1. What is the difference between end-of-life provisions and an advance directive?
The advance directive is governed by the law relating to palliative care, advance directives, and end-of-life support. The patient may describe their wishes regarding their “natural” end of life, that is to say without influencing the timing of their death.
The advance directive makes it possible to avoid unreasonable therapeutic obstinacy.
End-of-life provisions are governed by the law on euthanasia and assisted suicide. End-of-life provisions are a request for euthanasia made in advance in the event that, at a later point in life, a person finds themselves in a state of irreversible unconsciousness according to the current state of scientific knowledge and suffering from a serious and incurable accidental or pathological condition.
End-of-life provisions must be registered with the National Commission for Control and Evaluation in order to be valid.
End-of-life provisions must be recorded in writing, dated, and signed by the person concerned, unless that person is permanently physically unable to write and sign. End-of-life provisions must be registered with the National Commission for Control and Evaluation.
MWMW is available free of charge to help and advise you when drafting advance directives and end-of-life provisions:
Tel. 26 59 04 82
Email: info@mwmw.lu or secretaire@mwmw.lu
The law does not specify a validity period, but the National Commission for Control and Evaluation sends a reminder every 5 years so that the individual can verify whether the provisions still reflect their wishes.
End-of-life provisions may be renewed, withdrawn, or amended at any time.
Any changes must be declared and registered with the National Commission for Control and Evaluation.

When drafting end-of-life provisions, any person may appoint an adult trusted person.

The trusted person acts as the spokesperson for the patient if the patient can no longer express themselves. They do not express a personal opinion, but inform the attending physician of the patient’s wishes according to the patient’s latest statements to them.

End-of-life provisions are a request for euthanasia made in advance in the event that, at a later point in life, the patient finds themselves in a state of irreversible unconsciousness according to the current state of scientific knowledge and suffering from a serious and incurable accidental or pathological condition, and that this situation is irreversible according to the current state of scientific knowledge.

The law requires the following substantive conditions:
a) the patient must be an adult, legally competent, and conscious at the time of the request;
b) the request must be made voluntarily and deliberately by the patient and, where applicable, repeated, and it must not result from external pressure;
c) the patient must be in a serious and incurable medical condition with no prospect of recovery and experiencing constant and unbearable physical or psychological suffering with no prospect of improvement.

The patient’s health problems may result from any condition causing unbearable physical or psychological suffering.

In most cases, these involve advanced cancers or neuromuscular diseases causing fatal paralysis, but they may also involve any other serious, incurable, and irreversible condition meeting the legal requirements.

No relative and no doctor may decide on euthanasia. Only the person personally making the request for euthanasia or assisted suicide may ask a physician for assistance in dying painlessly, provided that the legal conditions are met.

If a trusted person has been appointed, they do not decide and do not express a personal opinion, but they must inform the physician of the patient’s wishes.

When a physician invokes conscientious objection, they are required to inform the patient and/or the trusted person within 24 hours and to transfer the file to a colleague designated by the patient, the trusted person, or a person of their choice.

The law recognizes the physician’s freedom of conscience, meaning the physician is free to perform or refuse euthanasia or assisted suicide. A physician may refuse to carry out such an act because of personal convictions.
However, freedom of conscience is an individual freedom and not an institutional one. A hospital, care, rehabilitation center, etc., cannot validly invoke this freedom to refuse a physician within its institution the possibility of carrying out euthanasia or assisted suicide when the legal conditions are fulfilled.

A patient residing abroad who has a treating physician in Luxembourg favorable to euthanasia may make end-of-life provisions and have them registered, since no residency or nationality requirement is attached either to such registration or to the other substantive and formal conditions of the law of 16 March 2009.

The patient must find a location where euthanasia or assisted suicide can take place unless the patient is hospitalized.

The law provides that a physician may only provide assistance in dying through euthanasia or assisted suicide if the request comes from an adult patient who is legally competent and conscious at the time of the request or at the time of drafting end-of-life provisions.

Neither a minor nor an incapacitated adult may validly request euthanasia or assisted suicide.

By simultaneously adopting the law relating to palliative care and the law concerning euthanasia and assisted suicide, the legislator intended, on the one hand, to emphasize the commitment to continue developing palliative care as much as possible. On the other hand, the legislator sought to allow patients freedom of choice regarding the manner of their end of life, while protecting physicians who agree to comply with requests for euthanasia or assisted suicide under the conditions provided by law by removing the risk of criminal prosecution against physicians.

The law of 16 March 2009 on euthanasia and assisted suicide thus creates the possibility of dying in cases where the patient considers the suffering unbearable. This possibility of requesting euthanasia or assisted suicide responds to wishes expressed by part of public opinion, as well as by some healthcare and legal professionals.