Act XII of 2026 establishes a comprehensive legal framework for the preparation, registration, recognition, and implementation of advance medical directives in Malta. An advance medical directive is a decision made by a mentally competent adult aged 18 or over to refuse specific medical treatments in defined future circumstances, should they lose decision-making capacity. The act affects all competent adults in Malta and any healthcare providers treating them.

Key obligations include: (1) directives must be prepared after consultation between the person (comparent) and a physician; (2) the physician must assess mental capacity and certify the person's understanding of the clinical implications; (3) the directive must be in writing and authenticated before a public notary within three months of preparation; (4) the notary must verify identity, confirm the person recognizes the directive's contents, and authenticate the signature; (5) authenticated directives must be submitted to the Public Registry and registered in the person's medical records with the Director General of Health Services within 15 working days. Physicians must respect valid and applicable directives and incur no civil or criminal liability when acting in accordance with them. Directives remain valid unless revoked or amended by the person while mentally capable. They do not apply when the person retains decision-making capacity or when circumstances differ from those specified. Revocation or amendment may be done verbally before a physician and one witness (documented in medical records) or in writing before a notary following the same procedure as the original directive. Violations—intentionally obstructing, falsifying, concealing, or destroying a directive—constitute a criminal offence punishable by imprisonment not exceeding 12 months or a fine not exceeding €10,000, or both. The act contains transitional provisions clarifying that pre-existing do-not-resuscitate orders and similar treatment limitations remain valid if made with contemporary clinical assessment and capacity evaluation, and documented in medical records. The act enters into force on dates prescribed by ministerial notice. Consequential amendments update the Notarial Profession and Archives Act and the Public Registry Act to accommodate the new directive regime.

Advance Medical Directives Act (Act XII of 2026)