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

1. 1

   Activate Home Palliative Care and Hospice Care

   In Italy, Law No. 38/2010 (Legge n. 38/2010) guarantees citizens free access to palliative care and pain therapy within the National Health Service (Servizio Sanitario Nazionale - SSN), as overseen by the Ministero della Salute (Ministry of Health) [1]. Care is delivered through Local Palliative Care Networks (Reti Locali di Cure Palliative) across two main settings:

   • Home palliative care (Cure palliative domiciliari - UCP-DOM): Delivered at the ill person's home by multi-professional Palliative Care Units (palliative care physicians, nurses, psychologists, physiotherapists, and healthcare assistants) in coordination with the General Practitioner (Medico di Medicina Generale - MMG), based on an Integrated Care Plan (Piano Assistenziale Integrato - PAI) that includes medication and medical equipment [1][2].
   • Hospice (inpatient residential facilities): Intended for patients requiring complex symptom management or temporary respite stays for the family when home care is no longer feasible [1][2].

   To activate care, the family member or the ill person should contact the General Practitioner (or the hospital ward during protected discharge planning / dimissioni protette), who submits the referral (impegnativa) to the Single Point of Access (Punto Unico di Accesso - PUA) or the Palliative Care Unit of the Local Health Authority (Azienda Sanitaria Locale - ASL) [1][2]. For guidance on regional networks and accredited facilities, you can consult the scientific society Società Italiana di Cure Palliative (Italian Society of Palliative Care - SICP) [2] and the Federazione Cure Palliative (Palliative Care Federation - FCP) [1].

2. 2

   Draft and Deposit Advance Healthcare Directives (DAT / Living Will)

   As long as the ill person is an adult and retains full decision-making capacity, they can execute Advance Healthcare Directives (Disposizioni Anticipate di Trattamento - DAT, also known as a living will or biotestamento under Law No. 219/2017) to express consent to or refusal of diagnostic tests, therapeutic choices, and specific medical treatments, including artificial nutrition and hydration [3][4]. In the DAT, the declarant (disponente) may appoint an adult healthcare proxy (fiduciario) who accepts the role (by co-signing the DAT or by subsequent written instrument) and represents the patient in dealings with physicians and healthcare facilities in the event of future incapacity [3][4].

   The DAT must be executed in one of the statutory forms provided by law:

   • Private written instrument delivered in person (scrittura privata consegnata personalmente) by the declarant to the Civil Status Office (Ufficio dello Stato Civile) of their municipality of residence (Comune) [3][4].
   • Public deed or authenticated private instrument (atto pubblico o scrittura privata autenticata) executed before a notary [3][4].
   • Submission at healthcare facilities in Regions that have implemented electronic collection through the Electronic Health Record (Fascicolo Sanitario Elettronico) [3].

   Upon deposit, the civil registrar or notary transmits a copy of the DAT (with the declarant's consent) to the National DAT Database (Banca Dati Nazionale delle DAT) established at the Ministero della Salute, which can be accessed by the declarant, the fiduciario, and the attending physician using digital identity credentials (SPID, CIE, or CNS) [3].

3. 3

   Execute Notarial Powers of Attorney, Bank Mandates, and Consider Support Administration

   In Italy, ordinary bank authorizations (deleghe bancarie) and informal mandates may be insufficient for extraordinary financial administration or may be challenged if cognitive incapacity arises. While the ill person retains full legal capacity (capacità di agire), it is important to formalize financial management through a notary via the Consiglio Nazionale del Notariato (National Council of Notaries) [4]:

   • General or special notarial power of attorney (Procura generale o speciale notarile): Grants a trusted person authority to carry out administrative, banking, tax, or real estate acts in the name and on behalf of the principal [4]. At the same time, verify specific account operating mandate forms directly with the relevant banks.
   • Support Administration (Amministrazione di Sostegno - Law No. 6/2004): Where the illness reduces, even partially or temporarily, a person's ability to manage daily affairs, the beneficiary, spouse, domestic partner (convivente), or relatives within the fourth degree may file a petition (ricorso) with the Guardianship Judge (Giudice Tutelare) at the Court (Tribunale) of the place of residence or domicile, following the official guidance of the Ministero della Giustizia (Ministry of Justice) [5]. While still capable, the ill person may also designate their future support administrator (amministratore di sostegno) in advance by public deed or authenticated private instrument before a notary [4][5]. Filing a petition for Amministrazione di Sostegno does not necessarily require a lawyer and is exempt from unified court fees (contributo unificato) and stamp duty [5].
4. 4

   Apply for Caregiver Leave, Paid Time Off, and Disability Benefits

   To support family caregivers and activate financial benefits for non-self-sufficiency, initiate the medical assessment for civil disability (invalidità civile) and severe disability status (handicap grave under Law No. 104/1992) through the national social security agency, the Istituto Nazionale della Previdenza Sociale (National Institute for Social Security - INPS, reachable at 803 164 from landlines), or through an accredited Ente di Patronato [6][7]:

   • Fast-track assessment for oncological or severe illnesses: The General Practitioner or hospital specialist submits the introductory medical certificate (certificato medico introduttivo) electronically; for patients with oncological pathologies, the assessment of civil disability and Legge 104 status is carried out under an accelerated statutory procedure within 15 days of the application [6].
   • Paid monthly caregiver leave under Law 104/1992 (Permessi retribuiti Legge 104/1992, Art. 33): Once severe disability status (disabilità in situazione di gravità, Art. 3, para. 3) is recognized, employed family members are entitled to 3 days of paid leave per month (which may also be split into hours) covered by notional pension contributions; multiple family caregivers may alternate taking leave to assist the same person [6][7].
   • Paid extraordinary caregiver leave (Congedo straordinario retribuito, Art. 42, para. 5, Legislative Decree 151/2001): Co-residing family members (in statutory order of priority: spouse, civil union partner, or cohabiting partner, parents, children, brothers, or sisters) may apply for up to a combined maximum of 2 years of paid extraordinary leave over their working life, which can be taken in days or months [8].
   • Attendance allowance (Indennità di accompagnamento): If the medical commission certifies an inability to walk without permanent assistance or an inability to perform everyday activities independently, a monthly tax-free cash benefit is payable regardless of personal income [6].
5. 5

   Review the Will, Pension Beneficiaries, and Estate Succession Requirements

   Organizing estate and pension documentation in advance substantially reduces future administrative burdens for the family:

   • Wills and forced heirship protection (quote di legittima): Under the official guides of the Consiglio Nazionale del Notariato, the ill person may dispose of their estate by holographic will (testamento olografo, handwritten, dated, and signed entirely by the testator) or by public notarial will (testamento pubblico) executed before a notary in the presence of two witnesses, while respecting the statutory reserved shares (quote di legittima) protected by law for the spouse, children, or ascendants [9][10]. Public wills and holographic wills formally deposited with a notary are registered in the General Registry of Wills (Registro Generale dei Testamenti) [10].
   • Pension records and insurance policies: Gather contribution statements to streamline the future online application for a survivor pension (pensione ai superstiti: pensione di reversibilità if the deceased was already a pensioner, or pensione indiretta for an insured worker) through the Istituto Nazionale della Previdenza Sociale [6], and review beneficiary designations on life insurance policies and supplementary pension funds.
   • Declaration of succession and releasing bank accounts: After death, heirs or estate beneficiaries (chiamati all'eredità) must file the electronic declaration of succession (dichiarazione di successione) within 12 months of the opening of the succession with the national tax authority, Agenzia delle Entrate (Italian Revenue Agency, toll-free number 800 90 96 96), a procedure that includes automatic cadastral title updates (voltura catastale) for real estate and issues the official receipt required by banks to release frozen accounts and financial assets [11][12].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Law 38/2010 and Home and Hospice Palliative Care Networks in Italy — Federazione Cure Palliative (FCP)
2. [2]
   Information for Citizens and Patients on Palliative Care — Società Italiana di Cure Palliative (SICP)
3. [3]
   Advance Healthcare Directives (DAT) and National Database — Ministero della Salute
4. [4]
   Information on Living Wills (DAT - Law 219/2017) and Notarial Instruments — Consiglio Nazionale del Notariato
5. [5]
   Practical Guide: Support Administration (Amministrazione di Sostegno - Law 6/2004) — Ministero della Giustizia
6. [6]
   Paid Caregiver Leave Under Law 104/1992 for Assisting Family Members with Severe Disabilities — Istituto Nazionale della Previdenza Sociale (INPS)
7. [7]
   Use of Law 104/1992 Leave and Removal of the Single Caregiver Restriction (Legislative Decree 105/2022) — Istituto Nazionale della Previdenza Sociale (INPS)
8. [8]
   Paid Extraordinary Leave for Assisting Family Members with Severe Disabilities — Istituto Nazionale della Previdenza Sociale (INPS)
9. [9]
   Citizen's Guide: Protected Successions and Rules for Safe Transfer of Assets — Consiglio Nazionale del Notariato
10. [10]
    Successions, Forms of Wills, and the General Registry of Wills — Consiglio Nazionale del Notariato
11. [11]
    Declaration of Succession: General Information, Deadlines, and Obligated Parties — Agenzia delle Entrate
12. [12]
    Completing and Filing the Online Declaration of Succession and Cadastral Transfers — Agenzia delle Entrate