Advance Directives

An older couple sitting close together at a desk, having signed important documents, looking calmly at the camera.

Our Focus Areas

Planning that gives your voice practical force

An advance directive is an arrangement made while a person has decision-making capacity, setting out wishes for future healthcare in case they later become unable to make or communicate decisions. It can deal with treatment preferences, the circumstances in which treatment should be withheld or withdrawn, and who should make decisions on the person's behalf.

Many people use advance directives to make clear that they want comfort, dignity and natural dying to be respected if recovery is no longer possible. Others use them to record values, spiritual or family priorities, and the outcomes that would matter most in a medical crisis.

DignitySA encourages people to treat advance directives as part of an ongoing conversation rather than a once-off form. The paperwork matters, but the shared understanding around it matters too.

The two main documents

A living will and a Section 7 Mandate do different jobs

They are strongest when they work together: one explains your wishes, the other appoints the person who can act on them.

Statement of wishes

Living will

Records the care you would or would not want

A living will gives guidance about future treatment if you become unable to refuse or request treatment yourself. It can describe when you would not want resuscitation, artificial nutrition and hydration, antibiotics, ventilation or other interventions that only prolong dying or severe suffering.

Best used to explain values, acceptable quality of life and treatment limits.
Not expressly named in South African legislation, but valuable evidence of wishes.
Most useful when discussed with family, a proxy and healthcare providers.

Legally recognised appointment

Section 7 Mandate

Appoints someone to make healthcare decisions

A Section 7 Mandate appoints a trusted person in writing to make healthcare decisions if you cannot. It is explicitly mentioned in the National Health Act of 2003 and gives the mandated person legal authority to consent to, refuse, withhold or withdraw health services on your behalf.

The appointed person should understand your values and wishes.
Their lawful decisions should be respected as if you were making the decision.
It reduces uncertainty for family members and treating teams during a crisis.

Legal status in South Africa

The clearest legal footing is the written mandate

South African law gives strong recognition to a person mandated in writing. A living will is not named in the same way, but it remains an important practical and evidentiary document.

01

Capacity comes first

Advance directives are made by competent people for a future time when they may no longer be able to make or communicate healthcare decisions.

02

Section 7 Mandates are named in law

The National Health Act recognises a person mandated in writing as a healthcare decision-maker when the patient cannot give informed consent.

03

Living wills still matter

A living will is not expressly named in South African law, but it can guide the mandated person, next of kin and healthcare team, and provide evidence of what the person would have wanted.

04

Legal reform is underway

DignitySA helped initiate the Advance Directives Coalition to strengthen the legal basis for advance directives in South Africa.

A couple in a sunlit kitchen, leaning into each other while reading a document together.

Advance healthcare planning

The conversation is as important as the document

Advance healthcare planning is an iterative process of thinking ahead, talking about future health and care goals, and making those wishes understandable to the people who may one day need to act. It helps loved ones feel less alone in a crisis and helps healthcare teams recommend treatment that aligns with the person's values.

These conversations are easiest to begin while a person is still doing well. Include the mandated person, close family and relevant clinicians so everyone knows where the documents are and what they mean in practice.

Conversation starters

01

Reflect on values

Think about what quality of life means to you, what outcomes would be unacceptable, and what kinds of treatment would feel too burdensome.

02

Choose a trusted person

Appoint someone who can remain calm under pressure, understand medical information and speak faithfully for your wishes.

03

Have the conversation

Discuss your wishes with loved ones and healthcare providers while you are well, before decisions become urgent or emotionally charged.

04

Complete the documents

Use a living will, a Section 7 Mandate or the combined template to make your wishes and appointment clear in writing.

05

Share and review

Give copies to your mandated person, family and relevant clinicians. Revisit the documents when health, relationships or wishes change.

Templates

Download DignitySA advance directive documents

The combined template is the best starting point for most people because it brings a living will and Section 7 Mandate into one document.

Combined advance directives template

Living will and Section 7 Mandate Word document

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Section 7 Mandate template

English Word document

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Section 7 Mandate template

Afrikaans Word document

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Advance Directives Planning Guide

English PDF document

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Legal reform

The Advance Directives Coalition

In 2025, DignitySA helped initiate a multi-stakeholder coalition to strengthen the legal basis for advance directives in South Africa. The Coalition brings together people working across law, healthcare, ethics, advocacy and lived experience.

This builds on work DignitySA began in 2018 with a parliamentary legal team, when an amendment to the National Health Act was drafted to legalise advance directives, including living wills and a durable power of attorney for healthcare. That process was interrupted by a new Parliament and then Covid-19, but the need remains.

Visit Advance Directives Coalition

2018

National Health Act amendment work

DignitySA worked with a parliamentary legal team on proposed reform to give advance directives clearer statutory force.

2025

Coalition convened

DignitySA helped initiate a broader coalition focused on a sound, practical legal basis for advance directives.

Guidance by audience

Find the guidance that fits your role

Choose the path that matches your situation. Each guide brings together practical next steps, templates and support for decisions that may need to be made under pressure.

For patients

Download templates and understand how living wills and Section 7 Mandates work together.

For families and carers

Understand how advance directives help relatives and proxies make decisions with confidence.

For medical professionals

Clinical and practical guidance on Section 7 Mandates, living wills and documentation.

Life support decisions

See how advance directives connect with refusal, withholding and withdrawal of treatment.

Start while you are well

Make your wishes easier to honour.

The best time to appoint a trusted person and explain your wishes is before there is a medical crisis. Put it in writing, talk it through and make sure the right people have copies.

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