Abstract: A living will is a legal document through which an individual, while in a sound state of consciousness, declares their medical treatment preferences for end-of-life care in advance. However, the implementation of living wills in China faces significant ethical dilemmas and practical challenges, constrained by multiple factors including traditional cultural beliefs, medical professional ethics, existing policy and legal frameworks, and healthcare service delivery capacities. To effectively promote the adoption of this system, a multi-dimensional approach is required, encompassing enhanced public education on life and death, refinement of relevant laws and regulations, and the establishment of robust institutional safeguards. These coordinated efforts aim to systematically address practical difficulties and foster the formation of societal consensus.