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

1. 1

   Coordinating Palliative Care and Family Health Insurance Coverage

   • Referral to Pain Medicine and Palliative Care units: Ask the attending specialist for a formal referral to the Pain Medicine and Palliative Care team (Medicina del Dolor y Cuidados Paliativos) at a secondary or tertiary hospital in the Dominican Republic (such as the National Cancer Institute Rosa Emilia Sánchez Pérez de Tavares - INCART, the Dr. Heriberto Pieter Oncological Institute, or regional public hospitals operating under the guidelines of the Ministry of Public Health and Social Assistance) in order to establish an integrated outpatient or home-based symptom management plan [1].
   • Family Health Insurance coverage and catastrophic care (SISALRIL): Verify with the ill person's Health Risk Administrator (Administradora de Riesgos de Salud - ARS) the benefits covered under the Health Services Plan (Plan de Servicios de Salud - PDSS), supervised by the Superintendency of Health and Occupational Risks (Superintendencia de Salud y Riesgos Laborales - SISALRIL) [2]. The Dominican Social Security System catalog covers oncological treatments, high-cost catastrophic procedures, hospitalization, and approved adjuvant and palliative medications [2].
   • High-Cost Medications Program of the Ministry of Public Health and Social Assistance: When treatment requires specialized high-cost medications, submit the histopathological report, updated medical prescriptions, and the patient's Identity and Electoral Card to apply for enrollment in the Directorate of Access to High-Cost Medications (DAMAC) of the Ministry of Public Health and Social Assistance [1][2].
2. 2

   Recording Advance Medical Directives and Appointing a Healthcare Representative

   • Informed consent and clinical preferences under the General Health Law: Although the Dominican Republic does not operate a single centralized national registry for living wills, General Health Law No. 42-01 (administered by the Ministry of Public Health and Social Assistance) guarantees every patient with decision-making capacity the right to receive complete clinical information, to grant or refuse written informed consent for surgical or invasive life-sustaining procedures, and to receive dignified care focused on the relief of suffering [1].
   • Notarizing medical preferences and a healthcare representative: While the ill person retains full mental clarity and legal capacity, it is advisable to execute a written statement of medical care preferences and end-of-life treatment instructions before a Dominican notary public (signed by the patient and witnesses), expressly designating a trusted relative or healthcare representative to communicate with treating physicians and with the Health Risk Administrator supervised by the Superintendency of Health and Occupational Risks [1][2].
   • Filing directives in the hospital medical record: Provide signed copies of this document to the attending physician, the medical director of the hospital or clinic, and the palliative care team so that it is formally incorporated into the patient's clinical chart before sedation or cognitive decline prevents direct expression of consent [1].
3. 3

   Executing Notarial Powers of Attorney and Bank Mandates While Capacity Is Intact

   • General or special power of attorney before a Notary Public: To prevent bank accounts or administrative matters from becoming frozen if physical or cognitive incapacity develops, the ill person may execute a General Power of Administration or a Special Power of Attorney (either as a formal notarial public deed or as a private instrument legalized by a commissioned Notary Public in the relevant Dominican municipality), presenting a valid Identity and Electoral Card (Cédula de Identidad y Electoral) issued by the Central Electoral Board (Junta Central Electoral - JCE) [3].
   • Specific bank mandates and financial institution registrations: Financial institutions in the Dominican Republic (commercial banks and savings and loan associations) generally require that a power of attorney explicitly enumerate powers to operate designated bank accounts, renew financial certificates, or withdraw funds, or that the account holder personally sign the bank's internal authorized signature cards while full legal capacity remains [3].
   • Cross-border validity via Hague Apostille (MIREX): If the appointed attorney-in-fact or any property is located abroad, or if a relative living outside the country executes a power of attorney for use in the Dominican Republic, the notarial instrument must be legalized by the Attorney General's Office (when executed domestically) and apostilled online through the official portal of the Ministry of Foreign Affairs (Ministerio de Relaciones Exteriores - MIREX) for international legal recognition [4].
4. 4

   Claiming Disability or Sickness Benefits and Caregiver Support

   • Disability pension claims through the AFP and the Superintendency of Pensions: If your family member is an active contributor under the Dominican Social Security System (Law No. 87-01) and the illness causes a permanent reduction in working capacity meeting the statutory thresholds, the affiliate may apply for a Disability Pension (Pensión por Discapacidad, total or partial) through the relevant Pension Fund Administrator (AFP), subject to medical evaluation by the Regional and National Medical Commissions regulated by the Superintendency of Pensions (Superintendencia de Pensiones - SIPEN) [5].
   • Paid sickness benefit and affiliate defense: During periods of temporary incapacity for work caused by a non-occupational illness, an employed contributor is entitled to claim the Sickness Subsidy (Subsidio por Enfermedad Común) through their employer and the system supervised by the Superintendency of Health and Occupational Risks for up to the statutory number of weeks [2]. Patients and family members can also contact the General Directorate for Information and Defense of Social Security Affiliates (DIDA) for free official guidance and mediation regarding benefit claims [2][5].
   • Caregiver leave and workplace arrangements: Family members serving as primary caregivers should coordinate with their employer's human resources department to arrange medically documented leave, paid family leave permits, or flexible work schedules supported by official clinical certificates from the treating hospital [1].
5. 5

   Advance Review of Wills, Beneficiary Designations, and Property Records

   • Executing a will under the Dominican Civil Code: While the ill person retains full testamentary capacity, they may organize their estate by executing a will before a Notary Public in the Dominican Republic (such as an authentic public will dictated to the notary in the presence of witnesses, or a holographic will written, dated, and signed entirely in the testator's own hand), taking care to respect the mandatory forced heirship share (reserva hereditaria) protected under Dominican law for descendants [3][6].
   • Updating beneficiaries on pension funds, insurance policies, and bank accounts: Review and update in writing the designated beneficiaries on life insurance policies, bank accounts, and individual capitalization pension accounts regulated by the Superintendency of Pensions, ensuring that all names and identity numbers match civil registry records [3][5].
   • Civil registry verification before the Central Electoral Board and tax organization before the DGII: Gather and verify birth and marriage certificates in the standardized unified format issued by the Central Electoral Board so that any spelling or identity discrepancies can be corrected proactively [3]. In addition, organize real estate Title Certificates (Certificados de Título), property tax status records, and asset documentation monitored by the General Directorate of Internal Taxes (Dirección General de Impuestos Internos - DGII), and use the online apostille service of the Ministry of Foreign Affairs if assets or family members are located in another country [4][6].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Public Health Guidelines, Patient Rights, and National Health Programs — Ministerio de Salud Pública y Asistencia Social (MISPAS)
2. [2]
   Coverage, Copayments, and Claims: Affiliate Rights in Family Health Insurance — Superintendencia de Salud y Riesgos Laborales (SISALRIL)
3. [3]
   Unification of Civil Status Certificates in a Standard Format (Resolution 9-2025) — Junta Central Electoral (JCE)
4. [4]
   Online Hague Apostille and Document Legalization Service — Ministerio de Relaciones Exteriores (MIREX)
5. [5]
   National Social Security Council Regulations and Pension Benefits — Superintendencia de Pensiones (SIPEN)
6. [6]
   Succession, Estate, and Documentary Requirements Guide Before the Tax Administration — Dirección General de Impuestos Internos (DGII)