visitor access, medical-information sharing, manner and timing of communicating impending death.
Organ Donation (Expert)
Express donation election under s.62 of the National Health Act 61 of 2003 — all organs / major organs only / research only / none. Express election eliminates family-consent barrier at time of death.
Funeral + Last Will Cross-Reference (Expert)
High-level funeral wishes + cross-reference to the Last Will and Testament for full detail and location.
How to Create a Living Will in South Africa
Five steps from drafting to a signed Advance Healthcare Directive.
- 1
Decide Triggering Conditions
Standard election covers all four (terminal illness, PVS, advanced dementia, irreversible coma). You can narrow if you have strong views — for example, some Declarants exclude advanced dementia from triggering withholding of treatment.
- 2
Decide Treatment Refusals
CPR and mechanical ventilation are commonly refused. Artificial nutrition and hydration is the most ethically contested category — withholding is supported by Clarke v Hurst but evokes strong family reactions. The "conditional on Healthcare Proxy" option preserves flexibility for situations the Declarant cannot anticipate.
- 3
Nominate a Healthcare Proxy
The single most important step. Choose someone (a) who knows your values intimately; (b) who is geographically reachable; (c) who is emotionally able to enforce difficult decisions against family and doctor resistance; (d) who is NOT a doctor or nurse currently treating you. Nominate a primary AND an alternate.
- 4
Sign Before Two Witnesses
Two competent adult witnesses (not beneficiaries under your Last Will, not the Healthcare Proxy) sign confirming you appeared of sound mind and signed of your own free will. The witnesses' SA IDs strengthen evidentiary weight.
- 5
Distribute Copies + Discuss
Original kept with your important documents (alongside Last Will). Certified copies to: your Healthcare Proxy; alternate Proxy; your GP / family doctor; your spouse / adult children. Have a family conversation NOW about your wishes — the document's effectiveness depends on family acceptance, not just legal form.
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Legal Considerations
Legally not yet codified, but practically respected under National Health Act + Constitution + Clarke v Hurst + SAMA ethics.
This template is for informational purposes only and does not constitute legal or medical advice. Living Wills involve sensitive end-of-life decisions with significant ethical, religious and family implications. Consult a qualified South African attorney for legal advice and your treating doctor for medical guidance.
Reviewed for South African law
The Statutory Vacuum — and Why Living Wills Still Work
South Africa has no statute that specifically recognises or regulates Living Wills. The National Health Amendment Bill 2019 proposed formal recognition of Advance Healthcare Directives and Durable Powers of Attorney for Healthcare, but the Bill has not been enacted and there is no current Parliamentary timeline. Despite the absence of a statute, four pillars support Living Will enforcement in SA: (a) sections 10 (dignity) and 12 (bodily integrity, including the right to make decisions about reproduction and the right not to be subjected to medical experiments without informed consent) of the Constitution of the Republic of South Africa, 1996; (b) the informed-consent framework in the National Health Act 61 of 2003 (sections 6-7), which establishes that competent adult patients have an absolute right to refuse treatment; (c) the Clarke v Hurst 1992 (D) common-law authority for withdrawal of treatment based on best-interests assessment that includes the patient's prior wishes; (d) the South African Medical Association (SAMA) ethical guidelines, which endorse Living Wills and provide practical guidance to doctors. The result: a properly executed Living Will, while not statutorily binding, is routinely respected by SA healthcare practitioners as the strongest available evidence of the patient's prior wishes.
Clarke v Hurst NO and Others 1992 (4) SA 630 (D) — The Landmark Case
Clarke v Hurst remains the leading SA case on withdrawal of life-prolonging treatment. The applicant's husband was in a persistent vegetative state following a heart attack, and she sought a court order authorising the discontinuance of artificial feeding. The Durban court (Thirion J) authorised the withdrawal, applying a "best interests" test that included the patient's prior wishes (in that case, expressed orally to family before incapacitation). Crucially, the court did NOT formally rule on the legal status of a Living Will as such, but the judgment is widely understood to support the proposition that a properly documented prior wish — including a written Living Will — is a powerful factor in the best-interests assessment. Subsequent cases (including the unreported Stransham-Ford 2015 (GP) — overturned on appeal but the reasoning remains influential) have continued to apply the Clarke v Hurst framework. The combined effect is that, while a Living Will is not strictly legally binding, it materially shifts the burden in any best-interests application — the question becomes "is there a reason to depart from the Declarant's expressed wishes" rather than "what would the Declarant have wanted".
The Healthcare Proxy and the Family-Acceptance Problem
The single biggest practical obstacle to Living Will enforcement is NOT legal — it is family disagreement at the bedside. When a Declarant is incapacitated, family members frequently override the Living Will out of guilt, hope, religious belief or simply discomfort with the decision. This is where the Healthcare Proxy designation becomes critical: a person specifically nominated by the Declarant, ideally well in advance and after a substantive conversation about the Declarant's values, has both the moral authority and the emotional preparation to enforce the Living Will against family resistance. The Proxy must therefore be (a) chosen with great care; (b) given a copy of the Living Will and a substantive briefing while the Declarant is competent; (c) ideally introduced to the Declarant's GP / family doctor / specialists in advance. The "alternate" Proxy designation handles the case where the primary is unavailable, travelling, or incapacitated themselves. Without a Healthcare Proxy, even the best-drafted Living Will can be neutralised by family disagreement.
Organ Donation — Section 62 of the National Health Act 61 of 2003
Section 62 of the National Health Act 61 of 2003 governs organ and tissue donation. A person may direct in writing, during their lifetime, that after their death their body or specific organs / tissue be donated for transplantation, medical training or research. Where the deceased made NO express direction during life, section 62(2) provides that the deceased's spouse, major partner, parent, guardian, major child, brother or sister (in that order) may give consent — but in practice this consent is frequently refused at the moment of bereavement. An express donation election in the Living Will (or in a separate Organ Donor Card / Driver's Licence donor indicator) eliminates this barrier. The South African Transplantation Society and the Organ Donor Foundation of South Africa report that an express written election dramatically increases donation rates. The standard election is "all organs and tissue" — South Africa has a chronic shortage of donor organs and a single donor can save up to seven lives plus restore sight to two corneal-transplant recipients.
Frequently Asked Questions
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