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

1. 1

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

   • France: The attending physician (médecin traitant) or hospital team can arrange 100% healthcare coverage under an exempting long-term illness scheme (Affection de Longue Durée exonérante - ALD) with Assurance Maladie (French National Health Insurance) and refer the patient to hospital-at-home care (Hospitalisation à domicile - HAD), a mobile palliative care team (équipe mobile de soins palliatifs - EMSP), or a dedicated inpatient palliative care unit (unité de soins palliatifs - USP) [5]. You can identify local support structures and patient rights through the Centre national des soins palliatifs et de la fin de vie (CNSPFV, National Center for Palliative and End-of-Life Care) and the national directory of the Société Française d'Accompagnement et de Soins Palliatifs (SFAP, French Society for Support and Palliative Care) [1][2].
   • Portugal: Access to home-based palliative care (community support teams, Equipas Comunitárias de Suporte em Cuidados Paliativos - ECSCP) or inpatient palliative units (Unidades de Cuidados Paliativos - UCP) is provided through the National Palliative Care Network (Rede Nacional de Cuidados Paliativos - RNCP) within the public health system, accessible via the portal or helpline of SNS 24 (National Health Service helpline at 808 24 24 24), with additional directory guidance from the Portuguese Association of Palliative Care (Associação Portuguesa de Cuidados Paliativos - APCP) [6]. If a medical transfer or care stay is planned between France and Portugal, verify cross-border coverage in advance with the competent health insurance fund (European Health Insurance Card for a temporary stay, portable document S1 for transferring residence, or prior authorization S2 for scheduled treatment).
2. 2

   Executing Written Advance Directives While Full Mental Capacity Remains

   Advance medical directives are governed by distinct national rules and should be executed separately in each country while the patient retains full decision-making capacity:

   • France: Under the Claeys-Leonetti Act (loi Claeys-Leonetti), any adult may draft written advance directives (directives anticipées, either on dated and signed plain paper or using the official CNSPFV template) regarding the continuation, limitation, or withdrawal of medical treatments, and designate in writing a healthcare proxy or trusted person (personne de confiance) whose opinion guides the medical team as a priority [1]. These documents can be uploaded to the digital health record (Mon espace santé) and provided to the attending physician [1].
   • Portugal: The patient can execute an Advance Directive of Will (Diretiva Antecipada de Vontade - DAV, commonly known as a Living Will or Testamento Vital) and appoint a healthcare proxy (procurador de cuidados de saúde) with the National Living Will Registry (Registo Nacional do Testamento Vital - RENTEV), managed by the Shared Services of the Ministry of Health (Serviços Partilhados do Ministério da Saúde - SPMS) and accessible through SNS 24 [6]. The official form must be signed in person before a RENTEV clerk (at a primary health center or Unidade Local de Saúde) or sent with a notarized signature; it remains valid for 5 years and is renewable [6].
3. 3

   Establishing Separate Financial Powers of Attorney and Protection Mandates

   To prevent bank accounts or day-to-day property management from being frozen in the event of incapacity, separate legal instruments should be formalized in France and Portugal:

   • France: In addition to bank powers of attorney (procurations bancaires) executed directly with each French bank using its own forms, your family member can establish a future protection mandate (mandat de protection future, either under private signature or as a notarial deed before a French notary via Notaires de France) in accordance with the rules set out on Service-Public.fr (the official French public administration portal), appointing one or more representatives in advance to manage their estate and personal welfare without immediate court intervention [3].
   • Portugal: Portuguese banks and public authorities generally require a formal power of attorney (procuração) executed before a notary's office (Cartório Notarial under the Ordem dos Notários), a registry office (Conservatória under the Instituto dos Registos e do Notariado - IRN), or a Portuguese consulate in France, or a mandate with a view to accompaniment (mandato com vista a acompanhamento) to anticipate a judicial supported decision-making measure (maior acompanhado) [3][6].
4. 4

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

   • France: An employed relative caring for a person in an advanced or terminal stage of a serious and incurable illness may apply for family solidarity leave (congé de solidarité familiale, for up to 3 months, renewable once) under the procedures detailed on Service-Public.fr, and claim 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]. For an older person experiencing rapid loss of autonomy at home, the Personalized Autonomy Allowance (Allocation personnalisée d'autonomie - APA) can be requested under an emergency departmental procedure (procédure d'urgence).
   • Portugal: Through Segurança Social (Portuguese Social Security), a dependent pensioner or person eligible under the special disability scheme can apply for the Dependency Supplement (Complemento por Dependência, 1st or 2nd degree), while a relative providing regular care may apply for formal recognition under the Informal Caregiver Statute (Estatuto do Cuidador Informal) as well as family assistance leave and working-time flexibility under the Portuguese Labor Code (Código do Trabalho) [7].
5. 5

   Aligning Wills, Survivor Benefits, and Cross-Border Estate Administration

   Under the EU Succession Regulation (Regulation (EU) No 650/2012), the law applicable to the estate as a whole is in principle that of the deceased's last habitual residence, unless an express choice of national law (Portuguese law for a Portuguese citizen) is made in a valid will.

   • France: Following death, eligible beneficiaries can claim the lump-sum death benefit (capital décès) from the local health insurance fund (within 2 years via Assurance Maladie), apply for survivor pensions (pensions de réversion) from the basic and supplementary pension funds (Assurance Retraite / CNAV and Agirc-Arrco), and entrust the estate settlement (deed of heirship or acte de notoriété, and inheritance tax return within 6 months if death occurs in France) to a notary's office [5].
   • Portugal: Through Segurança Social, eligible family members can claim the Death Grant (Subsídio por Morte, generally within 180 days of death), reimbursement of funeral expenses (Reembolso de Despesas de Funeral within 90 days), and the Survivor Pension (Pensão de Sobrevivência) [8]. Heirship formalities (habilitação de herdeiros) are completed at a one-stop bereavement desk (Espaço Óbito / Balcão das Heranças) or before a notary, and the tax declaration for assets located in Portugal (participação do Imposto do Selo) must be filed with the Tax and Customs Authority (Autoridade Tributária e Aduaneira) before the end of the 3rd month following the month of death [8].

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]
   Palliative Care Support and Directory of Palliative Care Structures (Accompagnement et annuaire des structures de soins palliatifs) — Société Française d'Accompagnement et de Soins Palliatifs (SFAP)
3. [3]
   Future Protection Mandate (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 Benefit and Health Insurance Benefits (Capital décès et prestations de l'Assurance Maladie) — Assurance Maladie (Ameli.fr)
6. [6]
   Living Will (Testamento Vital / DAV) and National Living Will Registry (RENTEV) — SNS 24 (Serviço Nacional de Saúde)
7. [7]
   Informal Caregiver Statute and Dependency Supplement (Estatuto do Cuidador Informal e Complemento por Dependência) — Instituto da Segurança Social
8. [8]
   Death Grant and Survivor Pension (Subsídio por Morte e Pensão de Sobrevivência) — Instituto da Segurança Social