FAQ

Anticipated directive is not the same as arrangements for the end of life. Both forms are found in the brochure “Ma volonté en fin de vie” (My will at the end of life) published under the patronage of the Ministry for Family and the Ministry for Health.

The anticipated directive, which is at the beginning of the brochure in the brown section, is governed by the law on palliative care, anticipated directive and accompaniment at the end of life. Through this directive the patient is able to describe their will concerning their “natural” end of life; that is without any influence on the moment of their passing away.

The patient will preferably hand copies to their person of trust, another person of their choice and to their treating doctor.
In that document, the patient does not put their signature in order to undergo euthanasia: the anticipated directive allows for the exclusion of aggressive and futile therapy. It is not required for it to be registered by La Commission Nationale de Control et d’Evaluation.

“The arrangements for the end of life”, which are at the end of the brochure in the blue section, are governed by the law on euthanasia and assistance to suicide.

The arrangement for the end of life are a request for euthanasia submitted in advance in case one is at a later time in life, in a situation of irreversible unconsciousness according to the current stance of science and suffers from a serious and incurable accidental or pathological condition.

The arrangement for the end of life must absolutely be registered by La commission Nationale de Controle et d’Evaluation in order to be valid. The registration of a person of trust remains optional but highly recommended to ensure their will is respected.
Both forms, the anticipated directive and the arrangement for the end of life, only come into force when the person is unconscious and is unable to express their will.

He or she is in an advanced or terminal stage of a serious and uncurable condition and a stop to examinations and treatment which bring neither relief nor improvement of the condition, will be requested through the signing of an anticipated directive.
A person signs their arrangement for the end of life in the event they find themselves later on in a situation of irreversible unconsciousness according to the current stance of science, suffering from a serious and incurable accidental or pathological condition. He or she may undergo euthanasia under the condition that the doctor is willing.

At the time of drawing up their arrangements for the end of life (will of end of life), any person may designate an adult as a person of trust.

The person of trust is the spokesperson for the patient if the latter is not able to express themselves anymore. The person of trust does not express a personal opinion, they rather bring to the attention of the treating doctor the will of the patient according to his or her latest statement to them.

The arrangements for the end of life (Will for the end of life) are a request for euthanasia submitted in advance in case one is at a later time in life, in a situation of irreversible unconsciousness according to the current stance of science and suffers from a serious and incurable accidental or pathological condition and that such a situation is irreversible according to the current stance of science.

Any legally capable adult may, in case they are not able to express their will anymore, make a written record in arrangements for the end of life (Will for the end of life) of the circumstances and conditions in which he or she would like to undergo euthanasia.

The arrangements for the end of life (Will for the end of life) may contain in addition a specific section where the registrant sets provisions in relation to the burial mode and the funeral ceremony.

In the arrangements for the end of life (Will for the end of life), the registrant may also designate an adult person of trust who brings to the attention of the treating doctor the will of the registrant according to his or her latest statement to them.

The arrangements for the end of life (Will for the end of life) must be made in writing, dated and signed by the person concerned, except if he or she is physically permanently unable to write and sign. The arrangements for the end of life (Will for the end of life) are mandatorily to be registered by La Commission Nationale de Controle et d’Evaluation.
If the person concerned is physically permanently unable to write and sign his or her arrangements for the end of life (Will for the end of life), his or her wishes may be recorded in the presence of two witnesses by an adult person of his or her choice. The arrangements for the end of life must then specify that the registrant cannot writ and sign, and state the reasons for that. The arrangements for the end of life (Will for the end of life) must be dated and signed by the person who recorded in writing the statement, by the witnesses and when applicable by the person of trust. A medical certificate acknowledging the permanent physical disability is annexed to the arrangements for the end of life (Will for the end of life)
The arrangements for the end of life (Will for the end of life) may be reiterated, withdrawn or adapted at any time. Such changes must be registered by La Commission Nationale de Nontrole et d’Evaluation. Nevertheless, the last will of the patient always takes precedency and euthanasia cannot be implemented if the doctor becomes aware of an expression of the will of the patient, which occurred after the arrangements for the end of life (Will for the end of life) duly registered, by means of which he or she withdraws his or her wish to undergo euthanasia.
The arrangements for the end of life, as well as any subsequent change are mandatorily to be registered by La Commission Nationale de Controle et d’Evaluation:
Commission Nationale de Contrôle et d’Evaluation sur l’Euthanasie
p/a Ministère de la Santé, L-2935 Luxembourg.
The form for the arrangements for the end of life is available for downloading on our Website
And also available at our Society:
Mäi Wëllen, Mäi Wee
1a, rue Christophe Plantin
L-2339 Luxembourg
Tél. 26 59 04 82
Mail secretariat@mwmw.lu

Nowadays, thanks to the advancement in medicine, the circumstances around death have changed and have resulted in an increased life expectancy. Nevertheless, medicine cannot always heal because the end of life is part of the cycle of life.

When illness occurs and pushes us closer to death, this happens most often unfolds in healthcare settings. Medicine makes it possible now to artificially prolong life or to shorten it. In the face of these facts, issues in relation to the end of life have been raised a lot among the public.
After extensive debate, lawmakers introduced two important laws on 16 March 2009:

1. The law on palliative care, on anticipated directive and on accompaniment at the end of life,
2. The law on euthanasia and assistance to suicide

These two pieces of legislation enhance and make a record of the person’s rights at the end of life.

There are nine members to La Commission Nationale de Controle et d’Evaluation, who are appointed on the basis of their knowledge and experience in the issues relating to issues within the scope of the commission.

Three members are MEDICAL DOCTORS. One member is proposed by the Medical Board (Le college Médical). The body which is the most representative of doctors and dentists proposes two members one of whom holds specific qualification and experience in connection to the treatment of pain.

Three members are jurists, one of whom is a barrister proposed by the Bar Council (le Conseil de l’Ordre des Avocats), a judge or a prosecutor proposed by the Supreme Court of Justice and a professor at the University of Luxembourg.
A member comes from HEALTHCARE PROFESSIONS and is proposed by The Supreme Council of certain healthcare professions.

Two members are REPRESENTATIVES OF AN ORGANISATION whose objective is to defend THE PATIENTS’ RIGHTS.
Being a member of the Commission is incompatible with being a deputy, a member of the government or a member of the Conseil d’Etat.

The members of the Commission are appointed by the Grand-Duc for a term of three years. The mandate is renewable three times. The Commission elects a president among its members.

The deliberations of the Commission are only valid under the condition that at least seven of its members are present. The decisions are made by simple majority vote.

Members of the Commission, its administrative staff and experts involved are to maintain confidentiality of the data which is disclosed to them in the performance of their duties.

The amendments of the 2009 law passed in 2021 provide that each member also has an alternate with the same initial training as themselves, which will facilitate achieving the quorum in the future.

When the doctor states their conscientious objection, he or she is to inform his or her patient and/or the person of trust within 24 hours and to hand over the file to a colleague designated by the patient or by the person of trust.

The law acknowledges a doctor’s freedom of consciousness, he or she is free to execute or not euthanasia or assistance to suicide. A doctor may refuse to perform such a medical procedure on the ground of his or her personal convictions. In the same way no nurse or any other person is under the obligation to provide any assistance or participate to euthanasia or assistance to suicide.

The freedom of consciousness is however a personal freedom, not an institutional one. Hospitals, healthcare or rehabilitation facilities, etc. may not validly invoke that freedom to deny a doctor to accept within his or her organisation to carry out euthanasia or assistance to suicide, when the conditions provided for by the law are fulfilled.

No relative, no doctor can decide about euthanasia. Only the person who is personally originated the request for euthanasia or assistance to suicide may request from the doctor their assistance for a painless death as long as the conditions provided for by the law are fulfilled.

No person can substitute for another and request euthanasia or assistance to suicide in their name. Therefore, a relative, or a treating doctor cannot decide instead of their relative or patient.

Even when arrangements for the end of life have been registered, the person concerned may at any moment change their mind. The doctor must in any case respect the patient’s latest will.
If a person of trust has been appointed, he or she does not decide and does not express himself or herself, they rather must inform the doctor about the will of the patient.

The law provides that at the request of the treating doctor, an adviser or expert of his or her choice may be consulted. The certificate may be added to the patient’s file. If this is a medical examination of the patient, it must be added to the file.

Only the doctor may express such a request without any need for any condition or definite formality provided for by the law.

The fellow doctor that the doctor in charge of the patient is mandatorily to consult prior to proceed with euthanasia has a role which is clearly defined by the law. He is not to issue a judgment in relation to his or her principled stand on euthanasia.

This consultation is not subject to definite formal requirements, the law requires however that the consulted doctor is qualified in relation to the pathology in question. Their mission is to confirm that the basic requirements concerning the medical condition of the patient are fulfilled.

In the case of a request for euthanasia expressed by a patient who is legally capable and conscious, the consulted doctor must then confirm that the patient is in a serious medical condition which is incurable, is without any prospect of recovery and state constant and unbearable physical or psychological pain without any expectation for improvement.

In a situation where the patient is no condition to express their will and where the treating doctor intends to execute the arrangements of the end of life, his or her mission is to confirm that the patient suffers from an accidental or pathological condition which is serious and incurable, is unconscious and that this situation is irreversible according to the state of science.

The independent doctor will consult the medical file and examine the patient to make sure that the condition of the latter matches the legal requirements.
The independent doctor’s conclusions will be draw up in writing in a report. It is the treating doctor who will inform the patient about it

A patient whose residence is abroad and who has a treating doctor in Luxembourg may make arrangements for the end of life and have them registered as there is no residency or nationality clause to this registration or to the other formal or substantial requirements in the law of 16 March 2009.

Nevertheless, the law requires a tight relationship between the patient and their doctor: the doctor must know well their patient as he or she must be able to assert that the request is expressed freely and without coercion, he or she must have several interviews at time intervals, verify and certify that the suffering is unbearable and is without prospect of improvement etc.

These provisions imply that the treating doctor must have been treating the patient continuously over a long enough period of time.

The law provides that the doctor can only proceed with help to die in the form of euthanasia or assistance to suicide if the request is made by an adult patient legally capable and conscious at the time of the request or at the time of writing their arrangements for the end of life (Will for the end of life)

No minor nor any legally incapable adult can validly request euthanasia or assistance to suicide.

This means that the parents cannot decide instead of their minor child for him or her to undergo euthanasia because they deem the pain to be unbearable for the latter. In the same way guardians cannot decide instead of an adult under guardianship or curatorship.

Once the requirements are fulfilled and unless the doctor states their conscientious objection, he or she must in any case and prior to proceeding with euthanasia:

1. Consult with a fellow doctor with a view to confirm the irreversibility of the serious and uncurable condition of the patient.
2. If there is a team of healthcare providers which is in regular contact with the patient, discuss the provisions of the arrangements for the end of life (Will for the end of life) with the team of healthcare providers or with its members.
3. If the arrangements for the end of life designate a person of trust, discuss with the latter about the will of the patient and discuss about the will of the patient with the patient’s relatives whom the person of trust designates.

The arrangements for the end of life (Will for the end of life) as well as all the mandatory steps for the doctor to take and their result, including the report of the consulted doctor, are to be added to the medical file of the patient.

The latest will of the patient always take precedence and no euthanasia can be carried out if the doctor becomes aware that the patient has manifested his or her will, after the formally registered arrangements for the end of life, to cancel their wish to undergo euthanasia.

If the doctor implements euthanasia, he or she must submit, within eight days a record to La Commission Nationale de Controle et d’Evaluation, which verifies if the requirements and the procedure have been fulfilled as provided by the law.

When the doctor is informed of the arrangements for the end of life, he or she must take them into consideration after making sure that:

1. The circumstances and requirements foreseen in the arrangements for the end of life are fulfilled;
2. The arrangements are valid and have been duly registered;
3. The essential conditions in relation to the condition of the patient are fulfilled:
   1. The patient suffers from a serious and incurable accidental or pathological condition,
   2. The patient is unconscious and
   3. This situation is irreversible according to the current state of science.

The doctor may refuse to proceed with euthanasia, but he or she must inform their patient and/or the person of trust about that within 24 hours and to transmit the file to a fellow doctor designated by the patient or the person of trust.

See also:
Does a doctor have the obligation to fulfil a request which complies with the law? How about the nursing staff? How about hospitals or other facilities hosting persons at the end of life?

Any doctor treating a patient at the end of life or a patient with a medical condition without prospect for recovery must, prior to implementing euthanasia, enquire at La Commission de Controle et d’Evaluation about whether arrangements for the end of life are registered in the name of the patient.

After the registration of the arrangements for the end of life, La Commission Nationale de Controle et d’Evaluation sends acknowledgement of receipt to the person that had them registered. It is recommended to provide a copy of the arrangements for the end of life (Will for the end of life) and of the acknowledgement of receipt to the treating doctor or, when applicable, to the person of trust.

The law does not specify a validity period, but La Commission Nationale de Controle et d’Evaluation must ask for the confirmation of the will of the declarant once every five years starting from the date of registration of the arrangements for the end of life.

The arrangements for the end of life may be reiterated, withdrawn or adjusted at any moment.

Any change that occurs must be declared and registered by La Commission Nationale de Controle et d’Evaluation. Let’s not forget that euthanasia cannot be implemented if the doctor, following the mandatory steps he or she takes, becomes aware that the patient has manifested his or her will, after the formally registered arrangements for the end of life, to cancel their wish to undergo euthanasia.

When the request for euthanasia or assistance to suicide is directly expressed by a patient who is conscious and able to express his or her will, the doctor who receives such a request must:

•  inform the patient about his or her health condition and about his or her life expectancy; discuss with the patient about their request for euthanasia or assistance to suicide and mention to them the therapeutical treatments that could still be implemented as well as the opportunities of palliative care and their consequences;
• come to the firm conclusion that the patient’s request is voluntary and that in the patient’s view there is not any other acceptable solution for their situation;
• have several interviews with the patient at time intervals which are deemed reasonable given the evolution of the condition of the patient, to make sure that the physical or psychological pain of the patient persists and that their recently expressed will is unchanged, or has been reiterated;
• consult with another fellow doctor about the condition being serious and incurable while indicating the reasons for the consultancy;
• unless the patient objects, discuss about the request of the latter with the healthcare team who is in regular contact with the patient or its members;
• unless the patient objects, discuss about the request of the latter with the person of trust that he or she designated in his or her arrangements for the end of life or at the time of his or her request for euthanasia or assistance to suicide;
• make sure that the patient had the opportunity to discuss about his or her request with the persons he or she wanted to meet;
• enquire by the Commission if arrangements for the end of life have been registered in the name of the patient.

The patient may of course at any moment change their mind and cancel their request.
If the doctor implements euthanasia, he or she must submit, within eight days a record to La Commission Nationale de Controle et d’Evaluation, which verifies if the requirements and the procedure have been fulfilled as provided by the law.

While certain objective factors may contribute to evaluating the unbearable aspect of suffering, experiencing suffering as unbearable is a subjective and personal issue for the patient which depends on their personality, their pain threshold and their very own views and values.

The issue of prospect for improvement of the suffering is a medical issue, but it must also be taken into consideration that the patient has the right to refuse treatment for pain, or even palliative care, especially when such treatment entail side effects or implementation procedures that he or she finds unbearable. A thorough discussion about this between the doctor and the patient is necessary.

Given the variability of these notions depending on the person concerned, the opinion of an independent doctor is mandatory in addition to that of the treating doctor.

Direct request by the patient for euthanasia is the usual case. It is a request expressed by a conscious and legally capable adult who are in a medical condition where the provisions of the law for implementing euthanasia are fulfilled.
The law requires the following substantive conditions in relation to the condition of the patient:

1. The patient must be an adult who is legally capable and conscious at the time of the request;
2. The request must be expressed voluntarily, thoughtfully, if applicable repeatedly and must not result from external pressure;
3. The patient’s medical condition is serious, incurable, without prospect, and entails constant and unbearable physical or mental suffering without prospect for improvement.

The direct request of the patient is recorded in writing. The document is written, dated and signed by the patient himself or herself. If the patient is in a permanent state of physical incapacity to write and sign his or her request, it may be transcribed and signed by an adult that the patient choses in the presence of the doctor, whose name will also be on the document. A record must be made of the reasons why the patient is not in a condition to write it personally.

A direct request expressed by the patient who is a legally capable and conscious adult remains valid throughout the time required for the implementation of euthanasia, even if the patient becomes unconscious during that period of time.

Notice: Any adult who is legally capable and conscious may also state in the arrangements for the end of life (Will for end of life), the circumstances and conditions in which he or she wishes to undergo euthanasia. These provisions for the end of life are for patients who cannot express their will and are unconscious.
See also:

• What is the role of the person of trust?
• Can one express their wishes in relation to euthanasia beforehand?
• How to write and register your arrangements for the end of life?
• In which cases must the doctor take into consideration the arrangements for the end of life?
• How is the doctor informed about the existence of arrangements for the end of life?
• How long are the arrangements for the end of life valid?
• What is the procedure that the doctor must follow prior to implementing euthanasia or assistance to suicide at the request of a conscious patient?

The origin of the medical condition without prospect referred to in the law of 16 March 2009 is irrelevant. The health problems of the patient may be the result of any ailment that entails unbearable physical or mental suffering.

Experience abroad shows that it is in most cases advanced cancer or neuromuscular diseases with lethal paralysis, but it could be any other serious condition which is incurable and irreversible that fulfils the legal requirements.

The law introduces conditional decriminalisation which aims at reassuring doctors who rigorously abide by the law. This way, the law ensures decriminalisation under the condition that euthanasia or assistance to suicide have been conducted by the patient’s doctor under the conditions provided for by the law. Only in such case is the procedure not considered a criminal offence and cannot give rise to a civil lawsuit for compensation. A particular motive for exclusion from criminal charges has also been added to the criminal law for this purpose.

Given that the law has not yet introduced a complete and utter decriminalisation, euthanasia and assistance to suicide remain punishable outside the legal frame of the law of 16 March 2009. The existence of that law does not therefore mean that just any person may help any person who have asked them for help to die.

The upholding of the requirements of the law is checked in every case by La Commission Nationale de Controle et d’Evaluation. If the Commission considers that the substantial requirements have not been fulfilled, it hands over the file to the Prosecutor Office, which decides about criminal charges. If a formal requirement has not been fulfilled, the Commission may turn to the Medical Board with a view of possible disciplinary proceedings.

By simultaneously passing the law on palliative care and the law on euthanasia and assistance to suicide, the legislature wanted on the one hand to highlight their will to bring all in motion to continue developing palliative care. Palliative care is active, continuous and coordinated, provided by a multidisciplinary team with regard to the dignity of the person receiving the care. It involves the treatment of pain and mental suffering. On the other hand, the legislature wanted to allow for the freedom of choice of patients regarding their end of life, while extending protection to doctors who accept to fulfil their request for euthanasia or assistance to suicide in accordance with the provisions of the law, by supressing the risk of a criminal lawsuit against doctors.

The law of 16 March 2009 on euthanasia and assistance to suicide provides therefore an opportunity to die in the instance when the suffering is deemed unbearable by the patient. This opportunity is an answer to a wish expressed by part of the public, as well as by part of healthcare professionals and jurists.

Rigorous legal requirements guarantee transparency and control of medical procedures in relation to voluntary interruption of life within the framework of euthanasia or assisted suicide.