Law on euthanasia and assisted suicide

of March 16^th, 2009

CHAPTER I

General

Art. 1

In the application of the present law, euthanasia must be understood as the act, performed by a medical doctor, which intentionally ends the life of a person at his or her specific and voluntary request.

CHAPTER II

Pre-conditions and procedure

Art. 2. 1

The physician who performs a euthanasia or an assisted suicide and cannot be prosecuted for harm and damages if the following conditions have been observed :

1. 
   the patient is an adult or an emancipated minor, capable and conscious at the time of his/her request ;
   

3) the patient suffers constant and unsupportable physical or psychological pains resulting

from a serious accident or from a pathological condition without hope of recovery ;

4) the request for euthanasia or assisted suicide has been made in writing.

1) inform the patient of the state of his/her health and of his/her life expectancy, discuss with the patient his/her request for euthanasia and the therapeutic measures which could still be considered, as well as the availability and consequences of palliative care. The physician must have reached the conviction, that in the patient’s view, there is no other acceptable solution to the situation. These conversations are to be registered in the medical file as relevant information.

2) ascertain the persistent nature of the patient’s physical or psychological suffering and of his/her reiterated wish. To this end, the physician will conduct several interviews with the patient, reasonably spaced with due regard to the evolution of the patient’s condition;
3) consult with another physician regarding the serious and incurable nature of the situation, specifying the reason for the consultation. The consulting physician will study the medical record, examine the patient and ascertain the constant, unbearable and unrelievable nature of the physical or psychological suffering. He will then write a report of his findings. The consulted physician must be independent in respect to the patient as well as the treating physician, and be competent in the pathological condition at hand. The treating physician will inform the patient on the outcome of this consultation;
4) discuss the patient’s request with the nursing team or with some of its members, unless the patient does not wish this;
5) unless the patient does not want it, discuss his request with those persons close to him/her that s/he designated in his living will;
6) assure that the patient has had the opportunity to discuss his requests with those persons;
7) assure with the Commission de Contrôle et d’Evaluation if the patient’s “dispositions de fin

de vie” have been registered with them.

All requests and related observations and reports by the doctor(s) should be consigned to the medical file of the patient.

The treating physician can, if he wants, ask to be accompanied by a councellor or expert of his choice and add their notifications to the medical file.

CHAPTER III

”dispositions de fin de vie” - “Bestimmungen zum Lebensende”

Art. 4. 1.

Every capable adult or emancipated minor may establish a written declaration of his/her will in anticipation of the eventuality when he/she would no longer be able to express his/her wishes concerning the circumstances and conditions under which a physician should perform a euthanasia should he recognize:

- that he/she is unconscious,

- and that this is an irreversible situation as far as the current scientific knowledge goes.
The end of life dispositions may also contain a special chapter in which the signatory defines his wishes for funeral or burial arrangements.
The declaration may designate one or several trusted adult persons, listed in order of preference, who will acquaint the treating physician with the wishes of the patient.
The end of life declaration may be made at any time. It must be made in writing, dated and signed by the declarant.
4.2. If the person who wishes to make an anticipated declaration is physically and permanently unable to write and to sign it, his/her declaration may be taken down in writing by an adult person of the declarant’s choice, in the presence of two adult witnesses.
The document must then specify the disability and the reasons why the person making the declaration is unable to write and sign. The declaration must be dated and signed by the person who has put the declaration in writing, by the witnesses and, when applicable, by the designated trusted person. A medical certificate to confirm the permanent physical incapacity will be joined.
The “dispositions de fin de vie” must be sent to and registered in the official system of registration of the Commission Nationale de Contrôle et d’Evaluation pour l’euthanasie et le suicide assisté.
The “dispositions de fin de vie” may be re-iterated, revoked or adapted at any time. Every 5 years, the Commission Nationale de Contrôle will contact the declarant to reconfirm his will. All changes must be registered with the Commission. However, no euthanasia may take place if the physician comes to know of the patient’s wish to revoke his wish for euthanasia registered in his initial declaration.
The details for such registration of end-of-life documents and their availability to physicians in charge of end-of-life-patients may be determined by Grand-Ducal regulations, which might even suggest a form to fill in for this purpose;
4. 3

The physician who performs euthanasia following an anticipated declaration, is not performing an unlawful act, as stipulated in paragraphes 1 and 2, if he has observed that the patient:

1) is suffering from a serious and incurable accidental or pathological condition,

2. 
   is unconscious,
   
3. 
   that this situation is irreversible according to the current state of scientific knowledge.
   

Before proceding to the act of euthanasia, the physician must always respect the following conditions of procedure :

4°. if the anticipated declaration designates a trusted person, discuss the content of the anticipated declaration with those persons that the trusted person designates as very close to the patient.

CHAPTER IV

Art. 5

The physician who performs a euthanasia will submit the document mentioned in article 7, duly completed, to the Commission de Contrôle et Evaluation within four working days, as described in article 6 of the present law.

CHAPTER V

La Commission

Art. 6

Three members are lawers, of which one “Avocat à la Cour”, as proposed by the l”Ordre des Avocats”, one magistrate proposed by the High Court of Justice and one professor of law from the University of Luxembourg.

One member from the group of Health professions as proposed by the “Conseil supérieur” of Health professions.

Two members represent organisations defending the rights of the patient.

Art. 7

The Commission drafts a registration document that must be completed by the physician and sent to the Commission each time a euthanasia is performed.

- the name, first names, number in the national health insurance registry, and address of the treating physician;

- the name, first names, number in the national health insurance registry and address of the physician(s) who has (have) been consulted concerning the request for euthanasia;

- the name, first names, address and function of all the persons who were consulted by the treating physician, as well as the dates of these consultations;

- if there exists “Disposition de fin de vie” designating a person of trust, the name, first names of the person of trust who intervened.
This first section is confidential. It is transmitted to the commission by the physician. It may be consulted only upon decision of the commission, and in no circumstance may it be used as basic information for the evaluation work of the commission.
The second section of the document is also confidential and contains the following data :
- if there exists a “disposition de fin de vie” or a request for euthanasia or assisted suicide

- the patient’s age and sexe;

- the serious and incurable - accidental or pathological –condition which affected the patient;

- the description of the constant and unbearable suffering;

- the reasons why this suffering has been deemed unrelievable;

- the facts confirming that the request was made voluntarily, was well thought through and was repeated without any external pressure;

- the procedure followed by the physician,

- the qualifications of the physician(s) who were consulted by the treating physician, with

the dates of these consultations;

- the qualifications of the persons consulted by the physician, with the dates of these consultations;

- the exact circumstances under which the euthanasia or assisted suicide was performed

and by what means.

The commission renders a decision within two months.

1. 
   a statistical report based upon the informations gathered from the duly completed second
   

2. 
   a report containing a description and an evaluation of the implementation of the present law;
   
3. 
   if needed, recommendations that may lead to a legislative initiative and/or other measures concerning the implementation of the present law.
   

In order to carry out those tasks the commission may gather all the relevant information from the various authorities and institutions. The information established by the commission is confidential.

The commission may decide to consult experts.

For the execution of its mission, the Commission may call on administrative personnel made available by the governmental administration.

The commission’s operating expenses are drawn from the Governmental budget.

Whoever is involved, in whatever manner, in the implementation of the present law, must respect the confidentiality of the data entrusted to him/her in the exercise of this mission.

This six-month delay is suspended, should there be a dissolution of the Chambre des Députés and/or an absence of an accepted Governmental body.

A new article 397-1 has been introduced into the penal code, with the following heading

“Art.397-1. The application of this particular section does not apply to the physician who replies to a request for euthanasia or assisted suicide respectful of the conditions set forth in the Law on euthanasia and Assisted Suicide of March 16^th, 2009

CHAPTER VII

Special measures
Art. 15
No physician is bound to perform euthanasia or assistance to suicide

No other person is bound to perform euthanasia or assistance to suicide.