Terminal Illness & End-of-Life Administration in Belgium: 5-Step Official Checklist

1. 1

   Coordinate Palliative Care, Home Support Teams, and the Palliative Lump-Sum Allowance

   In Belgium, setting up palliative support at home or in a specialist unit is coordinated with the general practitioner (médecin généraliste / huisarts) - or the hospital specialist in liaison with the hospital social service - and the patient's health insurance fund (mutualité / ziekenfonds), within the framework of the Institut national d'assurance maladie-invalidité (National Institute for Health and Disability Insurance - INAMI / RIZIV) [1][2]:

   • Palliative status and home palliative allowance (forfait palliatif / palliatief forfait): when the ill person is cared for at home and meets the medical criteria for palliative status, the attending physician completes the official notification form for the advising physician (médecin-conseil / adviserend arts) of the health insurance fund [1][2]. This status grants entitlement to the palliative lump-sum allowance (awarded for a 30-day period and renewable once, to cover medication, care supplies, and medical equipment) as well as the abolition of patient co-payments (ticket modérateur / remgeld) for GP home visits, home nursing care, and certain physiotherapy sessions [1][2].
   • Home support teams and inpatient palliative units: multidisciplinary second-line support teams assist the GP and home nurses at the patient's home, while residential palliative care units (unités de soins palliatifs) admit patients when care at home is no longer possible [2][3]. Depending on the region, you can locate the appropriate network or mobile team through the Fédération Wallonne des Soins Palliatifs in Wallonia [2][3], the Fédération bruxelloise pluraliste de soins palliatifs et continus in Brussels [4], or Palliatieve Zorg Vlaanderen in Flanders [5].
2. 2

   Draft and Register Written Advance Directives and the Care Plan

   As long as the ill relative is an adult and capable of expressing their wishes, they can formalise their medical preferences in writing as part of Advance Care Planning (which is reimbursed during a consultation with the general practitioner) [1][6]:

   • Negative advance directive on healthcare (déclaration anticipée négative de soins / negatieve wilsverklaring under the Patients' Rights Act): the patient can record in writing specific medical examinations or treatments that they refuse (such as cardiopulmonary resuscitation, mechanical ventilation, or artificial nutrition) in case they become unable to express their wishes, and appoint a healthcare proxy (mandataire) or trusted support person (personne de confiance) to uphold their rights with healthcare providers [6]. This directive is legally binding on practitioners and should be given to the GP for inclusion in the medical file.
   • Advance directive on euthanasia (déclaration anticipée relative à l'euthanasie): drafted according to the statutory template in the presence of two adult witnesses (at least one of whom has no material interest in the patient's death), this applies solely if a patient suffering from a serious and incurable condition falls into a state of irreversible unconsciousness (such as an irreversible coma) [6][7]. Following the April 2020 reform, advance directives drawn up or renewed after that date have unlimited validity and can be registered free of charge with the municipal administration (administration communale / gemeentebestuur) in the national database of the SPF Santé publique (Federal Public Service Health, Food Chain Safety and Environment) [6][7].
3. 3

   Execute an Extrajudicial Protection Mandate and Review Bank Powers of Attorney

   An ordinary bank power of attorney may prove insufficient for major asset management transactions or may be challenged if mental incapacity occurs. While your relative retains full legal capacity, they can draw up an extrajudicial protection mandate (mandat de protection extrajudiciaire / zorgvolmacht) with the assistance of a notary via the Fédération Royale du Notariat Belge (Royal Federation of Belgian Notaries - Fednot) [8][9]:

   • Financial and personal scope: the grantor (mandant) appoints one or more trusted representatives (mandataires) to manage bank accounts, income, and movable or immovable property and, if desired, to make personal welfare decisions (such as choosing a care residence or exercising patient rights) without having to apply immediately for judicial administration before the justice of the peace (juge de paix / vrederechter) [8][9].
   • Mandatory registration: to remain effective after the grantor loses decision-making capacity, the mandate must be registered in the Central Register of Mandate Contracts (Registre central des contrats de mandats) via a notary or the registry of the justice of the peace [8][9].
4. 4

   Access Statutory Palliative Care Leave and Informal Caregiver Leave

   Employed relatives or civil servants caring for the ill person can apply for a full suspension or a reduction of working hours with a replacement allowance from the Office national de l'Emploi (National Employment Office - ONEM / RVA) [10][11]:

   • Palliative care leave (congé pour soins palliatifs, Info Sheet T20): any employee may take a complete career break or reduce their working hours (by half or by one-fifth) for 1 month, which can be extended twice by 1 month (up to 3 months in total per patient) [10][11]. The employee provides their employer with a certificate issued by the patient's attending physician and submits an allowance application to the Office national de l'Emploi [10][11].
   • Informal caregiver leave (congé pour aidants proches, Info Sheet T164): after obtaining official recognition as an informal caregiver (reconnaissance de la qualité d'aidant proche with social rights) from their health insurance fund (mutualité), an employee can apply for thematic caregiver leave compensated by the Office national de l'Emploi [10][12].
5. 5

   Organise the Will, Pensions, Unblocking of Bank Accounts, and Inheritance Tax Declaration

   Gathering essential documents ahead of time simplifies the legal and administrative steps that follow a death:

   • Will and funeral preferences: a will (holographic or notarial) can be registered in the Central Register of Wills (Registre central des testaments) through a notary of the Fédération Royale du Notariat Belge [8][13], and the ill relative can also register their last wishes regarding burial or cremation (dernières volontés) with their municipality.
   • Survivor's pension (pension de survie) and health insurance fund: for employees and civil servants, the Service fédéral des Pensions (Federal Pensions Service - SFP, reachable via the Pension Line at 1765 or on MyPension.be) automatically examines entitlement to a survivor's pension (or transitional allowance, allocation de transition) if the deceased was already receiving a pension; if the deceased was still working, an application should preferably be submitted within 12 months of death [14]. Beneficiary clauses on life insurance and group insurance policies should also be reviewed.
   • Freezing and unblocking of bank accounts: as soon as a bank is notified of a death, the deceased's accounts and safe-deposit boxes are frozen [15]. Unblocking them requires either a free certificate of inheritance (certificat d'hérédité) issued by a Legal Certainty office (bureau Sécurité juridique) of the SPF Finances (available only for straightforward estates with no will, no marriage contract, and no legally incapacitated heir) or a notarial deed of inheritance (acte d'hérédité) drawn up by a notary [8][15]. Before full unblocking, the bank can release funds to pay funeral expenses as well as a capped statutory advance for the surviving spouse or legal cohabitant [15].
   • Inheritance tax declaration (déclaration de succession / aangifte van nalatenschap): when a death occurs in Belgium, heirs have a statutory deadline of 4 months from the date of death to file the inheritance tax declaration with the SPF Finances (for Wallonia and the Brussels-Capital Region) or the Flemish Tax Administration VLABEL (for Flanders) [16].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Financial support for palliative patients cared for at home (palliative lump-sum allowance) — Institut national d'assurance maladie-invalidité (INAMI)
2. [2]
   Palliative care in Wallonia, palliative allowance, and official forms — Fédération Wallonne des Soins Palliatifs (FWSP)
3. [3]
   Home palliative care support teams and regional networks in Wallonia — Fédération Wallonne des Soins Palliatifs (FWSP)
4. [4]
   Palliative and continuing care in the Brussels-Capital Region — Fédération bruxelloise pluraliste de soins palliatifs et continus (FBSP-BFPZ)
5. [5]
   Networks and organisations for palliative care in Flanders — Palliatieve Zorg Vlaanderen
6. [6]
   Advance directive on euthanasia and patient rights — Portail fédéral Belgium.be / SPF Santé publique
7. [7]
   Drafting and municipal registration of an advance directive on euthanasia — Portail fédéral Belgium.be
8. [8]
   Inheritance, certificate of inheritance, and deed of inheritance in Belgium — Fédération Royale du Notariat Belge (Notaris.be)
9. [9]
   Extrajudicial protection mandate and the Central Register of Mandate Contracts — Fédération Royale du Notariat Belge (Notaris.be)
10. [10]
    Palliative care leave and thematic career break leaves — Office national de l'Emploi (ONEM)
11. [11]
    Info Sheet T20: Palliative care leave (Congé pour soins palliatifs) — Office national de l'Emploi (ONEM)
12. [12]
    Informal caregiver leave (recognition by the health insurance fund and ONEM allowances) — Office national de l'Emploi (ONEM)
13. [13]
    Drafting and registering a will in Belgium — Fédération Royale du Notariat Belge (Notaire.be)
14. [14]
    Survivor's pension and formalities following a death — Service fédéral des Pensions (SFP)
15. [15]
    Unblocking a bank account after a death: certificate or deed of inheritance — Portail fédéral Belgium.be / SPF Finances
16. [16]
    Inheritance tax declaration (déclaration de succession) and statutory deadlines in Belgium — Portail fédéral Belgium.be / SPF Finances