Advance directives have legal status in Finland according to regulation 8 of the Act on the Status and Rights of Patients (1992).

Regulation 8 deals with emergency treatment and states that doctors cannot give treatment to a person who is unconscious or unable to express their will if such treatment would be against that person’s will, as expressed steadfastly and competently at some point in the past.

In 1999, an amendment to regulation 6 of the above-mentioned law made it necessary for legal representatives, next-of-kin or close friends who are making decisions on behalf of a person with incapacity to take into account their previously expressed wishes.

In Spring 2005, the Act on the Status and Rights of Patients will be amended again. A new regulation (6a) will make it clearer how decisions will be made on behalf of an adult with incapacity. Decisions will be made on the following basis:

1. according to instructions contained in an advance directive (if one has been made, it will always come first);
2. through consultation with a court appointed trustee (a guardian) in health care issues;
3. through consultation with a trustee who has been appointed by the patient to make health care decisions (i.e. a health care proxy);
4. through consultation with a parent, child or close friend or relative.

Conditions surrounding the writing, validity and registering of an advance directive

A person must have sufficient capacity to make a valid advance directive. Competence is presumed unless proven otherwise. In case of doubt, a doctor should assess a person’s capacity.

There is no set procedure for writing or registering advance directives but they should be recorded in the patient’s medical file. An advance directive can be made orally (e.g. by a person in hospital) or in writing. If made in writing, it is advisable to have two witnesses. A doctor and/or lawyer may be involved in the process of making an advance directive but this is not necessary.

Advance directives are not limited to a set period of time.

What an advance directive can cover

An advance directive can cover:

• The treatment of medical conditions;
• The treatment of a psychiatric condition;
• Care and welfare decisions;
• Research;
• Basic care (there is no definition of what this includes but as all care can be refused, it should be possible to refuse basic care);
• Life-supporting treatment;
• Life-saving treatment; and
• The appointment of a health care proxy.

Obligation to comply with instructions contained in an advance directive

In the case of emergency treatment, advance directives are legally binding. In other cases, they are advisory and it is good medical practice to comply with them.

After an amendment in 2005 to regulation 6 of the Act on the Status and Rights of Patients, doctors will not obliged to comply with advance directives if it is obvious that the advance directive is based on a person’s false perception of their health condition, the nature of the illness or the effectiveness of the treatment methods and medication proposed. Similarly, doctors should not comply with an advance directive if the patient’s will concerning treatment and care has changed for the above-mentioned or a similar reason.

If it would be against a doctor’s personal beliefs to comply with instructions contained in an advance directive, the doctor must find a colleague who is willing to take over the treatment of the patient.

Amending, renewing and cancelling advance directives

An advance directive can be amended, renewed or cancelled at any time. This can be done verbally, in writing or through behaviour which clearly indicates this decision. It is not necessary for a person to have full legal capacity (i.e. in every domain) as a greater level of capacity is needed to write an advance directive than to cancel it. This has been discussed in medical circles as well as in literature on jurisprudence.