Cross-Border Terminal Illness & Advance Care Checklist: France & Belgium

1. 1

   Organizing Palliative Care and Cross-Border Medical Coordination (France and Belgium)

   • France: The attending physician (médecin traitant) or hospital team can apply for 100% coverage under an exempting long-term illness scheme (Affection de Longue Durée exonérante - ALD) with Assurance Maladie (French National Health Insurance) and arrange hospital-at-home care (Hospitalisation à domicile - HAD), intervention by a mobile palliative care team (équipe mobile de soins palliatifs - EMSP), or admission to an inpatient palliative care unit (unité de soins palliatifs - USP) [5]. The Centre national des soins palliatifs et de la fin de vie (CNSPFV, National Center for Palliative and End-of-Life Care) and the directory of the Société Française d'Accompagnement et de Soins Palliatifs (SFAP, French Society for Support and Palliative Care) help locate nearby specialist teams [1][2].
   • Belgium: Home-based or residential palliative care relies on second-line support teams (coordinated by the Fédération Wallonne des Soins Palliatifs in Wallonia, the Pluralistische Federatie Palliatieve Zorg in Brussels, and Palliatieve Zorg Vlaanderen in Flanders) as well as the lump-sum palliative care allowance (forfait palliatif) and abolition of patient co-payments (ticket modérateur) granted by the Institut national d'assurance maladie-invalidité (INAMI, National Institute for Health and Disability Insurance) through the patient's health insurance fund (mutualité / ziekenfonds) upon notification by the general practitioner [6]. For cross-border care or transfer between France and Belgium, verify coverage in advance via the European Health Insurance Card, portable form S1 (residence in the other state), a Franco-Belgian cross-border healthcare zone agreement (ZOAST), or prior authorization S2.
2. 2

   Executing Written Advance Directives While Full Mental Capacity Remains

   Advance medical wishes must be formalized under each state's specific rules while the patient retains full decision-making capacity:

   • France: Under the Claeys-Leonetti Act (loi Claeys-Leonetti), any adult may write, date, and sign advance directives (directives anticipées) regarding the continuation, limitation, or withdrawal of treatments, and designate in writing a trusted person (personne de confiance) to be consulted first by the medical team [1]. These documents can be stored in the digital health space (Mon espace santé) and given to the attending physician [1].
   • Belgium: Under the Belgian Patient Rights Act (loi relative aux droits du patient) and Advance Care Planning (ACP, supported by the Institut national d'assurance maladie-invalidité), the patient can draft a negative advance directive (déclaration anticipée négative, legally binding to refuse specific treatments or resuscitation in the event of future incapacity) and appoint a formal patient representative (représentant du patient) or trusted person [6]. Specific statutory advance declarations may also be registered with the Belgian municipal administration (administration communale, overseen by the Federal Public Service Health, SPF Santé publique).
3. 3

   Establishing Separate Financial Powers of Attorney and Protection Mandates

   To prevent bank accounts or property administration from being frozen if the person's health deteriorates, separate legal instruments should be established in France and Belgium while legal capacity remains intact:

   • France: Alongside bank powers of attorney (procurations bancaires) signed directly with each French bank, your family member can execute a future protection mandate (mandat de protection future, either under private signature or by notarial deed before a French notary via Notaires de France) in accordance with the procedures detailed on Service-Public.fr (the official French administration portal) to appoint one or more representatives in advance to manage their assets and personal welfare [3].
   • Belgium: Your family member can establish an extrajudicial protection mandate (mandat de protection extrajudiciaire / zorgvolmacht) covering property management and personal welfare decisions, which must be registered in the Central Register of Mandate Contracts (Registre central des contrats de mandat) through a notary or the Royal Federation of Belgian Notaries via Notaire.be in order to take effect upon incapacity without requiring intervention by the justice of the peace (juge de paix) [7].
4. 4

   Caregiver Leave, End-of-Life Allowances, and Social Support

   • France: An employee caring for a relative in an advanced or terminal stage of illness can request family solidarity leave (congé de solidarité familiale, up to 3 months, renewable once) following the steps on Service-Public.fr and receive the Daily End-of-Life Accompaniment Allowance (Allocation journalière d'accompagnement d'une personne en fin de vie - AJAP, paid for up to 21 days by the local health insurance fund, CPAM, under Assurance Maladie) [4][5]. In cases of rapid loss of autonomy for an older adult at home, the Personalized Autonomy Allowance (Allocation personnalisée d'autonomie - APA) can be requested on an emergency basis from the departmental council.
   • Belgium: Employed caregivers can apply for palliative care leave (congé pour soins palliatifs, 1 month full-time or part-time, extendable twice for up to 3 months per patient) upon a certificate from the attending physician, or recognized informal caregiver leave (congé d'aidant proche) approved by their health insurance fund (mutualité), with career-break benefits paid by the Office national de l'emploi (ONEM, National Employment Office / RVA) [8].
5. 5

   Aligning Wills, Survivor Pensions, and Cross-Border Estate Settlement

   Under the EU Succession Regulation (Regulation (EU) No 650/2012), the estate as a whole is governed by the law of the state of the deceased's last habitual residence, unless an express choice of national law (Belgian law for a Belgian citizen) is recorded in a valid will.

   • France: After death, beneficiaries can apply for the lump-sum death benefit (capital décès) from the CPAM (within 2 years via Assurance Maladie), claim survivor pensions (pensions de réversion) from the basic and supplementary pension schemes (Assurance Retraite / CNAV and Agirc-Arrco), and entrust the estate settlement (deed of heirship or acte de notoriété and inheritance tax declaration within 6 months if death occurs in France) to a notary [5].
   • Belgium: Entitlements to a survivor pension (pension de survie) or transition allowance (allocation de transition) are assessed by the Service Fédéral des Pensions (SFP, Federal Pensions Service / MyPension.be), and the health insurance fund (under the Institut national d'assurance maladie-invalidité) must be notified [6][9]. In Belgium, bank accounts are frozen upon notification of death and are only unblocked upon presentation of a certificate or deed of heredity (certificat or acte d'hérédité, issued by the Legal Certainty office of SPF Finances or by a notary via Notaire.be); the inheritance return (déclaration de succession) must be filed with SPF Finances (Wallonia/Brussels) or VLABEL (Flanders) within 4 months if death occurs in Belgium (or 5 months if death occurs in another European country such as France) [7][9].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Advance Directives and the Trusted Person (Les directives anticipées et la personne de confiance) — Centre national des soins palliatifs et de la fin de vie (Parlons Fin de Vie)
2. [2]
   Advance Directives and Support in Palliative Care (Les directives anticipées et l'accompagnement en soins palliatifs) — Société Française d'Accompagnement et de Soins Palliatifs (SFAP)
3. [3]
   Guide to the Future Protection Mandate (Notice du mandat de protection future) — Service-Public.fr
4. [4]
   Family Solidarity Leave and AJAP Allowance (Congé de solidarité familiale et AJAP) — Service-Public.fr
5. [5]
   Death of a Relative: The Lump-Sum Death Benefit (Décès d'un proche : le capital décès) — Assurance Maladie (Ameli.fr)
6. [6]
   Financial Support for Home Palliative Patients: The Palliative Lump Sum (Intervention financière pour les patients palliatifs à domicile) — Institut national d'assurance maladie-invalidité (INAMI)
7. [7]
   The Extrajudicial Protection Mandate and Successions in Belgium (Le mandat extrajudiciaire et les successions en Belgique) — Fédération Royale du Notariat Belge (Notaire.be)
8. [8]
   Palliative Care Leave (Congé pour soins palliatifs) — Office national de l'emploi (ONEM)
9. [9]
   Survivor Pension and Steps Following a Death (Pension de survie et démarches en cas de décès) — Service Fédéral des Pensions (SFP)