ADVANCE MEDICAL DIRECTIVES ACT

CHAPTER 658

ADVANCE MEDICAL DIRECTIVES ACT

AN ACT to regulate the drawing of, the registration, recognition

and implementation of advance medical directives and any matter

ancillary thereto.

*

ACT No. XII of 2026

(1)

The short title of this Act is the Advance Medical

Directives Act.

(2)

This Act shall come into force on such date or dates as the

Minister may by notice in the Gazette establish and different dates may

be so established for different provisions and, or different purposes of

this Act.

(Article 4(5))

Model Form of Advance Medical Directive

PART I – IDENTIFICATION OF THE APPEARER

I, the undersigned

Full name and surname:...................................................................

Son / Daughter of:.............................................................. (father)

and.............................................................. (mother,

née..........................................................................)

Born in:..............................................................

On:.....................................................................

Residing in (locality):.....................................................................

Holder

of

Identity

Card

/

Passport

No.:..........................................................................

hereby declare that I am making this Advance Medical Directive

freely, voluntarily and after having been provided with adequate

medical information.

PART II – CAPACITY AND MEDICAL DISCUSSION

I declare that

☐ I have discussed this Advance Medical Directive with a medical

practitioner;

☐ I have been informed in a clear and comprehensible manner of

the nature and consequences of the refusals contained herein;

☐ I understand that this directive applies only if at the material

time, I lack capacity to give or refuse consent.

PART III – CIRCUMSTANCES OF APPLICATION

This Advance Medical Directive shall apply only in the event that

☐ I lack capacity to make or communicate decisions regarding my

medical treatment; and

☐ I am in one (1) or more of the following situations (tick as

applicable)

☐ Terminal illness with no reasonable prospect of recovery;

☐ Permanent unconsciousness, persistent vegetative state, or

minimally conscious state with no reasonable prospect of recovery;

☐ Advanced, irreversible condition resulting in total dependency

and severe suffering with no prospect of meaningful improvement.

PART IV – REFUSAL OF MEDICAL TREATMENT

If the circumstances described in Part III apply, I hereby refuse the

following medical treatments (tick as applicable)

☐ Cardiopulmonary resuscitation (CPR);

☐ Mechanical ventilation;

☐ Artificial nutrition;

☐ Artificial hydration;

☐ Renal replacement therapy (dialysis);

☐ Antibiotic treatment primarily aimed at prolonging life;

☐ Any other specified treatment

I understand that refusal of the above treatments may result in my

death.

The appearer

appoints (Name and Surname)

................................................... (Identity Card No.) in order that the

authorities notify him/her, if required, however the said person may not

alter or vary the directive of the appearer.

PART V – RELIEF FROM PAIN AND COMFORT CARE

Notwithstanding any refusal of medical treatment expressed in this

Advance Medical Directive, I instruct that appropriate palliative and

comfort care shall always be provided, in accordance with established

standards of medical care.

In particular, I instruct that treatment for the alleviation of pain,

suffering, breathlessness, anxiety or any other discomfort shall be

provided, even if such treatment may incidentally shorten my life.

Unless I state otherwise below, I consent to the provision of pain

relief and comfort measures as medically indicated

.........................................................................................................

(If no limitation is expressed above, full palliative care shall be

provided.)

PART VI – REVIEW AND CONSISTENCY

I understand that

☐ I may revoke or amend this directive at any time while I have

capacity;

☐ Any oral revocation made in the presence of a medical

practitioner and at least one (1) witness shall be valid;

☐ Any subsequent conduct clearly inconsistent with this directive

may affect its validity or applicability in accordance with the Advance

Medical Directives Act.

PART VII – MEDICAL PRACTITIONER CERTIFICATION

I, the undersigned medical practitioner

Name and surname:.........................................................................

Professional registration number:...................................................

Speciality / Practice:.......................................................................

certify that

☐ I have discussed advanced medical planning with the appearer;

☐ In my professional opinion, the appearer demonstrated capacity

at the time of signing this directive;

☐ The appearer demonstrated understanding of the nature and

consequences of the refusal contained herein.

Signature of medical practitioner:...................................................

Name and surname:.........................................................................

Registration number:.................................

STAMP

Date:..........................................................

PART VIII – DECLARATION BY THE APPEARER (TO BE

MADE BEFORE A NOTARY)

I declare that I have read and understood the contents of this

Advance Medical Directive and that it reflects my present, free and

settled wishes.

This declaration is made and signed by me in the presence of a

notary for the purposes of authentication in accordance with the

Advance Medical Directives Act.

Signature of appearer:......................................................................

Date:..............................................

PART IX – NOTARIAL AUTHENTICATION

I, the undersigned notary, hereby certify that the appearer

personally appeared before me on the date hereunder indicated, and

that I verified his/her identity in accordance with law, and that the

appearer signed the declaration contained in Part VIII in my presence

after acknowledging and reconfirming that the contents of this

Advance Medical Directive express his/her present and settled wishes.

Signature of Notary:..............................................................

Name and surname:.........................................................................

STAMP

Date:..............................................

In this Act, unless the context otherwise requires

"advance medical directive" or "directive" means a prior

decision made by an appearer while having capacity, by which

he refuses specified medical treatment in defined future

circumstances when the appearer lacks capacity to give

consent;

"appearer" means the person making an advance

medical directive in accordance with this Act;

"material time" means the time at which a decision

regarding the provision, withholding or withdrawal of medical

treatment is required to be taken in respect of the appearer;

"medical practitioner" shall have the same meaning

assigned to it in the Mental Health Act;

* Not yet in force.

"medical records" means all documents containing data,

assessments and information of any kind relating to a patient’s

situation and clinical development throughout the treatment

process, and includes the electronic health record of the patient;

"Minister" means the Minister responsible for the

promotion of equality in consultation with the Minister

responsible for health;

(1)

Any person who has attained the age of eighteen (18)

years and has mental capacity may make an advance medical directive

in accordance with this Act.

(2)

A directive shall include refusal of specified medical

treatments in defined circumstances.

(3)

Any stipulation contained in a directive which requires the

omission, instruction or practice that is contrary to law shall be null

and void.

PART II

Preparation, Form and Legal Effect of

Advance Medical Directives

(1)

An advance medical directive shall be prepared

following consultation between the appearer and a medical

practitioner.

(2)

The medical practitioner shall assist the appearer in

advanced medical planning and shall ensure that the appearer is

adequately informed of the nature and clinical implications of the

refusals contained in the directive.

(3)

The medical practitioner shall assess the mental capacity of

the appearer at the time of the preparation of the directive and shall

certify that

(a)

such assessment regarding capacity was carried

out and the assessment was properly documented;

(b)

the appearer possessed mental capacity at that

time; and

(c) the directive reflects the wishes of the appearer as

clearly expressed, during and after the discussion with the

medical practitioner.

(4)

The directive as prepared and certified in accordance with

this Act shall be signed by the appearer and by the medical

practitioner.

(5)

The model form contained in the Schedule to this Act and

the guidelines which the Minister may from time to time prescribe by

means of regulations, may be used for the purposes of assisting

appearers and medical practitioners in the drawing up of a directive.

(6)

(a)

Notwithstanding any other provision of this Act, any

processing of special categories of personal data, as referred to in

Article 9(1) of Regulation (EU) 2016/679, shall be carried out solely

for the purposes of drawing up, registering, recognising and, or

implementing an advance medical directive, and shall be performed

by, or under the responsibility of a medical practitioner subject to

professional secrecy obligations.

(b)

Such processing shall be proportionate to the aim pursued,

respect the essence of the right to data protection and provide for

suitable and specific measures to protect the fundamental rights and

the interests of the data subject.

(1)

An advance medical directive drawn up and certified

in accordance with article 4 shall be made in writing and shall be

authenticated by a notary public in accordance with article 2(2)(d) of

the Notarial Profession and Notarial Archives Act.

(2)

For the purposes of authentication, the appearer shall

personally appear before the notary public not later than three (3)

months from the date of the directive as drawn up by the appearer and

certified by the medical practitioner. The notary shall

(a)

verify the identity of the appearer;

(b)

confirm in a secure manner, that the appearer

acknowledges and reaffirms that the contents of the directive

express his present and settled wishes; and

(c)

authenticate the signature of the appearer.

(3)

The notary public shall, within fifteen (15) working days

from the date of authentication, submit to the Director of the Public

Registry a note of the directive.

(4)

The appearer, or any person authorised by the appearer,

shall submit the authenticated directive to the Director General for

Health Care Services.

(5)

Upon receipt of an authenticated directive in terms of sub-

article (4), the Director General for Health Care Services, established

under the Health Act, in his capacity as data controller for the purposes

of Regulation (EU) 2016/679, shall ensure that the advance medical

directive is recorded and archived in the medical records of the

appearer in such manner as may be prescribed.

(6)

Any personal data processed by the Department for Health

Care Services through the Director General for Health Care Services

or by notaries public for the purposes of this Act shall fully comply

with the provisions of Regulation (EU) 2016/679 of the European

Parliament and of the Council of 27 April 2016 on the protection of

natural persons with regard to the processing of personal data and on

the free movement of such data, and repealing Directive 95/46/EC (the

General Data Protection Regulation), and with the Data Protection

Act, including any regulations made thereunder, as well as with the

fundamental rights and freedoms of data subjects.

(7)

An advance medical directive shall be valid and have legal

effect from the moment of its authentication before a notary public,

notwithstanding that any registration or transmission in terms of this

Act has not yet taken place.

(1)

A directive shall form part of the confidential

medical records of the appearer and shall be stored in accordance with

industry standards and subject to the implementation of appropriate

technical and organisational measures to ensure a level of security

appropriate to the risks arising from the processing of personal data.

(2)

Access to a directive may be granted exclusively to a

medical practitioner subject to professional secrecy obligations who is

directly involved in the treatment of the appearer, and where such

access is strictly required for the provision of such treatment.

(1)

A directive shall be valid unless and until it is

revoked, amended or substituted in accordance with this Act.

(2)

A directive shall not have legal effect and shall not apply

where at the material time

(a)

the appearer has capacity to consent to or refuses

the treatment in question; or

(b)

the treatment or circumstances do not correspond

to those specified in the directive.

(3)

An appearer may revoke or amend a directive at any time

while having the required capacity.

(4)

Any revocation or amendment made orally in the presence

of a medical practitioner and at least one (1) witness shall be valid and

shall be documented by the medical practitioner in the medical records

of the appearer, subject to the obligations of the Director General for

Health Care Services under article 5(5).

(5)

Without prejudice to sub-article (4), any revocation or

amendment of a directive shall be made by a written declaration

authenticated before a notary and carried out in accordance with the

procedure applicable to a directive under article 5 of this Act.

PART III

Duties and Enforcement

(1)

Medical practitioners shall respect and give effect to

any valid and applicable directives.

(2)

Medical practitioners shall not incur any civil or criminal

liability for acting in accordance with a valid and applicable directive.

(3)

Where reasonable doubt arises as to the existence, validity

or applicability of a directive, any necessary treatment to prevent

serious and imminent deterioration of the appearer’s condition shall be

provided pending clarification or a decision by the competent court.

(4)

Any question as to the existence, validity or applicability of

a directive shall be determined by the Civil Court (Voluntary

Jurisdiction Section).

(5)

Any proceedings in accordance with this Act shall be

initiated by an application filed in the said Court as mentioned in sub-

article (4), which shall be determined within a period not exceeding

ten (10) days from the date of its filing in the registry of the court. The

Court may, where it considers appropriate, appoint one (1) or more

experts to assist it in its decision.

Any person who knowingly interferes with, falsifies,

conceals, or destroys a directive shall be guilty of an offence and shall

be liable on conviction to imprisonment for a term not exceeding

twelve (12) months, or to a fine (multa) not exceeding ten thousand

euro (€10,000), or to both such imprisonment and fine.

(1)

Any document or declaration made prior to the

coming into force of this Act, purporting to express the will of a

person concerning future medical treatment, shall not have legal effect

and shall not constitute a valid directive unless such wishes are

expressed anew in accordance with this Act

(2)

This article shall not invalidate or otherwise affect the legal

or clinical effect of any do-not-resuscitate (DNR) order or similar

treatment limitation issued by a medical practitioner in the course of a

patient’s care, where such order

(a)

was made following a contemporaneous

assessment of the patient’s clinical condition and

capacity; and

(b)

was recorded in the medical records of

such patient.

(1)

The Notarial Profession and Notarial Archives Act

shall be amended as follows

(i)

in paragraph (p) of sub-article (1) of article 50

thereof the word "Succession." shall be substituted by the word

"Succession;" and immediately thereafter there shall be added

the following new paragraph

"(q) any advance medical directive authenticated by a

notary in accordance with the Advance Medical Directives

Act.";

(ii)

sub-article (3) of article 50 thereof shall be

substituted by the following new sub-article

"(3) In the case of public wills or of the publication of

secret wills, or of advance medical directives authenticated in

accordance with the Advance Medical Directives Act, the note

shall only contain the date and nature of the act, and the

designation of the testator or appearer, as the case may be, in

accordance with article 28(1)(c).".

(2)

Sub-article (2) of article 8 of the Public Registry Act shall

be substituted by the following new sub-article

"(2)

In the case of a will, or of an advance medical directive

made and authenticated in accordance with the Advance Medical

Directives Act, the note shall only contain the date and nature of the act

and the designation of the testator or appearer, as the case may be, in

accordance with article 2042 of the Civil Code.".