One of the most important estate planning documents is also one of the least discussed.
Most people have a Last Will and Testament, a Durable Power of Attorney, or a Trust, but very few have considered what would happen if they became seriously ill or suffered an accident and could no longer communicate their medical wishes.
Costa Rica now has comprehensive legislation that allows individuals to prepare a legally binding Advance Directive, known in Spanish as a Declaración de Voluntades Anticipadas.
Understanding this law should be an essential part of your estate planning and that is why I will be breaking it down for you here:
What Is a Living Will?
A Living Will, also called an Advance Directive, is a legal document in which a competent adult expresses, in advance, the medical treatments they wish—or do not wish—to receive if they later become incapable of communicating those decisions.
Unlike a traditional Last Will and Testament, which takes effect after death, a Living Will operates during your lifetime when you cannot speak for yourself.
Costa Rica formally recognizes this right under Law No. 10231 (Ley de Voluntades Anticipadas), enacted in 2022 and fully implemented through its regulations and the National Registry
What Is the Purpose of Costa Rica's Advance Directive Law?
The purpose of the law is straightforward:
To guarantee every competent adult the right to decide in advance what medical care they wish to receive if they later become unable to communicate those wishes.
The law was designed to protect patient autonomy while respecting existing Costa Rican medical and legal principles. Importantly, the legislative history makes clear that the law does not create a right to euthanasia, but rather ensures that previously expressed lawful medical decisions are respected.
Is a Costa Rica Living Will the Same as Euthanasia?
No.
This is one of the most common misconceptions.
Costa Rica’s law expressly states that an Advance Directive cannot be interpreted as authorizing euthanasia, nor does it legalize physician-assisted death.
Instead, it allows a person to:
- Accept certain medical treatments;
- Refuse specific medical treatments;
- Request palliative care;
- Express personal values that should guide physicians when making clinical decisions.
The distinction is significant.
The law protects the patient’s right to refuse unwanted treatment but does not authorize intentionally causing death.
Who Can Create a Living Will in Costa Rica?
To execute a valid Advance Directive, a person must:
- Be at least 18 years old;
- Possess legal capacity;
- Freely and consciously express their wishes.
These requirements must be verified at the time the document is signed.
What Can Be Included in a Costa Rica Living Will?
Costa Rica’s law is intentionally flexible.
Among other things, your declaration may include:
- Medical Treatment Instructions
You may specify which medical interventions you wish to receive or refuse if you suffer from:
- terminal illness,
- irreversible brain injury,
- permanent unconsciousness,
- advanced dementia,
- severe neurological disease,
- or other future medical conditions.
These instructions must always be consistent with accepted
medical standards (“lex artis”).
- Appointment of a Health Care Representative
One of the most valuable features of the law is the ability to appoint a:
- Primary Health Care Representative
- First Alternate
- Second Alternate
This individual acts as your spokesperson with physicians to ensure your wishes are respected.
Unlike a general Power of Attorney, this appointment is specifically limited to healthcare decisions contemplated by your Advance Directive.
- Personal Values and Religious Beliefs
The law allows you to include statements concerning:
- religious beliefs,
- ethical principles,
- personal values,
- quality of life considerations.
These statements assist physicians in interpreting your wishes when unforeseen medical situations arise.
- Palliative Care
A person may request that every effort be made to alleviate pain and suffering through appropriate palliative care, even in end-of-life situations.
- Organ Donation
The declaration may also include your wishes regarding organ donation, which are coordinated with Costa Rica’s organ donation legislation.
Who Can Witness the Document?
The law requires two qualified witnesses.
The witnesses:
- must be adults,
- must have legal capacity,
- cannot be your spouse,
- cannot be your common-law partner,
- cannot be relatives within the second degree of consanguinity or affinity,
- cannot have a financial interest in your affairs.
These restrictions are intended to protect the integrity of the declaration.
How Can a Living Will Be Executed?dd Your Heading Text Here
Option 1 – Before a Costa Rican Notary Public
This is generally the preferred method because the Notary verifies legal capacity, identity, formal requirements, and the authenticity of the declaration.
Option 2 – Before Healthcare Professionals
The declaration may be executed before:
- at least two physicians,
- nurses,
- or clinical psychologists,
together with two qualified witnesses.
Option 3 – Before the National Registry of Advance Directives
The National Archives may also formalize declarations through its authorized personnel.
The National Registry of Advance Directives
One of the most significant developments occurred in 2025.
Costa Rica established the Registro Nacional de Voluntades Anticipadas (RNVA), administered by the National Archives.
The Registry:
- records that a valid Advance Directive exists,
- maintains identifying information,
- allows updates,
- records modifications,
- records revocations.
Importantly, the Registry does not retain the confidential contents of the declaration itself. Instead, it maintains an index identifying that a declaration has been executed, while the original document is returned to the declarant so it can be incorporated into the appropriate medical records.
Can a Living Will Be Changed?
Yes.
The declaration may be:
- modified,
- substituted,
- revoked,
at any time, provided the individual still has legal capacity.
This flexibility recognizes that medical conditions, personal beliefs, and family circumstances can change over time.
Does the Document Expire?
Yes.
Costa Rica requires the declaration to be updated every five years.
If more than five years pass without renewal, the declaration generally ceases to have legal effect.
However, if the directive has already begun to be implemented before expiration, it remains effective for that medical episode until completion.
Are There Situations Where a Living Will instruction Will Not Be Followed?
Yes.
The law establishes several important limitations.
For example:
- If the patient can still communicate, the patient’s current wishes always prevail.
- The directive cannot require actions contrary to Costa Rican law.
- It cannot require physicians to violate accepted medical standards.
- It cannot override public health measures.
- In genuine medical emergencies where there is no realistic opportunity to verify the existence of the directive, emergency treatment may proceed until the patient’s wishes can be confirmed.
What About Foreigners Living in Costa Rica?Add Your Heading Text Here
The regulations specifically address foreign nationals.
Private medical providers treating non-resident medical tourists are required to inform eligible patients of their right to execute an Advance Directive during their treatment. For these cases, the declaration may be incorporated into the patient’s clinical file without completing the ordinary RNVA registration and EDUS process.
For expatriates and legal residents who live in Costa Rica, executing a Costa Rican Advance Directive is generally advisable, even if they already have one from another country. A local document prepared in accordance with Costa Rican law is more likely to be readily recognized and implemented by healthcare providers.
How Does a Living Will Differ from a Durable Power of Attorney?
Many people confuse these documents.
A Living Will focuses on medical treatment decisions when you cannot communicate.
A Durable Power of Attorney authorizes another person to act on your behalf in legal, financial, or property matters.
Most comprehensive estate plans include both documents because they address different situations.
Conclusion
Estate planning is about far more than deciding who inherits your assets.
It is also about preserving your dignity, protecting your autonomy, and ensuring your medical wishes are respected when you are unable to speak for yourself.
Costa Rica’s Living Will – Advance Directive Law, together with its implementing regulations and the creation of the National Registry of Advance Directives, provides a modern legal framework that allows individuals to make these deeply personal decisions in advance while balancing patient autonomy with accepted medical standards.
If you are living in Costa Rica, planning to retire here, or own property in the country, you should discuss with an experienced Costa Rican attorney whether a Living Will should be included as part of your overall estate planning package.
