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

1. 1

   Coordinate Specialist Palliative Care and Home Care Services

   The first step should be coordinated with the attending medical team or the hospital where the ill person receives treatment:

   • Public healthcare network (Sistema Único de Saúde, SUS): Within the SUS, the National Palliative Care Policy (Política Nacional de Cuidados Paliativos) of the Ministério da Saúde (Ministry of Health) integrates pain control, relief of physical symptoms, and psychosocial support across the public network [1]. When the ill person has mobility limitations and needs frequent clinical follow-up at home, the primary care team (Unidade Básica de Saúde, UBS) or the hospital team (at discharge) can refer them to the Melhor em Casa program (Home Care Service, Serviço de Atenção Domiciliar), run by multidisciplinary teams providing free clinical care at home [1].
   • Private health insurance (saúde suplementar): If care is provided through a private health plan or private hospital network, the family should request an individualized palliative care or home care (internação domiciliar) plan from the medical team, and may consult technical standards published by the National Academy of Palliative Care (Academia Nacional de Cuidados Paliativos, ANCP) [1].
2. 2

   Formalize Advance Directives of Will (Living Will)

   While the ill person is lucid and has full civil capacity, they can record in writing their Advance Directives of Will (Diretivas Antecipadas de Vontade, commonly known as a Living Will or Testamento Vital), regulated by Resolution CFM No. 1,995/2012 (Resolução CFM n.º 1.995/2012) of the Conselho Federal de Medicina (Federal Council of Medicine) [2]:

   • Medical record registration (prontuário médico): This document states the medical treatments and procedures the ill person accepts or refuses (such as cardiopulmonary resuscitation, invasive mechanical ventilation, or artificial feeding) should they become unable to express their wishes autonomously [2]. The ill person can ask their attending physician directly to record these directives in the medical chart (where they are binding on the clinical team) and designate a trusted representative to communicate with healthcare professionals [2].
   • Public deed at a Civil Law Notary (Cartório de Notas): For greater legal certainty and easier access by hospitals and relatives, the ill person can also execute a Public Deed of Advance Directives of Will (Escritura Pública de Diretivas Antecipadas de Vontade) at a Cartório de Notas or 100% digitally via videoconference through the e-Notariado platform, administered by the Colégio Notarial do Brasil (Notarial College of Brazil) [3].
3. 3

   Execute a Public Power of Attorney for Financial, Property, and Healthcare Management

   To prevent day-to-day financial and administrative management from becoming blocked if the illness progresses to an inability to communicate or travel, the ill person should grant a Public Power of Attorney (Procuração Pública) while retaining full civil capacity [3]:

   • In-person or digital execution: The deed is drawn up in person at any Cartório de Notas or electronically via the e-Notariado portal of the Colégio Notarial do Brasil (or at a Brazilian Consulate abroad if the person resides outside Brazil) [3].
   • Specific powers and bank registration: In the public deed, specify express powers to operate bank accounts, manage investments, pay medical expenses, represent the principal before public bodies (such as the Instituto Nacional do Seguro Social and the Receita Federal), and administer real estate [3]. Because many Brazilian banks require periodic updates of powers of attorney or prior branch registration, the appointed attorney-in-fact (procurador) should present the Procuração Pública directly to the bank immediately after issuance to validate operational access.
4. 4

   Apply for Incapacity Benefits, Income Tax Exemption, and FGTS Withdrawal

   Several statutory social security, tax, and labor fund entitlements apply when a serious or terminal illness prevents work or requires ongoing care [4][5][6]:

   • INSS incapacity benefits and 25% care supplement: When the illness prevents working, the ill person (or their legal representative) should apply for temporary incapacity benefit (auxílio por incapacidade temporária) or permanent incapacity retirement (aposentadoria por incapacidade permanente) with the Instituto Nacional do Seguro Social (INSS, National Social Security Institute) via the Meu INSS portal/app or by calling 135 [4]. For listed severe illnesses (such as malignant neoplasm, severe heart or liver disease, Parkinson's disease, or irreversible paralysis), the 12-contribution waiting period (carência) is waived [4]. If a retiree receiving permanent incapacity retirement requires permanent assistance from another person for daily activities, the law provides a 25% supplement (acréscimo de 25%) to the benefit subject to medical examination [4].
   • Income Tax exemption (isenção de Imposto de Renda): Retirees and pensioners diagnosed with a qualifying severe illness under Law No. 7,713/1988 are entitled to exemption from Individual Income Tax (Imposto de Renda) on their pension income, requested through the Instituto Nacional do Seguro Social and regulated by the Receita Federal (Federal Revenue Service of Brazil) upon submission of a medical report containing the ICD (CID) code and physician's stamp [5].
   • Full FGTS withdrawal: Finally, an account holder (or their dependent) in a terminal stage of life or with a qualifying severe illness can request full withdrawal of the Severance Indemnity Fund (Fundo de Garantia do Tempo de Serviço, FGTS) directly in the FGTS app of the Caixa Econômica Federal, attaching the Medical Report of Severe Illness (Relatório Médico de Doenças Graves) signed by the attending physician [6].
5. 5

   Organize the Will, Social Security Dependents, Vital Documents, and Funeral Directives

   While still living and capable, it is advisable to organize estate documents, beneficiary designations, and funeral instructions to prepare for post-death procedures in Brazil:

   • Will, beneficiaries, and INSS dependents: Verify whether a public will (testamento público) exists (or execute one at a Cartório de Notas if the person wishes to dispose of the available portion of their estate), update beneficiary designations on life insurance and private pension plans (VGBL/PGBL), and gather updated birth or marriage certificates, ID documents (RG and CPF), insurance policies, and bank statements in an accessible place [3][4]. Also confirm the registration of legal dependents in Meu INSS to facilitate future survivor's pension (Pensão por Morte) claims with the Instituto Nacional do Seguro Social [4].
   • Funeral wishes and 2-month estate inventory deadline: Recording preferences regarding burial or cremation (which in Brazil requires an express lifetime declaration witnessed by two witnesses under local rules, plus a death certificate signed by two physicians in cases of natural death) helps the family coordinate municipal or private funeral services smoothly. After death, the heirs have a statutory deadline of two months (60 days) from the date of death to open judicial or extrajudicial estate inventory proceedings (inventário judicial ou extrajudicial) at a Cartório de Notas, avoiding state penalties on the Estate and Gift Tax (Imposto sobre Transmissão Causa Mortis e Doação, ITCMD) [3].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Melhor em Casa Home Care Program and Palliative Care in the Unified Health System (SUS) — Ministério da Saúde (gov.br)
2. [2]
   CFM Resolution No. 1,995/2012 - Patients' Advance Directives of Will — Conselho Federal de Medicina (CFM)
3. [3]
   Electronic Notarial Acts: Public Power of Attorney and Living Will on e-Notariado — Colégio Notarial do Brasil
4. [4]
   Permanent Incapacity Benefit and Social Security Services (Meu INSS) — Instituto Nacional do Seguro Social (gov.br)
5. [5]
   Individual Income Tax Exemption for Persons with Severe Illness — Receita Federal do Brasil (gov.br)
6. [6]
   FGTS Withdrawal Due to Severe Illness or Terminal Stage of Life — Caixa Econômica Federal