Terminal Illness & End-of-Life Planning in Bolivia: 5-Step Official Checklist

1. 1

   Activating Palliative Care and Health System Coverage

   • Coordination under the Single Health System (SUS) or Health Funds: The treating medical team at a secondary or tertiary hospital must issue a formal referral to the pain management and palliative care unit in accordance with the clinical guidelines of the Ministry of Health and Sports of Bolivia [1]. Whether the ill person is insured through a short-term Health Fund (such as the Caja Nacional de Salud - CNS) or covered under the public Single Health System (SUS), they are entitled to controlled analgesic medication, multidisciplinary symptom management, and clinical follow-up [1].
   • Home care and symptom control: When clinical circumstances make remaining at home preferable, the family may request scheduled home medical and nursing visits from the referral healthcare facility or private insurer, together with official special prescriptions for continuous palliative pain relief [1].
   • Certified copies of medical records: It is advisable to request certified copies of the clinical history, diagnostic reports, and updated medical certificates issued under the standards of the Ministry of Health and Sports of Bolivia, as these documents will be needed for social security and notarial procedures [1].
2. 2

   Advance Medical Directives, Informed Consent, and Healthcare Proxy

   • Exercising patient rights: Under Law No. 3131 on Medical Professional Practice and healthcare regulations overseen by the Ministry of Health and Sports of Bolivia, every patient with intact decision-making capacity has the right to receive truthful clinical information, to accept or refuse invasive or disproportionate medical procedures, and to record treatment preferences in their medical chart through informed consent or treatment-refusal forms [1].
   • Notarial appointment of a healthcare representative: Although Bolivia does not maintain a centralized administrative registry for living wills, the ill person may execute a sworn declaration or express mandate by public deed before a Public Notary Office regulated by the Plurinational Notary Directorate (DIRNOPLU) [2]. This instrument allows them to designate a trusted relative or representative to communicate with the medical team and state clear preferences regarding life-sustaining treatment and end-of-life care [1] [2].
3. 3

   Executing Notarial Powers of Attorney and Banking Mandates

   • Special or general power of attorney before a Public Notary: While the ill person retains full cognitive and legal capacity, it is a priority to execute a comprehensive special or general power of attorney (poder especial o general de administración) before a Public Notary under the supervision of the Plurinational Notary Directorate (DIRNOPLU) [2]. This deed authorizes the designated representative to handle administrative procedures, represent the principal before public agencies, collect pensions or income, and manage movable or immovable property [2].
   • Bedside notarial service at home or in hospital: If the ill person has limited mobility or is hospitalized while remaining lucid, the family may request that the Public Notary attend the residence or healthcare facility in person to verify legal capacity, take the declaration of intent, and record the signature or thumbprint in accordance with Law No. 483 [2].
   • Registering powers of attorney with financial institutions (ASFI): Because Bolivian banks require explicit clauses to operate accounts or savings deposits on behalf of an account holder, the certified notarial power of attorney should be submitted directly to the legal department of each financial institution where the ill person holds accounts for prior registration and verification [2] [3].
4. 4

   Disability Benefits, Dependency Support, and Caregiver Protections

   • Disability pension and medical degree assessment: If the serious illness prevents the person from working, the insured person or their attorney-in-fact may apply for a Disability Pension (Pensión por Invalidez) through the Public Long-Term Social Security Manager (Gestora Pública) [3]. The procedure involves an assessment by the Medical Qualifying Board to determine the percentage of disability and, when constant third-party assistance is required for daily living activities, eligibility for the Severe Disability supplement (Gran Invalidez) [3].
   • Disability registration and workplace protections for family caregivers: Where a severe or very severe disability is certified by the assessment teams of the Departmental Health Services (SEDES) and the Ministry of Health and Sports of Bolivia, the family can register the patient in the National Single Registry of Persons with Disabilities (SIPRUNPCD), which provides job security protections (inamovilidad laboral) for the family caregiver or guardian, as well as access to applicable disability allowances [1] [3].
5. 5

   Preventive Review of Wills, Insurance Beneficiaries, and Estate Documents

   • Executing an open or closed will before a Notary: To prevent future disputes and organize asset distribution while respecting forced heirship shares (la legítima, which reserves four-fifths of the estate for children or descendants and two-thirds for a surviving spouse or ascendants under the Bolivian Civil Code), the ill person may execute an open or closed will before a Public Notary Office supervised by the Plurinational Notary Directorate (DIRNOPLU) in the presence of the statutory witnesses [2].
   • Updating pension and insurance beneficiaries: It is advisable to verify and update the registered beneficiary records (derechohabientes) held by the Public Long-Term Social Security Manager (Gestora Pública), as well as beneficiary designations on life insurance, health insurance, and mortgage credit life policies (seguro de desgravamen) [3].
   • Document consolidation and international Apostille: Families should gather into a secure file the valid Identity Card, birth and marriage certificates issued by the Civic Registry Service (SERECI), real property title folios (Folios Reales from Derechos Reales), and banking contracts [4]. If assets or family members are located abroad, powers of attorney or public documents intended for foreign use can be authenticated via the Digital Apostille through the Ministry of Foreign Affairs of Bolivia [5].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Ministry of Health and Sports - Single Health System and Clinical Guidelines — Ministerio de Salud y Deportes de Bolivia
2. [2]
   Plurinational Notary Directorate - Notarial Services, Powers of Attorney, and Wills — Dirección del Notariado Plurinacional (DIRNOPLU)
3. [3]
   Integral Pension System Benefits and Beneficiary Registration — Gestora Pública de la Seguridad Social de Largo Plazo
4. [4]
   Civic Registry Service (SERECI) - Civil Status and Family Certificates — Órgano Electoral Plurinacional (OEP)
5. [5]
   Consular Services and Digital Apostille for Public Documents — Ministerio de Relaciones Exteriores de Bolivia