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

1. 1

   Organizing Palliative Care and Cross-Border Healthcare Coordination

   • Spain: Access to palliative care is arranged through the primary care physician or hospital specialist within the National Health System (Sistema Nacional de Salud - SNS), who refers the patient to hospital palliative care units or home palliative support teams (Equipos de Soporte de Atención Domiciliaria - ESAD) in their autonomous community, supported by the care directory of the Spanish Society for Palliative Care (Sociedad Española de Cuidados Paliativos - SECPAL) and the coordination of the Ministerio de Sanidad (Spanish Ministry of Health) [1].
   • France: Palliative care is delivered through hospital-at-home care (Hospitalisation à domicile - HAD), mobile palliative care teams (équipes mobiles de soins palliatifs - EMSP), and specialized inpatient palliative care units (unités de soins palliatifs - USP), with official guidance and directories maintained by the Centre national des soins palliatifs et de la fin de vie (CNSPFV, National Center for Palliative and End-of-Life Care via its Parlons Fin de Vie portal) and the French Society for Support and Palliative Care (Société Française d'Accompagnement et de Soins Palliatifs - SFAP) [2]. For patients insured under the French system with a serious or progressive illness, the attending physician applies to Assurance Maladie (French National Health Insurance) for exempting long-term illness status (Affection de Longue Durée exonérante - ALD), which covers 100% of medical and palliative costs linked to the condition under French statutory tariffs [3]. If a medical transfer between Spain and France is considered, verify coverage beforehand using the European Health Insurance Card (temporary stays), portable document S1 (resident pensioners), or prior authorization S2 for scheduled care.
2. 2

   Executing Advance Directives in Both Countries (*Instrucciones Previas* and *Directives Anticipées*)

   While the patient retains full legal capacity, separate advance directive documents should be executed in both countries, as national clinical registries do not cross-reference each other automatically.

   • Spain: Your family member can execute an Advance Directive Document (Documento de Instrucciones Previas or Voluntades Anticipadas, commonly known as a Living Will or Testamento Vital, governed by Law 41/2002) before a notary, before authorized regional registry staff, or before witnesses in accordance with the legislation of their autonomous community [1]. Once registered in the regional registry (Registro Autonómico), the document is integrated into the National Registry of Advance Directives (Registro Nacional de Instrucciones Previas - RNIP) of the Ministerio de Sanidad so that physicians at any hospital in Spain can consult it [1].
   • France: Under the Claeys-Leonetti Act (loi Claeys-Leonetti), any adult can draft written advance medical directives (directives anticipées regarding the limitation or withdrawal of end-of-life treatments) and designate in writing a trusted person (personne de confiance) to be consulted first by the medical team if the patient can no longer express their wishes [2][4]. These documents can be stored in the French digital health record (Mon espace santé) and provided to the attending physician or hospital in accordance with the guidance on Service-Public.fr (the official French public administration portal) [4].
3. 3

   Preventive Powers of Attorney, Bank Mandates, and *Mandat de Protection Future*

   A power of attorney granted in Spain generally does not allow direct operation of bank accounts or property sales in France without apostille, sworn translation, or notarial equivalence formalities, and vice versa. Separate instruments should therefore be executed in both states while full legal capacity remains.

   • Spain: It is advisable to execute a public deed before a notary (through the General Council of Notaries, Consejo General del Notariado) granting a Preventive Power of Attorney (Poder Preventivo, or a general power of attorney with an express subsistence clause in the event of future incapacity or support needs), enabling the appointed representative to manage bank accounts, real estate, and tax affairs in Spain without awaiting a court order [1].
   • France: For everyday management of accounts at French banks, a bank power of attorney (procuration bancaire) should be signed directly with each French financial institution. In addition, to prepare for a potential loss of physical or mental capacity, the patient can execute a future protection mandate (Mandat de protection future), either by registered private deed (sous seing privé) or - preferably where real estate or complex assets are involved - by notarial deed before a French notary (Notaires de France), in accordance with the rules detailed on Service-Public.fr [4].
4. 4

   Fast-Track Dependency Benefits, Employment Leave, and Caregiver Support

   Both countries provide fast-track dependency procedures and statutory employment leave for family caregivers.

   • Spain: An urgent dependency assessment (valoración urgente de la situación de dependencia under Law 39/2006, coordinated by IMSERSO and regional social services) can be requested to access home care or care-linked financial benefits. In addition, the Workers' Statute (Estatuto de los Trabajadores) provides paid employment leave for serious illness or hospitalization of family members, as well as the right to reduced working hours (reducción de jornada) or unpaid caregiver leave (excedencia) for direct care of a dependent relative [5].
   • France: Employees in France accompanying a relative in an advanced or terminal phase of a serious, incurable illness are entitled to family solidarity leave (congé de solidarité familiale of up to 3 months, renewable once), as detailed on Service-Public.fr [6]. During this leave or when switching to part-time work, the caregiver can apply to the primary health insurance fund (Caisse primaire d'assurance maladie - CPAM, via Assurance Maladie) for the Daily End-of-Life Accompaniment Allowance (Allocation journalière d'accompagnement d'une personne en fin de vie - AJAP), which pays a daily benefit for up to 21 days (or 42 days when working part-time) [3]. For individuals aged 60 or over in France experiencing a sudden loss of autonomy, the Personalized Autonomy Allowance can also be requested on an emergency basis (Allocation personnalisée d'autonomie - APA en urgence) from the departmental council (Conseil départemental).
5. 5

   Aligning Wills, Survivor Pensions, and Post-Death Formalities

   Coordinating wills, life insurance policies, and bank accounts in advance between Spain and France avoids conflicts between forced heirship rules in both countries under the EU Succession Regulation (Regulation (EU) No 650/2012).

   • Testamentary coordination: Review testamentary dispositions with a notary in Spain (Consejo General del Notariado) and a notary in France (Notaires de France), assessing whether to include an express choice of national law governing the succession (professio iuris) and checking beneficiary designations on life insurance policies (assurance-vie in France) [4].
   • Post-death procedures in Spain: Following death, applications are submitted to the Instituto Nacional de la Seguridad Social (INSS) (Spanish National Institute of Social Security) for the death grant (auxilio por defunción) and widowhood or orphan pensions (pensiones de viudedad u orfandad) [5][7]. Once 15 working days have passed since the death, the Certificate of the General Registry of Last Wills (Certificado del Registro General de Actos de Última Voluntad, Ministry of Justice Modelo 790) is requested to execute the inheritance deed before a notary, and the Inheritance and Gift Tax self-assessment (Impuesto sobre Sucesiones y Donaciones) is filed within the general 6-month period from death [5][7].
   • Post-death procedures in France: In France, eligible dependents or beneficiaries can claim the lump-sum death benefit (capital décès) from the Caisse primaire d'assurance maladie (CPAM, via the Ameli.fr portal of Assurance Maladie) if the deceased contributed to the general scheme, as well as survivor pensions (pensions de réversion) from the pension funds (Assurance Retraite / CNAV and the Agirc-Arrco supplementary scheme) [8]. Estate administration in France (including the deed of heirship or acte de notoriété and the French inheritance tax return) is normally handled by a French notary (Notaires de France) [4][8].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   National Registry of Advance Directives and Living Wills (Registro Nacional de Instrucciones Previas - RNIP) — Ministerio de Sanidad
2. [2]
   Advance Directives and End-of-Life Support (Les directives anticipées et l'accompagnement de la fin de vie) — Centre national des soins palliatifs et de la fin de vie (Parlons Fin de Vie)
3. [3]
   Daily End-of-Life Accompaniment Allowance (Allocation journalière d'accompagnement d'une personne en fin de vie - AJAP) — Assurance Maladie (ameli.fr)
4. [4]
   Advance Directives: Final Wishes on End-of-Life Care (Directives anticipées : dernières volontés sur les soins en fin de vie) — Service-Public.fr
5. [5]
   Death Grant and Family Benefits (Auxilio por defunción y prestaciones familiares) — Instituto Nacional de la Seguridad Social (INSS)
6. [6]
   Family Solidarity Leave for Private-Sector Employees (Congé de solidarité familiale pour un salarié du secteur privé) — Service-Public.fr
7. [7]
   Widowhood Pension and Death and Survivor Benefits (Pensión de viudedad y prestaciones por muerte y supervivencia) — Instituto Nacional de la Seguridad Social (INSS)
8. [8]
   Death of a Relative: The Lump-Sum Death Benefit (Décès d'un proche : le capital décès) — Assurance Maladie (ameli.fr)