Cross-Border Terminal Illness & Advance Care Checklist: Germany & Ukraine

1. 1

   Palliative and Hospice Care and Cross-Border Coordination (Germany and Ukraine)

   Begin with the attending medical team in the country where the ill person is currently staying to set up pain management, symptom control, and outpatient or inpatient support:

   • Germany: In the case of an incurable, progressive illness with complex symptoms, the patient is entitled to Specialized Outpatient Palliative Care (Spezialisierte Ambulante Palliativversorgung - SAPV under Section 37b SGB V), prescribed by a physician and covered by statutory health insurance [1]. Where palliative or hospice care is needed, a shortened fast-track care level assessment deadline of one week (Eilbegutachtungsfrist, Section 18a SGB XI) applies for classification by the Medical Service (Medizinischer Dienst) [1]. Regional SAPV teams, outpatient hospice services, palliative wards, and inpatient hospices can be located through the national umbrella association, Deutscher Hospiz- und PalliativVerband e.V. (German Hospice and Palliative Association) [1].
   • Ukraine: If care takes place in Ukraine or a return there is planned, under the state Program of Medical Guarantees (Програма медичних гарантій) the National Health Service of Ukraine (Національна служба здоров'я України, telephone contact center 16-77) covers the costs of inpatient palliative care (стаціонарна паліативна медична допомога) as well as mobile home palliative teams (мобільна паліативна медична допомога) [6]. Admission requires an electronic referral (е-направлення) issued by a family physician or attending specialist in accordance with the guidelines of the Ministry of Health of Ukraine (Міністерство охорони здоров'я України) [6][7]. Before any patient transfer between Germany and Ukraine, fitness to travel, pain-medication continuity, and health insurance coverage should be coordinated in advance with the attending physicians.
2. 2

   Written Advance Directives and Medical Proxies While Maintaining Full Capacity

   Because living wills and medical information rights vis-à-vis physicians are governed by the law of the respective country of treatment, separate declarations should be drawn up for both countries while the ill person retains capacity:

   • Germany: Prepare a written, personally signed living will (Patientenverfügung under Section 1827 BGB) documenting specific decisions on life-sustaining measures, supplemented by a palliative emergency sheet (palliativmedizinischer Notfallbogen / Krisenbogen) for emergency medical services [2]. Official, free text modules and drafting guides are provided by the Federal Ministry of Justice (Bundesministerium der Justiz) [2].
   • Ukraine: Under the Fundamentals of Legislation of Ukraine on Healthcare (Основи законодавства України про охорону здоров'я), which fall under the remit of the Ministry of Health of Ukraine (Міністерство охорони здоров'я України), an adult with decision-making capacity submits a written informed consent to or refusal of medical interventions (письмова інформована згода пацієнта) and explicitly designates a trusted person (довірена особа) in the medical file who is authorized to receive information about their health status and inspect medical documentation [7].
3. 3

   Separate Healthcare, Financial, and Banking Powers of Attorney in Both Jurisdictions

   Powers of attorney for real estate, bank accounts, and public authorities should be executed according to each country's local formal requirements to avoid rejection in German-Ukrainian legal transactions:

   • Germany: Combine a written healthcare and financial power of attorney (Vorsorgevollmacht) with a care directive (Betreuungsverfügung) [2] and register them with the Central Register of Advance Directives of the Federal Chamber of Notaries (Zentrales Vorsorgeregister der Bundesnotarkammer) so that guardianship courts (Betreuungsgerichte) and attending physicians have immediate access in an emergency [3]. If real estate transactions or commercial register matters in Germany are covered, notarial recording (Beurkundung) or certification (Beglaubigung) is required; additionally, a separate post-mortem bank power of attorney (transmortale Kontovollmacht, valid beyond death) should be lodged directly with German banks.
   • Ukraine: For banking transactions, asset administration, dealings with authorities, and real estate matters in Ukraine, a notarized power of attorney (нотаріальна довіреність) entered into the Unified Register of Powers of Attorney (Єдиний реєстр довіреностей) is required [8]. This can be executed either in Ukraine before a state or private notary (organized within the Notary Chamber of Ukraine, Нотаріальна палата України) [8] or outside Ukraine directly at a Ukrainian consular mission in Germany - such as the Embassy of Ukraine in Germany (Botschaft der Ukraine in der Bundesrepublik Deutschland in Berlin or the Consulates General in Munich, Frankfurt am Main, Hamburg, or Düsseldorf) - which eliminates the need for a separate Apostille [9].
4. 4

   Short-Term Care Absence, Caregiver Leave, and Support Benefits for Relatives

   Both countries provide statutory leave entitlements and financial support for family caregivers and seriously ill individuals:

   • Germany: In an acute care situation, employees may take up to 10 working days off work and apply to the ill person's long-term care insurance fund (Pflegekasse) for the care support allowance (Pflegeunterstützungsgeld) as a wage-replacement benefit [4]. For end-of-life accompaniment (Begleitung in der letzten Lebensphase), the Caregiver Leave Act (Pflegezeitgesetz) allows full or partial leave from work for up to 3 months (including when care is provided in a hospice) [4]. Free, confidential advice is available from the Care Helpline (Pflegetelefon) of the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (Bundesministerium für Familie, Senioren, Frauen und Jugend, reachable at 030 20 17 91 31 or by email at [email protected]) [4].
   • Ukraine: In Ukraine, the attending medical team issues an electronic medical conclusion of temporary incapacity for work to care for a sick family member (медичний висновок про тимчасову непрацездатність по догляду за хворим членом сім'ї), on the basis of which sickness benefit is paid through the Pension Fund of Ukraine (Пенсійний фонд України) [10]. In addition, where long-term care is required, entitlements exist for state social care assistance (державна соціальна допомога на догляд) and disability pensions administered by the Пенсійний фонд України [10].
5. 5

   Aligning Wills, Survivor Benefits, and Succession Procedures

   Early coordination of estate planning prevents subsequent conflicts between German and Ukrainian authorities:

   • Germany: With specialist notarial advice, review any choice-of-law clause in the will and place testamentary dispositions into official custody (amtliche Verwahrung) with the probate court (Nachlassgericht at the Amtsgericht), registered in the Central Register of Wills (Zentrales Testamentsregister). Upon death, notify the statutory health insurance fund (Gesetzliche Krankenversicherung) and apply for widow's, widower's, or orphan's pensions with the German statutory pension insurance body (Deutsche Rentenversicherung) [5]. If the deceased person was already receiving a German pension, an advance payment for the three-month transition period (Sterbevierteljahr, three months at the full insured pension rate) can be claimed within 30 days of death through the Renten Service der Deutschen Post; to access estate assets without a post-mortem power of attorney, the Nachlassgericht at the Amtsgericht issues a certificate of inheritance (Erbschein) [5].
   • Ukraine: Following a death, the Ukrainian funeral grant (допомога на поховання, generally equal to two months of pension) and survivor pension for loss of a breadwinner (пенсія у зв'язку з втратою годувальника) are claimed from the Пенсійний фонд України (or online via the PFU electronic services web portal, as detailed on the state portal Портал Дія) [10]. To open succession proceedings in Ukraine (відкриття спадкової справи, registered in the Inheritance Register of the Ministry of Justice of Ukraine, Спадковий реєстр Міністерства юстиції України), a strict statutory deadline of 6 months from the date of death applies, within which heirs must submit their personal declaration of acceptance of inheritance (заява про прийняття спадщини) before a Ukrainian notary (member of the Нотаріальна палата України) or file it with a signature certified by a notary or a Ukrainian consulate (such as the Botschaft der Ukraine in der Bundesrepublik Deutschland) [8][9].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Specialized Outpatient Palliative Care (SAPV) and Hospice Support — Deutscher Hospiz- und PalliativVerband e.V. (DHPV)
2. [2]
   Living Will (Patientenverfügung), Power of Attorney (Vorsorgevollmacht), and Care Directive (Betreuungsverfügung) — Bundesministerium der Justiz (BMJ)
3. [3]
   Central Register of Advance Directives of the Federal Chamber of Notaries — Bundesnotarkammer / Bund.de
4. [4]
   Pathways to Care: Caregiver Leave, Care Support Allowance, and Care Helpline — Bundesministerium für Familie, Senioren, Frauen und Jugend (BMFSFJ)
5. [5]
   Survivor Pensions: Widow's/Widower's Pension, Orphan's Pension, and Three-Month Transition Period (Sterbevierteljahr) — Deutsche Rentenversicherung (DRV)
6. [6]
   Palliative Care under the Program of Medical Guarantees (Inpatient and Mobile) — Національна служба здоров'я України (НСЗУ)
7. [7]
   Palliative Care for Patients with Severe and Incurable Illnesses Remains Free of Charge — Міністерство охорони здоров'я України (МОЗ)
8. [8]
   Notarial Documents, Inheritance, and Powers of Attorney — Нотаріальна палата України (НПУ)
9. [9]
   Consular Affairs and Notarial Certifications of the Embassy of Ukraine in Germany — Außenministerium der Ukraine (MFA)
10. [10]
    Funeral Grant Payment and Services of the Pension Fund of Ukraine — Портал Дія / Пенсійний фонд України