An increasing number of people in the Basque Country are choosing to formally document their preferences for medical care should they become unable to express their wishes. This document, known as advance directives, living will, or prior instructions, has shown sustained growth in Euskadi, with 14,851 new documents registered in 2025, marking a 26% increase compared to the previous year. In addition to new registrations, the Basque Advance Directives Registry also processed 819 substitutions or modifications of previously registered documents.

Since its establishment in 2004, the Advance Directives Registry, managed by the Basque Government's Department of Health, has accumulated 76,683 registrations. Of these, 69,451 correspond to individuals who are current users of the Basque Health Service and have active documents. This figure has doubled in just three years, with 2025 marking its highest annual registration total. According to information from the Basque Advance Directives Registry, approximately 37 out of every 1,000 adults in Euskadi have already registered their advance directives. Notably, among age groups, 1 in 9 people over 75 years old (117 per 1,000 inhabitants) in Euskadi have their advance directives actively registered in the RVVA.

Of the total new registrations in 2025, three out of four individuals were between 46 and 75 years old. Geographically, 13% of registrations were made in Araba (1,889), 55% in Bizkaia (8,142), and 32% in Gipuzkoa (4,797), with an additional 23 registrations from outside Euskadi. Among municipalities with over 20,000 inhabitants, Donostia, Getxo, and Zarautz stand out for their higher proportion of registered documents relative to their adult population.

Euskadi remains the second autonomous community in Spain with the highest registration rate, according to data from the National Registry of Advance Directives (RNIP), trailing only Navarra and significantly exceeding the national average (13.78 per 1,000 inhabitants). It is also noteworthy that 86% of those who registered their document chose a representative, a non-mandatory but highly recommended figure. When an individual can no longer express their will, the representative ensures the correct interpretation and fulfillment of the signer's wishes.

The advance directives document can be formalized before authorized medical and nursing staff, the person in charge of the Basque Advance Directives Registry, three witnesses, or a notary. Currently, a total of 890 medical and nursing professionals within the Basque public health system are authorized to formalize these documents; in 2025 alone, 447 professionals performed this function.