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

1. 1

   Organize Palliative and Hospice Care in Switzerland and France and Coordinate Cross-Border Health Insurance

   First, ask the attending medical team or hospital social service to establish an interdisciplinary treatment and palliative care plan, and clarify with the competent health insurer whether care will be provided in Switzerland, in France, or across the border [1][2].

   • Palliative Care and Spitex in Switzerland: Under the guidelines of the Swiss Federal Office of Public Health (Bundesamt für Gesundheit, phone: +41 58 462 21 11) and the Healthcare Benefits Ordinance (Krankenpflege-Leistungsverordnung - KLV), mandatory basic health insurance (obligatorische Krankenpflegeversicherung - OKP) covers medically prescribed outpatient palliative nursing at home through specialized Spitex services as well as inpatient palliative care wards (subject to the annual deductible and co-payment) [1]. Regional palliative networks, mobile palliative care teams, and inpatient hospices across the cantons (such as Zurich, Geneva, Basel, or Bern) can be accessed via the Swiss Association for Palliative Medicine, Care and Support (palliative.ch - Schweizerische Gesellschaft für Palliative Medizin, Pflege und Begleitung) [1].
   • Palliative Care Structures in France and 100% Cost Coverage (ALD): In France, palliative care is delivered at home through hospital-at-home services (Hospitalisation à domicile - HAD) and mobile palliative care teams (équipes mobiles de soins palliatifs - EMSP), or on an inpatient basis in specialized palliative care units (unités de soins palliatifs - USP) [2]. Guidance on care structures is available from the French National Center for Palliative and End-of-Life Care (Centre national des soins palliatifs et de la fin de vie, phone: +33 1 53 72 33 04) and the French Society for Accompaniment and Palliative Care (Société Française d'Accompagnement et de Soins Palliatifs - SFAP) [2]. Clarvia provides directory information solely for orientation and does not endorse or rate individual providers. For severe, progressive illnesses, the attending physician in France applies for recognition as a long-term illness (Affection de Longue Durée - ALD) with the French statutory health insurance fund (Assurance Maladie, phone from France: 36 46; from abroad: +33 1 84 90 36 46), which covers illness-related medical costs at 100% of the statutory tariff [2][9]. If a transfer of care or cross-border commuter (frontalier) arrangement between Switzerland and France is planned, obtain form S1 (residence in the neighboring country) or prior authorization form S2 (planned treatment in the other state) from the health insurer in advance [1][9].
2. 2

   Execute Legally Valid Written Advance Directives in Switzerland and France While Full Capacity Remains

   To ensure that end-of-life medical decisions are respected without delay in both countries, the ill person should put their treatment wishes in writing according to each country's national requirements [3][4].

   • Advance Directive in Switzerland (Art. 370 et seq. ZGB): Any person with decision-making capacity may, pursuant to Articles 370 et seq. of the Swiss Civil Code (Zivilgesetzbuch - ZGB), specify in a written, dated, and personally signed advance directive (Patientenverfügung) which medical measures they consent to or refuse in the event of incapacity, and designate a natural person as their healthcare representative [3]. Official guidance is published on the Swiss authorities' information portal (Schweizer Portal ch.ch); recognized template forms are provided, among others, by the Swiss Medical Association (Verbindung der Schweizer Ärztinnen und Ärzte - FMH) and the Swiss Red Cross (Schweizerisches Rotes Kreuz - SRK) [1][3]. The advance directive should be handed to the family doctor or care team and uploaded to the Electronic Patient Record (Elektronisches Patientendossier - EPD); its storage location can also be recorded on the health insurance card [1][3].
   • Advance Directives and Trusted Person in France (Loi Claeys-Leonetti): For medical care in France, the ill person should draw up, date, and sign written advance directives (directives anticipées) and designate in writing a healthcare trusted person (personne de confiance), whose testimony takes priority when consulted by the medical team if the patient can no longer express their wishes [2][4]. The forms can be completed using the official template of the French Ministry of Health and stored in the digital health space (Mon espace santé) as well as in the medical file of the attending French hospital or general practitioner [4].
3. 3

   Establish Separate Financial, Care, and Representation Powers of Attorney in Switzerland and France

   A foreign power of attorney is often not readily accepted by banks, land registries, or adult protection authorities in the other country. Execute separate instruments in both jurisdictions while full decision-making and legal capacity remains [3][5]:

   • Advance Care Mandate (Art. 360 et seq. ZGB) and Bank Proxies in Switzerland: To cover personal care, financial management, and legal representation in the event of incapacity, a Swiss advance care mandate (Vorsorgeauftrag under Art. 360 et seq. ZGB) must either be handwritten in its entirety from beginning to end, dated, and signed (eigenhändiger Vorsorgeauftrag) or be publicly notarized (öffentlich beurkundet) by a notary [3]. The storage location of the Vorsorgeauftrag can be recorded with the civil registry office in the civil status register (Infostar); if incapacity occurs, the competent Child and Adult Protection Authority (Kindes- und Erwachsenenschutzbehörde - KESB, or in the Canton of Geneva the Tribunal de protection de l'adulte et de l'enfant) examines and validates the document and issues a certificate of representation to the appointed representative [3]. In addition, the ill person should sign dedicated bank powers of attorney directly with their Swiss banks (explicitly valid beyond death if desired), as banks frequently require their own internal forms for ongoing payment transactions [3].
   • Future Protection Mandate (Mandat de protection future) and Bank Proxies in France: For assets, real estate, or legal affairs in France, a future protection mandate (mandat de protection future) under French law can be executed either as a private deed (sous seing privé, countersigned or registered with the tax office) or as a notarial deed (mandat notarié) through the professional body of French notaries (Notaires de France, phone: +33 1 44 90 30 00) [5]. A notarized mandate is particularly necessary if the representative may later need to carry out major acts of disposition such as selling real estate without court guardianship proceedings (tutelle) [5]. In parallel, explicit account powers of attorney (procurations bancaires) should be set up directly with the French banks holding the accounts [5].
4. 4

   Claim Statutory Caregiver Leave, Care Allowances, and Severe Illness Benefits

   Both Swiss and French law provide financial assistance and statutory leave from work for seriously ill individuals and family caregivers [6][7]:

   • Caregiver Leave and Helplessness Allowance in Switzerland: Working relatives employed under the Swiss Code of Obligations (Obligationenrecht - OR) are entitled to paid short-term leave of up to 3 days per event and up to 10 days per year to care for a family member with a health impairment (Art. 329g OR; for seriously ill minor children, up to 14 weeks of paid care leave is available through the Loss of Earnings Compensation scheme under Art. 329i OR) [6]. If the ill person permanently requires third-party assistance or personal supervision for everyday activities, an income-independent helplessness allowance (Hilflosenentschädigung) under the AHV or IV can be claimed from the cantonal IV office or compensation office; official information leaflets are provided by the AHV/IV Information Center (Informationsstelle AHV/IV) [6]. In addition, cantons and non-profit organizations (such as the Cantonal Cancer League or the Swiss Red Cross) offer respite services for family caregivers [1][6].
   • Family Solidarity Leave (Congé de solidarité familiale), Daily Accompaniment Allowance (AJAP), and Autonomy Allowance (APA) in France: Employees in France who accompany a close relative in an advanced or terminal stage of illness may request statutory family solidarity leave (congé de solidarité familiale) from their employer for up to 3 months (renewable once) or on a part-time basis [7]. During this leave, the Caisse primaire d'assurance maladie (CPAM) under Assurance Maladie pays, upon application, the Daily End-of-Life Accompaniment Allowance (Allocation journalière d'accompagnement d'une personne en fin de vie - AJAP) for up to 21 days (or 42 days if taken part-time) [7]. For ill persons aged 60 or over residing in France, an emergency Personal Autonomy Allowance (Allocation personnalisée d'autonomie - APA en urgence) can also be requested from the departmental council (Conseil départemental) [7].
5. 5

   Align Wills, Beneficiary Designations, Bank Access, and Funeral or Repatriation Wishes Between Switzerland and France

   Because cross-border estates engage both Swiss succession law (ZGB) and French succession law alongside the EU Succession Regulation (Regulation (EU) No 650/2012, under which Switzerland is treated as a third state), early alignment prevents duplicate proceedings and frozen bank accounts [3][5][8][9]:

   • Pension Funds, AHV Survivor Pensions, and Probate in Switzerland: Review in advance the regulations of the ill person's Swiss occupational pension fund (Pensionskasse / 2nd pillar) and tied private pension (Säule 3a), and submit a written beneficiary designation (Begünstigtenordnung) to the institution if needed, as 2nd and 3rd pillar benefits are paid directly to designated beneficiaries outside the probate estate [3][8]. Following a death, survivors register claims for widow's, widower's, or orphan's pensions with the competent cantonal compensation office or, where residence or cross-border ties are abroad, with the Central Compensation Office (Zentrale Ausgleichsstelle, phone: +41 58 461 91 11) [8]. For the Swiss estate, the competent cantonal inheritance office (Erbschaftsamt) or district court (Bezirksgericht, or a notary depending on the canton) issues the certificate of inheritance (Erbenbescheinigung); note the statutory deadline of 3 months from learning of the death to renounce (Ausschlagung) an over-indebted estate under Art. 566 et seq. ZGB [3].
   • Lump-Sum Death Grant, Survivor Pensions, and Notarial Estate Settlement in France: If the deceased was insured under the French social security system, eligible survivors can apply to the Caisse primaire d'assurance maladie via Assurance Maladie for the lump-sum death benefit (capital décès) and to the basic pension fund (Assurance Retraite / CNAV) and supplementary pension fund (Agirc-Arrco) for a survivor pension (pension de réversion) [9]. Where assets or the last habitual residence are in France, estate settlement (règlement de la succession, including drafting the deed of heirship, acte de notoriété) is handled by a French notary belonging to Notaires de France; the French inheritance tax return (déclaration de succession) must be filed with the tax authorities within 6 months if the death occurred in France, or within 12 months if the death occurred outside France (for example in Switzerland) [5][9]. Finally, record in writing whether local burial or cremation in Switzerland or repatriation to France is desired, so that a licensed funeral director can apply for the international laissez-passer for a corpse (laissez-passer mortuaire) without delay when death occurs [1][5].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Palliative Care in Switzerland - Services, Strategy, and Financing — Bundesamt für Gesundheit (BAG)
2. [2]
   Palliative Care, Patient Rights, and End-of-Life Support in France (Parlons Fin de Vie) — Centre national des soins palliatifs et de la fin de vie (CNSPFV)
3. [3]
   Advance Directives (Patientenverfügung) and Advance Care Planning in Switzerland — ch.ch - Offizielles Informationsportal der Schweizer Behörden
4. [4]
   French Advance Directives and End-of-Life Trusted Person (Directives anticipées - F32010) — Service-Public.fr - Direction de l'information légale et administrative
5. [5]
   French Future Protection Mandate and Protection of Vulnerable Relatives (Mandat de protection future) — Notaires de France - Conseil supérieur du notariat
6. [6]
   Information Leaflet 6.10 - Care Allowance and AHV/IV/EO Benefits — Informationsstelle AHV/IV
7. [7]
   Family Solidarity Leave and Daily Accompaniment Allowance in France (Congé de solidarité familiale et AJAP - F1767) — Service-Public.fr - Direction de l'information légale et administrative
8. [8]
   AHV Survivor Pensions (Widow's, Widower's, and Orphan's Pensions) — Zentrale Ausgleichsstelle (ZAS)
9. [9]
   Death of a Relative: Lump-Sum Death Grant (Capital décès) and Procedures with Assurance Maladie — Assurance Maladie (ameli.fr)