Guides › Making an Advance Medical Directive

Making an Advance Medical Directive

How to legally document which treatments you refuse if you lose capacity — Act XII of 2026

The Advance Medical Directives Act (Act XII of 2026) gives any mentally competent adult aged 18 or over the right to prepare a legally binding written dire

1. Decide what you want your directive to say

   An advance directive can refuse specific medical treatments in defined future circumstances where you may lose decision-making capacity — for example, refusing mechanical ventilation, resuscitation, or artificial nutrition in defined terminal or vegetative conditions. You cannot use a directive to request illegal treatment (such as euthanasia, which is not legal in Malta) or to demand specific treatment — only to refuse it. Be as specific as possible about the circumstances and the treatments you are refusing. Vague directives are harder to apply. Write a draft before your doctor's appointment.

2. Consult your doctor — they must certify your capacity

   Before the directive can be notarised, you must consult a physician who will: (1) assess that you have the mental capacity to make the directive, (2) explain the clinical implications of refusing the treatments you have specified, and (3) provide a written certificate confirming your capacity and understanding. This certificate is a legal requirement — a notary cannot sign the directive without it. Your GP can do this. If you have a pre-existing condition, a specialist may be more appropriate. The consultation should be documented in your medical records.

3. Have your directive notarised — within 3 months

   Within 3 months of preparing the directive (the clock starts when you prepare it, not when you see the doctor), bring it to a notary with your ID card and the physician's certificate. The notary will: verify your identity, confirm you recognise the contents of the directive and are signing it of your own free will, and then authenticate the document as a notarial deed. Notary fees apply (typically €100–€250). If you do not notarise within 3 months, you must restart the process. Find a notary at: maltanotaries.org.mt.

4. Register at the Public Registry — within 15 working days

   Within 15 working days of notarisation, the directive must be registered at the Public Registry (publicregistry.gov.mt). The notary can do this on your behalf — confirm this at the notarisation appointment. Registration makes the directive legally effective and searchable by hospitals and treating physicians. Without registration, a directive has no legal force even if properly notarised. A registration fee applies. Keep your own certified copy of the registered directive in a safe place.

5. Notify your GP and hospital — add it to your medical records

   Once registered, give a certified copy of your directive to your GP with a request that it be placed prominently in your medical records. If you have a known condition or are a regular patient at a specific hospital, notify that hospital's patient records department as well. Tell your next of kin or trusted person where the directive is kept. In an emergency, medical staff should check for an advance directive — but they can only find it if it is registered and your medical records reference it.

6. Revoking or changing your directive

   You can revoke your directive at any time while you have mental capacity. Revocation can be done verbally in front of a physician and one witness (the physician documents it in your records), or in writing before a notary. Once revoked, the old directive is no longer valid. If your wishes change, you can prepare a new directive following the same process. If you lose capacity before revoking it, the directive stands — so make sure it accurately reflects your current wishes at all times.

7. What happens if someone ignores your directive

   A physician who follows a valid, registered advance directive has full legal protection — no civil or criminal liability. A physician who ignores a valid directive may face professional and legal consequences. If someone intentionally obstructs, falsifies, conceals or destroys your directive, that is a criminal offence under the Act carrying up to 12 months imprisonment and/or a fine of up to €10,000. Existing DNR orders (Do Not Resuscitate) and documented treatment limitations that were in place before the Act came into force remain valid under transitional provisions — no action is needed to reconfirm them.