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

1. 1

   Coordinate Palliative Care, Public Health Services, and Off-Island Referral Coverage

   • Hospital and home-based palliative care in Majuro and Ebeye: Coordinate a comprehensive symptom-management and palliative care plan through the treating medical team at Leroij Atama Zedkaia Memorial Hospital (Majuro Public Hospital) or Leroij Kitlang Memorial Health Center in Ebeye under the Ministry of Health and Human Services [1]. For patients returning to a family residence or outer atoll, obtain a detailed clinical summary, pain-management prescription schedule, and outer-island dispensary nursing instructions from the attending physician [1].
   • Marshall Islands Health Fund and off-island medical referral: Verify the ill person's enrollment and benefit coverage under the Basic Health Fund and Supplemental Health Fund administered alongside the Marshall Islands Social Security Administration and the Ministry of Health and Human Services [1] [2]. When specialized oncology or palliative procedures require off-island referral (for example, to Honolulu, Guam, or Manila), the National Medical Referral Committee reviews clinical documentation prior to authorizing travel [1] [2].
   • Travel and consular readiness for cross-border treatment: If off-island medical care or family caregiving in the United States under the Compact of Free Association is anticipated, ensure the ill person and accompanying caregiver hold valid Marshall Islands passports and certified civil status documents through the Ministry of Foreign Affairs and Trade or the Embassy of the Republic of the Marshall Islands [3].
2. 2

   Record Advance Healthcare Directives and Designate a Medical Representative

   • Written advance medical directives and treatment preferences: While your family member retains full decision-making capacity, they should execute a written Advance Healthcare Directive (living will) stating their preferences regarding life-sustaining interventions, mechanical ventilation, cardiopulmonary resuscitation (DNR orders), artificial nutrition, and palliative pain relief, and file a signed copy in their medical chart at Majuro Public Hospital or Ebeye Health Center [1].
   • Appointing a healthcare proxy or medical representative: In the same written instrument, the ill person should designate a trusted adult family member as their primary healthcare representative (and name an alternate proxy) authorized to make clinical decisions if the patient loses capacity to communicate [1] [4]. Having the directive signed before two adult witnesses and notarized ensures hospital clinicians and the High Court of the Republic of the Marshall Islands can rely on the patient's clear intent [4] [5].
   • Cross-border recognition for off-island hospitals: If the patient may be referred to a hospital in Hawaii, Guam, or the Philippines, prepare the advance directive and durable power of attorney for healthcare in English using standard dual-witness and notarial execution so receiving hospitals recognize the proxy without delay [1] [3].
3. 3

   Execute Financial Powers of Attorney and Bank Mandates While Capacity Is Intact

   • General or Durable Power of Attorney: While your family member has full mental and legal capacity, they should execute a written Power of Attorney authorizing a chosen representative to manage property, administrative filings, social security correspondence, and legal affairs in the Marshall Islands [4] [5]. The document should be signed before a licensed Notary Public or Clerk of the High Court of the Republic of the Marshall Islands [4] [6].
   • Direct commercial bank mandates (Bank of Marshall Islands / Bank of Guam): Local banking institutions operating in Majuro and Ebeye (including Bank of Marshall Islands and Bank of Guam) generally require account holders to sign the bank's own power-of-attorney or authorized-signatory forms directly with bank compliance officers while the customer is mentally competent. Arrange an in-branch or verified bedside signing early so household and medical expenses can be paid uninterrupted.
   • Preventing contested guardianship proceedings: Executing valid financial and medical powers of attorney while capacity is intact avoids the need for relatives to file an urgent guardianship or conservatorship petition before the High Court of the Republic of the Marshall Islands under the Marshall Islands Rules of Civil Procedure if the illness later impairs cognition [4, 5, 6].
4. 4

   Activate Disability Pensions, Workers' Compensation, and Caregiver Support

   • Marshall Islands Social Security Administration disability benefits: If the illness prevents your family member from engaging in substantial gainful employment and is expected to last at least twelve months or result in end-stage progression, file an application for Disability Insurance Benefits with the Marshall Islands Social Security Administration (MISSA) [2]. The application requires clinical evidence and physician certification on Form MISSA-200 confirming the severity of the impairment, alongside proof of required coverage quarters [2].
   • Work-related illness and U.S. Social Security coordination: If the condition is linked to occupational exposure, check eligibility under the RMI Workers' Compensation program administered with the Marshall Islands Social Security Administration [2]. If the ill person previously accrued insured work quarters in the United States, contact the U.S. Social Security Administration or the Consular Section at the U.S. Embassy in the Republic of the Marshall Islands regarding federal disability benefits [1] [2].
   • Public service and employer medical/caregiver leave: If the ill person or a caregiving relative is employed in the Marshall Islands (including under the Public Service Commission), present the attending physician's medical certificate to claim accrued sick leave, compassionate family leave, or an approved leave of absence.
5. 5

   Organize Wills, Customary Land Dispositions (*Kalimur*), and Civil Records

   • Drafting a written will and addressing customary land (Kalimur): Under the Marshall Islands Probate Code, an adult of sound mind may execute a written will attested by two competent witnesses to govern personal property, bank accounts, and business assets [4] [5]. Where the ill person holds customary land rights (bwidrej) as Iroij, Alap, or Senior Dri Jerbal, any testamentary disposition (kalimur) must comply with Marshallese customary law and lineage consultation rules, which are reviewed by the High Court of the Republic of the Marshall Islands and the Traditional Rights Court [4] [5].
   • Updating beneficiary designations and civil status records: Review beneficiary designations on life insurance policies, bank accounts, and Marshall Islands Social Security Administration records, and verify that birth certificates, marriage certificates, and passports are accurate and up to date with the Office of the Registrar General and the Embassy of the Republic of the Marshall Islands [2, 3, 4].
   • Cross-border estate and Apostille preparation: Compile a clear inventory of all local and foreign bank accounts, debts, and property titles, and store it with the original will so the designated executor has immediate access to the documents required by the High Court of the Republic of the Marshall Islands [4, 5, 6]. Where powers of attorney or civil documents must be used in another Hague Apostille country, obtain an Apostille certificate through the RMI Registrar / Attorney General's Office [3] [4].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Ministry of Health and Human Services & Hospital Facilities Overview — U.S. Embassy in the Republic of the Marshall Islands
2. [2]
   Disability Insurance Benefits & Form MISSA-200 Guidelines — Marshall Islands Social Security Administration (MISSA)
3. [3]
   Consular Services and Citizen Documentation — Embassy of the Republic of the Marshall Islands
4. [4]
   Court Forms for Self-Represented Litigants - RMI Judiciary — Republic of the Marshall Islands Judiciary
5. [5]
   Marshall Islands Rules of Civil Procedure — Republic of the Marshall Islands Judiciary
6. [6]
   Schedule of Court Costs and Fees (General Order) — High Court of the Republic of the Marshall Islands