Advance Directive (Living Will) in Finland

What is an advance directive

An advance directive, known in Finnish as hoitotahto, is a document in which a person expresses their wishes about medical treatment for situations where they are no longer able to communicate or make decisions themselves. It is sometimes referred to as a living will, though in Finland the term hoitotahto specifically addresses healthcare decisions rather than estate matters.

The advance directive becomes relevant in situations such as terminal illness, severe dementia, permanent unconsciousness, or any condition that renders the person unable to express their treatment preferences. Without a written advance directive, healthcare professionals must rely on the views of family members or make decisions based on what they consider to be in the patient's best interest.

An advance directive is one element of comprehensive advance planning, alongside a continuing power of attorney for financial and care matters and a will for the distribution of assets. While these documents serve different purposes, they are best prepared together to ensure complete coverage.

Legal basis and validity

The legal foundation for advance directives in Finland is the Act on the Status and Rights of Patients (Laki potilaan asemasta ja oikeuksista, 785/1992). Section 8 of this Act establishes the key principles:

• A competent patient has the right to refuse treatment, even life-sustaining treatment.
• A patient's previously expressed wishes regarding care must be respected when the patient can no longer express their will.
• Healthcare professionals must ascertain whether the patient has made an advance directive before making treatment decisions.

The advance directive is legally binding, meaning that healthcare professionals are obligated to follow it. However, it applies only to the situations it describes. If a medical situation arises that the directive does not address, healthcare professionals must act according to the patient's best interest, consulting family members and other close persons.

There is no specific formal requirement defined by law for the document's format. The directive can be in free form, though clarity and specificity strengthen its practical applicability. Unlike a will, there is no statutory requirement for witnesses, but their inclusion is considered best practice.

What to include

A well-drafted advance directive should address the following areas:

General treatment preferences -- state whether you want all available treatments to extend life, or whether you prefer comfort-focused care (palliative care) if your condition is terminal or recovery is not expected. Be as specific as possible about the circumstances in which you want treatment limited.

Specific medical interventions -- address particular treatments such as mechanical ventilation, artificial nutrition and hydration, resuscitation (CPR), dialysis, antibiotics for life-threatening infections, and admission to intensive care. For each, state whether you accept or refuse the intervention under specified circumstances.

Pain management -- express your wishes regarding pain relief, including whether you accept strong analgesics even if they might shorten life. In Finland, adequate pain management is considered a patient's right under the Healthcare Act (1326/2010).

Organ and tissue donation -- state your wishes regarding organ donation after death. While Finland maintains an opt-in system through the organ donation card, stating your wishes in the advance directive provides additional documentation.

Personal values -- describe what quality of life means to you and what conditions would be unacceptable. This helps healthcare professionals interpret the directive in unforeseen situations.

Named contact person -- identify who should be consulted about your care if questions arise about interpreting the directive. This person may be the same as the agent named in your continuing power of attorney.

How to make and store an advance directive

Creating an advance directive does not require a lawyer, though consulting one or discussing the document with a healthcare professional can help ensure it is clear and comprehensive.

Steps to create an advance directive:

1. Reflect on your values and treatment preferences, ideally after discussing them with family members and your doctor.
2. Write the directive clearly, dating and signing it.
3. Have two witnesses sign the document (recommended but not legally required).
4. Consider including a doctor's statement confirming your competence at the time of signing.
5. Distribute copies and inform relevant people.

Storage options:

• Kanta Patient Data Repository -- Finland's national electronic health records system (Kanta) allows patients to record an advance directive electronically. This is the most reliable option because healthcare professionals can access it directly.
• With your medical records -- ask your healthcare provider to attach the directive to your patient records.
• With your named contact person -- give a copy to the person you have designated to speak on your behalf.
• Personal files -- keep the original in a safe place known to your family.

It is wise to use multiple storage methods simultaneously. The Kanta system is particularly valuable because it ensures healthcare professionals can find the directive even in emergency situations.

Advance directive in practice

When a patient arrives at a healthcare facility unable to communicate, the treating physician is legally required to check whether an advance directive exists. In practice, the physician will check the Kanta system, the patient's medical records, and ask family members.

If an advance directive is found, the physician must assess whether it applies to the current medical situation and whether it was made by a competent person. If there is no reason to doubt the directive's validity, the physician must follow it -- even if family members disagree.

Situations where a directive may not be followed are narrow: if the directive was clearly made without understanding its consequences, if medical circumstances have changed so fundamentally since the directive was made that the person could not have anticipated the current situation, or if following the directive would conflict with law.

Healthcare professionals in Finland generally respect advance directives, but the more specific and clearly written the document is, the more confidently it can be applied. Vague phrases like "no extraordinary measures" are harder to implement than specific instructions about named treatments.

Discussing your advance directive with your family and doctor while you are healthy ensures that everyone understands your wishes and can advocate for them when the time comes.

Frequently asked questions

Is an advance directive legally binding in Finland?

Yes. The Act on the Status and Rights of Patients requires healthcare professionals to follow a valid advance directive made by a competent person.

Can family members override an advance directive?

No. A written advance directive takes precedence over the views of family members.

Does an advance directive need to be witnessed?

It is not strictly required by law, but two witnesses are strongly recommended to strengthen the document's validity.

Can I change my advance directive?

Yes, at any time while you are competent. The most recent dated version supersedes all earlier ones.