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

1. 1

   Activating Home or Hospital Palliative Care

   • Coordination through Primary Healthcare: Within the public network of the Ministry of Public Health (MINSAP), continuous care for patients with advanced chronic or oncological conditions is anchored at the neighborhood Family Doctor and Nurse Office (Consultorio del Médico y Enfermera de la Familia), working closely with the multidisciplinary team of the community polyclinic [1] [5].
   • Home hospitalization (ingreso en el hogar) and pain management: When clinical needs allow the ill person to remain at home, the family doctor can activate home hospitalization, coordinating regular home visits, specialist consultations in internal medicine, geriatrics, or oncology from the polyclinic, and controlled prescriptions for opioid analgesics and palliative medications dispensed through the designated municipal pharmacy [1] [5].
   • Referral to hospital units and specialized oncology services: If refractory symptoms or acute complications arise that cannot be managed at home, the attending physician arranges referral to the provincial clinical-surgical hospital or specialized institute for inpatient stabilization and symptom control under the universal coverage of the National Health System [2] [5].
   • Controlled medication cards and medical diets: The family should ask the attending physician to update the medical certificates for regulated medications (tarjetón de medicamentos) and special medical diets, which are then registered at the local pharmacy and the municipal consumer registry office (OFICODA) [2] [5].
2. 2

   Advance Medical Directives and Healthcare Proxy Designation

   • Patient autonomy and informed consent: Cuban health legislation and the Family Code (Código de las Familias) recognize the right of every person with decision-making capacity to receive clear medical information regarding diagnosis, prognosis, and treatment options, and to accept or refuse invasive medical procedures or disproportionate life-sustaining measures [2] [4] [5].
   • Notarial deeds of self-protection and advance directives: While the ill person retains full mental capacity, they may appear before a State Notary (Notaría Estatal) of the Ministry of Justice (MINJUS) to execute a public deed of self-protection (escritura de autoprotección) or advance manifestation of will. In this notarial instrument, the person can record care preferences, preferred place of care, refusal of therapeutic obstinacy, and the designation of a trusted representative to communicate with the medical team if the patient later becomes unable to express decisions directly [2] [4].
   • Filing with the healthcare team: Once executed before the notary, certified copies should be kept at home and provided to the family doctor and attending specialist of the Ministry of Public Health (MINSAP) for inclusion in both outpatient and hospital medical records [4] [5].
3. 3

   Notarial Powers of Attorney and Preventive Banking Mandates

   • Executing a general or special power of attorney before a notary: To prevent administrative bottlenecks if mobility declines, it is important to visit a State Notary of the Ministry of Justice (MINJUS) in the municipality of residence to execute a Special Power of Attorney (Poder Especial) or General Power of Administration (Poder General de Administración) in favor of a trusted family member [2] [4].
   • Notary visit to the home or hospital: If the ill person has severe mobility limitations but retains full mental capacity and ability to communicate, family members may request that the state notary travel to the residence or hospital to verify the grantor's capacity in person and authorize the public deed on site, supported by a current medical certificate when required [2] [4].
   • Scope of financial and administrative authority: The power of attorney should explicitly detail authority to represent the principal before Cuban banks (Banco Popular de Ahorro, BANDEC, or Banco Metropolitano), collect pensions or stipends, conduct housing registry procedures, manage utility contracts, and appear before public agencies [2] [4].
   • Bank account authorizations and beneficiaries: Alongside a notarial power of attorney, the family should check directly with the relevant bank branch regarding internal procedures to register authorized signatures or designate account beneficiaries on savings accounts and term deposits while the account holder is able to sign [2].
4. 4

   Disability Benefits, Social Assistance, and Caregiver Support

   • Sickness subsidies and total or partial disability pensions: If the ill person is employed, the attending physician issues a temporary medical incapacity certificate to claim sickness benefits. When the illness causes permanent loss of working capacity, the patient is referred to the Medical-Labor Expertise Commission (Comisión de Peritaje Médico Laboral) to certify disability and process a disability pension through the municipal branch of the National Social Security Institute (INASS), under the Ministry of Labor and Social Security (MTSS) [3] [5].
   • Social Assistance benefits and home care support: For households facing economic vulnerability or severe dependency, the Municipal Directorate of Labor and Social Security of the Ministry of Labor and Social Security (MTSS) evaluates, through social workers, eligibility for temporary monetary assistance, material resources, or caregiver support programs [2] [3].
   • Employment leave for family caregivers: Cuban labor regulations allow employed family members to request unpaid care leave or justified schedule adjustments from their employer to provide direct care for a seriously ill relative, supported by official medical documentation [3].
5. 5

   Preventive Will Review and Document Preparation

   • Executing or updating an open notarial will: While full legal capacity is intact, executing an open notarial will (testamento abierto) before a State Notary of the Ministry of Justice (MINJUS) is the most reliable and straightforward way to govern the transfer of the family home, vehicles, bank accounts, and personal property, avoiding a subsequent intestate declaration of heirs proceeding [2] [4].
   • Rules on specially protected heirs (herederos especialmente protegidos): Under the Cuban Civil Code and Family Code, the notary will verify whether specially protected heirs exist (minor or disabled children or descendants, spouse or registered domestic partner, or economically dependent ascendants who are unable to work), for whom the law reserves half of the estate as a mandatory share [2] [4].
   • Reviewing property deeds and civil registry records: The family should gather and inspect the home ownership title (título de propiedad de la vivienda) to confirm registration in the Property Registry and verify that no spelling or boundary errors exist, along with vehicle registration certificates, bank passbooks, and birth or marriage certificates of future heirs [2] [4].
   • Coordinating with heirs or assets abroad: If future heirs reside outside Cuba, it is advisable to verify that their Cuban birth or marriage certificates are free of clerical errors and to review the legalization requirements before the Ministry of Foreign Affairs (MINREX) and the relevant Cuban consulate so future estate representation proceeds smoothly [2] [4].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Medical Records and Health Statistics Regulations in Primary and Hospital Care — Ministerio de Salud Pública de Cuba - Dirección Nacional de Registros Médicos y Estadísticas de Salud
2. [2]
   Citizen Services and Procedures: Notarial Services, Registries, and Public Assistance — Presidencia y Gobierno de la República de Cuba
3. [3]
   Social Security Procedures, Medical Expertise, and Social Assistance — Ministerio de Trabajo y Seguridad Social (MTSS)
4. [4]
   Official Portal of the Ministry of Justice: Notarial Services and Public Registries — Ministerio de Justicia de la República de Cuba (MINJUS)
5. [5]
   Official Portal of the Ministry of Public Health: Primary Healthcare and Medical Assistance — Ministerio de Salud Pública de la República de Cuba (MINSAP)