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

1. 1

   Activating Palliative Care and Home Care in the Health System

   • Pain Control and Palliative Care Clinic Network (CCSS): In Costa Rica, the Costa Rican Social Security Fund (CCSS) operates the National Center for Pain Control and Palliative Care alongside regional hospital and health-area palliative clinics overseen by the Ministry of Health of Costa Rica [1] [2]. The treating physician at the local EBAIS clinic, public hospital, or private practice must issue a formal medical referral with the clinical and histopathological summary so the patient can enter the interdisciplinary program for symptom management, nutritional support, and opioid analgesia [1] [2].
   • Home visits and medical equipment loans: When the clinical condition limits mobility, palliative care teams within the Costa Rican Social Security Fund (CCSS) and accredited palliative care foundations registered with the National Council of Palliative Care under the Ministry of Health of Costa Rica coordinate home medical visits as well as the loan of hospital beds, oxygen concentrators, and wheelchairs [1] [2].
   • Accessing the Single Digital Health Record (EDUS): Families should ensure that the ill person or their authorized representative has active access to the EDUS mobile and web application maintained by the Costa Rican Social Security Fund (CCSS) and request certified copies of the clinical chart to support pension, leave, and insurance procedures [1].
2. 2

   Advance Directives, Informed Consent, and Healthcare Proxy

   • Patient rights and clinical directives: Under Law No. 8239 on the Rights and Duties of Users of Public and Private Health Services overseen by the Ministry of Health of Costa Rica, every patient with intact decision-making capacity has the right to receive clear information regarding their diagnosis and prognosis and to accept or refuse disproportionate medical or surgical interventions, recording these instructions in their clinical file at the Costa Rican Social Security Fund (CCSS) or private hospital [1] [2].
   • Notarial declaration of advance medical directives: To give clear legal standing to end-of-life care preferences and designate a trusted family member or representative to communicate with the medical team if the patient later loses the ability to express wishes, the ill person may execute a sworn declaration or advance directive by public deed before a Costa Rican Public Notary [2] [4].
3. 3

   Executing Notarial Powers of Attorney and National Registry Registration

   • Plenary power of attorney (poder generalísimo) or special mandate: While the ill person retains intact legal capacity, it is a priority to execute before a Public Notary either a special power of attorney (for specific acts) or a general or plenary power of attorney (poder generalísimo, with or without a monetary limit, governed by Article 1253 of the Costa Rican Civil Code) [4]. Unlike special powers, every general or plenary power of attorney must be registered in the Persons Registry of the National Registry of Costa Rica (RNP Digital) in order to take legal effect before third parties, banks, and public agencies [4].
   • Autonomy safeguards (Law No. 9379): In addition, to prepare for any potential future cognitive impairment, Costa Rican law permits individuals to record preventive support arrangements in a public deed before a Public Notary [4].
   • Bank account authorizations and signature registration: Because public and private banks in Costa Rica verify online whether a power of attorney is registered with the National Registry of Costa Rica (RNP Digital), once the mandate is recorded, the attorney-in-fact should visit each financial institution to register their signature on the principal's accounts [3] [4].
4. 4

   Disability Benefits and Paid Caregiver Leave (Law No. 7756)

   • Paid leave and subsidy for family caregivers of terminally ill patients (Law No. 7756): Costa Rica provides a dedicated statutory benefit under Law No. 7756 on Benefits for Caregivers of Terminally Ill Patients [1]. Once the treating physician certifies that the patient is in a terminal phase, an employed worker (a family member or trusted person designated by the patient as primary caregiver) may apply through the medical facility of the Costa Rican Social Security Fund (CCSS) for special caregiver leave with a wage-replacement subsidy (renewable every 30 days) to care for the patient while preserving job security [1].
   • Temporary disability and invalidity pension (IVM Regime): If the ill person is an active contributor, they may claim sickness benefits and, in the event of a permanent loss of at least two-thirds of general working capacity, apply for an Invalidity Pension under the Disability, Old Age, and Death (IVM) regime administered by the Costa Rican Social Security Fund (CCSS), as well as review supplementary benefits with their pension operator overseen by the Superintendence of Pensions (SUPEN) [1] [3].
5. 5

   Preventive Review of Wills, Account Beneficiaries, and Property Records

   • Executing an open or closed will before a Public Notary: Costa Rican civil law recognizes testamentary freedom, subject only to the statutory obligation to secure maintenance support (pensión alimentaria) for minor or disabled children, a surviving spouse, or economically dependent parents [4]. While retaining full mental capacity, the ill person may execute an open will by public deed before a Public Notary and three witnesses (or a closed will), which the notary must report and file with the National Archives (Archivo Nacional) for official custody [4].
   • Direct beneficiary designations on bank accounts and pensions (ROP / FCL): One of the most practical preventive steps in Costa Rica is updating in-life beneficiary designations on all bank accounts, certificates of deposit, National Insurance Institute (INS) policies, and supplementary pension contracts supervised by the Superintendence of Pensions (SUPEN) [3]. Funds held in bank accounts or ROP and FCL pension accounts with a named beneficiary are released directly to the designated beneficiaries without being frozen in civil probate [3].
   • Property registry review and international Apostille: Families should verify the title status of real estate and vehicles on the portal of the National Registry of Costa Rica (RNP Digital), as well as civil status records with the Supreme Electoral Tribunal (TSE) [4] [5]. If assets or relatives are located abroad, powers of attorney or public documents can be legalized by Apostille through the Ministry of Foreign Affairs and Worship [4] [5].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Health Services, Palliative Care, Law No. 7756 Caregiver Leave, and IVM Regime — Caja Costarricense de Seguro Social (CCSS)
2. [2]
   Health Governance, National Council of Palliative Care, and Patient Rights — Ministerio de Salud de Costa Rica
3. [3]
   Consultation of Pension Operators and Beneficiary Designations (ROP and FCL) — Superintendencia de Pensiones (SUPEN)
4. [4]
   Online Services - Persons Registry (Powers of Attorney) and Real Estate Registry — Registro Nacional de Costa Rica (RNP Digital)
5. [5]
   Civil Registry Certifications and Identification Procedures — Tribunal Supremo de Elecciones (TSE) de Costa Rica