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

1. 1

   Organizing palliative care and coordinating health coverage between Portugal and Brazil

   The first step is to activate the palliative care team in the country where care is taking place and verify bilateral healthcare protection rules if travel or relocation between Portugal and Brazil is being considered.

   • National Palliative Care Network in Portugal: Within the Serviço Nacional de Saúde (Portuguese National Health Service - SNS), referrals to community palliative care support teams (home care) or inpatient palliative care units of the National Palliative Care Network (Rede Nacional de Cuidados Paliativos - RNCP, integrated into Local Health Units, Unidades Locais de Saúde, such as in Lisbon or Porto) are made by the family doctor or hospital team, with guidance also available via the SNS 24 helpline (808 24 24 24) [1]. Additional resources and directories of specialized teams are provided by the Portuguese Association for Palliative Care (Associação Portuguesa de Cuidados Paliativos - APCP).
   • Palliative care under SUS and coordination with Brazil: In Brazil, the National Palliative Care Policy (Política Nacional de Cuidados Paliativos) within the Unified Health System (Sistema Único de Saúde - SUS, coordinated by the Ministério da Saúde) integrates palliative support across primary, hospital, and home care through the Melhor em Casa program [2], supported by technical mapping from the Conselho Federal de Medicina (Federal Council of Medicine - CFM) [3] and the Academia Nacional de Cuidados Paliativos (National Academy of Palliative Care - ANCP) [4]. For travel or relocation between Portugal and Brazil, verify in advance the issuance of the Certificate of Entitlement to Medical Assistance (Certificado de Direito à Assistência Médica - CDAM / PB4) under the bilateral Portugal-Brazil social security agreement, as well as medical air transport coverage with the insurer.
2. 2

   Executing Advance Healthcare Directives (Living Wills) in Portugal and Brazil

   Written advance medical directives follow the formal requirements of each jurisdiction; it is therefore advisable to register them separately in Portugal and Brazil while your family member has full capacity.

   • Advance Directive (Diretiva Antecipada de Vontade - DAV) and RENTEV in Portugal: In Portugal, the ill person can formalize an Advance Healthcare Directive (Diretiva Antecipada de Vontade / Testamento Vital) and appoint a Healthcare Proxy (Procurador de Cuidados de Saúde) to make decisions on medical treatments (such as artificial life support or futile treatments) if they become unable to express their wishes autonomously [5]. The official form is registered in 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) either in person at a RENTEV desk or with a digital signature via the SNS 24 portal, making it accessible to doctors in the electronic health record for a renewable 5-year period [5].
   • Advance Directives (Diretivas Antecipadas de Vontade) in Brazil: In Brazil, the Living Will (Testamento Vital / Diretivas Antecipadas de Vontade) is regulated by CFM Resolution No. 1,995/2012 (Resolução CFM n.º 1.995/2012) of the Conselho Federal de Medicina, which directs physicians to respect the instructions previously expressed by the patient regarding care and treatment in the terminal phase [3][4]. To ensure legal certainty and easy access, the document should be recorded directly in the patient's medical chart (prontuário médico) with the treating team and may also be executed as a public deed at a Notary Office (Cartório de Notas) in Brazil (or via the e-Notariado platform) [4].
3. 3

   Granting separate financial and healthcare Powers of Attorney in both jurisdictions

   Banks, registry offices, notary offices, and public agencies in Portugal and Brazil require instruments of representation issued in accordance with their respective national rules.

   • Notarial power of attorney and mandate for accompanied adulthood in Portugal: While retaining full mental capacity, the ill person can grant a power of attorney (procuração) at a Notary Office (Cartório Notarial, overseen by the Order of Notaries, Ordem dos Notários) or at a Registry Office (Conservatória) of the Instituto dos Registos e do Notariado (Institute of Registries and Notary - IRN) for banking transactions, property management, and tax representation in Portugal [6]. To prepare for potential future incapacity, Portuguese law also allows the execution of a mandate with a view to accompaniment (mandato com vista a acompanhamento), which guides the court if the accompanied adult legal regime (regime jurídico do maior acompanhado) later becomes necessary.
   • Public and social security Powers of Attorney for Brazil: To manage bank accounts, real estate, and benefits in Brazil, a Public Power of Attorney (Procuração Pública) drawn up at a Notary Office (Cartório de Notas, for example in São Paulo or Rio de Janeiro, or electronically via the e-Notariado platform of the Colégio Notarial do Brasil - CNB for holders of a notarized digital certificate) is required. If your family member resides in Portugal and holds Brazilian citizenship, they can execute a Public Power of Attorney directly at a Consulate-General of Brazil (in Lisbon, Porto, or Faro) with immediate validity in Brazil, in addition to registering a specific power of attorney for representation before the Instituto Nacional do Seguro Social (National Institute of Social Security - INSS, helpline 135) [7].
4. 4

   Claiming serious illness support, disability benefits, and caregiver leave

   Both countries provide fast-track social benefits for severe dependency and labor protections for family caregivers.

   • Dependency Supplement, Informal Caregiver Status, and caregiver leave in Portugal: In Portugal, Segurança Social (Social Security) grants the Dependency Supplement (Complemento por Dependência) to pensioners who require permanent third-party assistance and recognizes Informal Caregiver Status (Estatuto do Cuidador Informal, which includes a means-tested Main Informal Caregiver Support Allowance, Subsídio de Apoio ao Cuidador Informal Principal) [8][9]. Under the Portuguese Labor Code (Código do Trabalho), employees in Portugal are also entitled to statutory absences and leave to provide urgent and indispensable care to a family member with a serious or chronic illness.
   • 25% INSS supplement, Income Tax exemption, and FGTS withdrawal in Brazil: In Brazil, a person insured with the Instituto Nacional do Seguro Social (INSS) is entitled to temporary incapacity benefit (auxílio por incapacidade temporária) or permanent incapacity retirement (aposentadoria por incapacidade permanente), increased by a 25% supplement (acréscimo de 25%) when permanent assistance from another person is required [7]. Retirees and pensioners diagnosed with a qualifying serious illness under Law No. 7,713/1988 (Lei n.º 7.713/1988, such as malignant neoplasia, severe heart disease, or irreversible paralysis) can apply for an Income Tax exemption (isenção de Imposto de Renda) through the INSS and the Receita Federal (Federal Revenue Service of Brazil) [10][11], and a worker (or account holder with a dependent suffering from a serious illness or in the terminal stage of life) may withdraw their full FGTS balance through the Caixa Econômica Federal (including via the FGTS app) [12].
5. 5

   Aligning wills, bank access, funeral wishes, and estate settlement between Portugal and Brazil

   Planning estate succession and post-death formalities in advance prevents conflicts between the EU Succession Regulation (applicable in Portugal) and Brazilian law (which reserves the probate and partitioning of assets located in Brazil exclusively to Brazilian courts and notary offices).

   • Succession planning and post-death formalities in Portugal: Following a death in Portugal, family members can apply to Segurança Social for the Death Grant (Subsídio por Morte, within 180 days), Reimbursement of Funeral Expenses (Reembolso de Despesas de Funeral, within 90 days), and the Survivor Pension (Pensão de Sobrevivência) [13]. Confirmation of heirs (habilitação de herdeiros) and estate partitioning are handled through the Inheritance Desk (Balcão das Heranças) and the Death Desk (Espaço Óbito) of the Instituto dos Registos e do Notariado [6][14], and the head of the estate (cabeça-de-casal) must file the free property transfer declaration (Stamp Duty Form 1, Modelo 1 do Imposto do Selo) with the Tax and Customs Authority (Autoridade Tributária e Aduaneira) via the Finance Portal on Gov.pt by the end of the third month following the month of death [15].
   • Succession planning and post-death formalities in Brazil: In Brazil, dependents apply for the Survivor Pension (Pensão por Morte) from the Instituto Nacional do Seguro Social (INSS, via the Meu INSS portal or app or by calling 135) [16] and request the release of remaining FGTS and PIS/PASEP balances at the Caixa Econômica Federal [12]. If there are assets located in Brazil, opening judicial or extrajudicial probate (inventário judicial ou extrajudicial, the latter at a Cartório de Notas of the Colégio Notarial do Brasil when all heirs are of legal age, capable, and in agreement) is mandatory within the statutory deadline of 2 months (60 days) from the date of death to avoid state penalties on the Estate and Gift Tax (Imposto sobre Transmissão Causa Mortis e Doação - ITCMD). It is also advisable to record preferences between a local funeral and international repatriation in writing.

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   National Palliative Care Network (Rede Nacional de Cuidados Paliativos - RNCP) — Serviço Nacional de Saúde (SNS)
2. [2]
   National Palliative Care Policy in the Unified Health System (SUS) — Ministério da Saúde (Gov.br)
3. [3]
   Palliative care and advance directives in Brazil — Conselho Federal de Medicina (CFM)
4. [4]
   CFM Resolution No. 1,995/2012 on Advance Healthcare Directives (Living Will) — Academia Nacional de Cuidados Paliativos (ANCP)
5. [5]
   Living Will (Advance Healthcare Directive and RENTEV) — SNS 24 / Serviços Partilhados do Ministério da Saúde (SPMS)
6. [6]
   Inheritance Desk (Balcão das Heranças) and confirmation of heirs — Justiça.gov.pt / Instituto dos Registos e do Notariado (IRN)
7. [7]
   Power of attorney for representation before the INSS — Instituto Nacional do Seguro Social (Gov.br)
8. [8]
   Main informal caregiver support allowance and dependency benefits — Segurança Social
9. [9]
   Informal Caregiver Status (Estatuto do Cuidador Informal): rights and support — SNS 24
10. [10]
    Apply for Income Tax exemption due to serious illness — Governo Federal (Gov.br)
11. [11]
    Income Tax exemption for serious illness (Law No. 7,713/1988) — Receita Federal (Gov.br)
12. [12]
    FGTS withdrawal for serious illnesses or terminal stage of life — Caixa Econômica Federal
13. [13]
    Death grant, funeral expense reimbursement, and survivor pension — Segurança Social
14. [14]
    Death Desk Guide (Guia do Espaço Óbito): confirmation of heirs and post-death procedures — Justiça.gov.pt (IRN)
15. [15]
    Tax obligations on property transfers upon death (Stamp Duty by the end of the 3rd month) — Gov.pt / Autoridade Tributária e Aduaneira
16. [16]
    Survivor Pension (Pensão por Morte): rules and application on Meu INSS — Instituto Nacional do Seguro Social (Gov.br)