Advance directives do not currently have legal status in Luxembourg. However, a law proposal has been presented to the Parliament to pass the “Loi relative aux soins palliatifs et à l’accompagnement en fin de vie” (Law relating to palliative care and accompaniment at the end-of-life). The following information is based on the legal provisions which will come into force, should the law proposal be successful.

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

In order to make an advance directive, a person must be an adult or an “emancipated minor”, have capacity and be a resident of Luxembourg. There is no test of capacity. It is sufficient to be an adult and not subject to a guardianship measure at the time of writing the advance directive. The advance directive must be made in writing and be dated and signed by the person making it.

To register an advance directive, it must be sent by registered mail to the “Direction de la Santé” (Department of Health). The duration of validity of advance directives is not limited to a set period of time.

What an advance directive can cover

An advance directive can cover palliative care and assistance at the end-of-life as well as the refusal of treatment, examinations in view of treatment, life-supporting treatment and life-saving treatment. It cannot be used to cover decisions relating to:

• The treatment of a psychiatric condition;
• Care and welfare decisions;
• Research;
• Basic care; or
• The appointment of a health care proxy.

Obligation to comply with instructions contained in an advance directive

Doctors are obliged to comply with refusals expressed in advance directives in the case of incurable and terminal illnesses where the proposed treatment is unlikely to bring either relief or an improvement in the patient’s condition. Doctors are bound to take into account an advance directive but also the evolution of medical knowledge since the advance directive was written. If an advance directive is contrary to the beliefs or values of the doctor in charge of a patient’s treatment and he/she therefore does not want to comply with it, he/she is obliged to transfer the treatment of the patient to a colleague who is willing to do so.

Amending, renewing and cancelling advance directives

An advance directive can be amended, renewed or cancelled at any time by sending a new version or instructions to cancel it to the Department of Health by registered mail. Usually this can only be done by a person with capacity but according to the Ministry of Health (Mousty, 2004), a doctor could decide whether to comply with a request to cancel an advance directive made by a person lacking capacity. A doctor could also decide whether to respect currently expressed wishes made a person lacking capacity in cases where they differ from those previously expressed in an advance directive.