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

1. 1

   Coordinate Palliative Care, Home Nursing, and Health Coverage

   • Specialist hospital and palliative care units: Coordinate ongoing oncology, organ-failure, or supportive care through tertiary public hospitals overseen by the Ministry of Health and Population (such as Bir Hospital, Bhaktapur Cancer Hospital, B.P. Koirala Memorial Cancer Hospital in Bharatpur, or Patan Hospital) as well as dedicated palliative and hospice centers (including Hospice Nepal, Karuna Foundation, and Nepalese Association of Palliative Care partner units) [1]. Ask the treating specialist for a comprehensive written clinical summary (Diagnosis and Treatment Summary) and an outpatient symptom-management and pain-relief plan.
   • National Health Insurance Board (Swasthya Bima Board) coverage: If your family member is enrolled in the national health insurance scheme administered by the Health Insurance Board, verify active household coverage and designate the primary first-service point hospital (Pratham Bindu Aspatal) so referrals to tertiary care centers and covered prescription medications are billed directly [2].
   • Bishoweshwar Prasad Koirala / Impoverished Citizens Medical Treatment Fund (Bipanna Nagarik Aushadhi Upachar Kosh): Under the Ministry of Health and Population impoverished citizens' severe-disease relief program, Nepali citizens diagnosed with one of the eight listed critical illnesses (including cancer, renal failure, heart disease, Parkinson's disease, Alzheimer's disease, sickle cell anemia, spinal injury, and head injury) can apply for a recommendation letter from their municipal Ward Office to receive up to NPR 100,000 in subsidized hospital treatment at empanelled facilities [1, 3].
2. 2

   Record Healthcare Preferences, Informed Consent, and Medical Decision-Makers

   • Statutory framework under the Public Health Service Act, 2075 (2018): Nepal does not currently have a standalone living-will statute, but patients' rights to informed consent, refusal of treatment, and dignified care are governed by the Public Health Service Act, 2075 (Janaswasthya Sewa Ain, 2075) and the National Penal and Civil Codes published by the Nepal Law Commission [1, 5]. While your family member has full capacity, they have the legal right to accept or decline invasive medical interventions and to request transition to comfort-focused palliative care.
   • Designating a primary family medical representative: Under Nepali hospital regulations and the Public Health Service Act, when a patient becomes unable to provide informed consent directly, physicians rely on the written consent of the closest adult family member (Natedar / next of kin) [1]. To prevent uncertainty among relatives, your family member should sign a written statement naming their primary and alternate family decision-makers for medical consultations, hospital admissions, and intensive-care decisions, and have this placed in their medical chart at the treating hospital [1].
   • Clinical capacity verification: Before signing legal powers of attorney or property dispositions, obtain a dated clinical note from the attending physician confirming that your family member is conscious, oriented, and retains full mental capacity (Hosh Hawaas / sound mind) at the time of execution [1, 5].
3. 3

   Execute Valid Financial and Legal Powers of Attorney (Waresnama) and Bank Mandates

   • Authorized Power of Attorney (Adhikrit Waresnama) for property and legal affairs: Under the National Civil Procedure (Code) Act, 2017 (Muluki Dewani Karyabidhi Samhita, 2074) published by the Nepal Law Commission, a person with full legal capacity may execute a general or specific Authorized Power of Attorney (Adhikrit Waresnama) appointing a trusted adult representative to manage movable and immovable property, sign official filings, or appear before administrative and land revenue offices [5].
   • Court verification and consular execution: An Adhikrit Waresnama authorizing the sale, transfer, or formal management of immovable property (Jagga Jamin) must be drafted in legal form, accompanied by passport-size photographs, citizenship certificates, and property ownership certificates (Lalpurja), and authenticated before a Judge of the District Court (Jilla Adalat) in Nepal (or before a Nepali Ambassador or Consul General if executed abroad and attested via the Ministry of Foreign Affairs) [5, 6].
   • Bank account mandates and nominee updates: Nepali commercial banks generally require either their own internal account operation mandate or a registered nominee (Ichchhayeko Byakti) on individual deposit accounts [5]. While your family member is able to sign in person (or via bank home/hospital verification visit), update the account nominee form and establish joint signatory access for household and medical expenses.
4. 4

   Activate Critical-Illness, Disability, and Caregiver Support Benefits

   • Social Security Fund (SSF) medical and disability protection: If your family member is an active contributor to the Social Security Fund, file claims under the Medical Treatment, Health and Maternity Protection Scheme and the Accident and Disability Protection Scheme via the Social Security Fund portal [4]. Contributors who suffer permanent total disability due to illness or injury may qualify for a monthly disability pension (Ashaktata Pensan) or medical expense reimbursement up to the statutory ceilings [4].
   • Municipal disability identity card and monthly allowance: If the illness causes severe or profound physical functional impairment, apply at the local municipal office and Ward Office under the Department of National ID and Civil Registration framework for a Disability Identity Card (Apangata Parichayapatra - Category 'Ka' Red Card for complete disability or Category 'Kha' Blue Card for severe disability), which entitles the holder to a monthly federal social security disability allowance and municipal chronic-illness support grants (up to NPR 5,000 per month for designated catastrophic illnesses) [3].
   • Statutory sick leave and family caregiver leave: Under the Labour Act, 2074 (2017), formal-sector employees in Nepal are entitled to paid sick leave (Birami Bida, 12 days per year at full pay) and accumulated annual home leave (Ghar Bida), while family caregivers may request paid or unpaid special leave from their employer supported by a hospital medical certificate [4, 5].
5. 5

   Organize Civil Status Records, Property Partition (Angsabanda), and Testamentary Deeds

   • Distinguishing joint family property (Angsa) from testamentary gifts (Shesh Pachhiko Bakaspatra): Under the National Civil (Code) Act, 2017 (Muluki Devani Samhita, 2074) maintained by the Nepal Law Commission, joint or ancestral family property (Sagawaas / Angsa Sampatti) is subject to mandatory equal coparcenary shares (Angsa) among spouses, sons, and daughters and cannot be unilaterally willed away without the consent of coparceners [5]. However, a person with full mental capacity may freely dispose of their self-acquired property (Niji Arjit Sampatti) or their demarcated personal share by executing a Deed of Gift Effective After Death (Shesh Pachhiko Bakaspatra - Nepal's statutory equivalent of a testamentary bequest) registered at the Land Revenue Office (Malpot Karyalaya) [5].
   • Nominations (Ichchhayeko Byakti) on financial and retirement accounts: Review and update named beneficiaries on bank accounts, life insurance policies, the Social Security Fund, the Employees Provident Fund (Karmachari Sanchaya Kosh), the Citizen Investment Trust (Nagarik Lagani Kosh), and demat securities accounts (Mero Share), as valid statutory nominations allow rapid disbursement without court litigation [4, 5].
   • Consolidating civil registration and property records: Gather and verify the accuracy of the Nepali Citizenship Certificate (Nagarikta), National Identity Card (Rastriya Parichayapatra), Marriage Registration Certificate (Bibaha Darta), children's Birth Registration Certificates, and Land Ownership Certificates (Lalpurja) at the local Ward Office under the Department of National ID and Civil Registration so that names and dates match across all registries [3].
   • Cross-border family coordination: If family members or assets are located outside Nepal, ensure any foreign powers of attorney or property documents are attested through the relevant Nepali Embassy and the Department of Consular Services of the Ministry of Foreign Affairs in Kathmandu [6].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Ministry of Health and Population - Public Health and Critical Illness Programs — Ministry of Health and Population (Government of Nepal)
2. [2]
   Health Insurance Board (Swasthya Bima Board) - National Health Insurance Portal — Health Insurance Board (Nepal)
3. [3]
   Department of National ID and Civil Registration - Vital Registration and Social Security — Ministry of Home Affairs (Government of Nepal)
4. [4]
   Social Security Fund (SSF) - Contributor Medical and Disability Schemes — Social Security Fund (Nepal)
5. [5]
   National Civil (Code) Act, 2017 (Muluki Devani Samhita, 2074) — Nepal Law Commission
6. [6]
   Ministry of Foreign Affairs - Consular Attestation and Legalization Services — Ministry of Foreign Affairs (Government of Nepal)