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

1. 1

   Coordinate Palliative Care, Home Nursing, and Health Coverage

   • Hospital palliative care and oncology units: Specialized palliative care, pain management, and supportive symptom relief in Pakistan are delivered through major tertiary public and charitable hospitals (such as Shaukat Khanum Memorial Cancer Hospital, Aga Khan University Hospital, and federal hospitals overseen by the Ministry of National Health Services, Regulations and Coordination (NHSRC)) [1]. You should ask the primary specialist for a comprehensive clinical summary and a written home-care and pain-management protocol.
   • Public and private health coverage: For eligible families registered under federal or provincial social health protection schemes (such as the Sehat Sahulat Program), inpatient treatment and critical-illness care at empaneled public and private hospitals are covered up to statutory limits under frameworks coordinated with the Ministry of National Health Services, Regulations and Coordination (NHSRC) [1]. If your family member holds private health or critical-illness insurance, notify the insurer early to obtain pre-authorization for inpatient or home nursing care.
   • Home nursing and clinical continuity: Keeping an organized medical file at home - including diagnostic reports, prescriptions for controlled analgesics, and an attending physician's contact details - ensures uninterrupted symptom management and facilitates medical documentation if an emergency occurs [1].
2. 2

   Record Medical Treatment Preferences and Designate a Healthcare Representative

   • Written treatment preferences and informed consent: Pakistan does not currently have a standalone federal statute governing statutory living wills for all provinces, so medical consent and end-of-life care decisions are governed by hospital clinical ethics policies, constitutional protections of dignity, and physician-family consultation [1]. While your family member has full mental capacity, it is advisable to consider recording their written preferences regarding cardiopulmonary resuscitation (CPR), mechanical ventilation, intensive care admission, and comfort-focused care.
   • Designating a primary medical spokesperson: Your family member should formally name a trusted adult relative as their primary medical representative in their hospital admission records and in a notarized declaration witnessed by two adults [1] [2]. Having a clear written designation prevents disagreements among extended relatives when urgent clinical decisions are required.
   • Hospital ethics committee alignment: Provide signed copies of your family member's care preferences to the treating consultant and hospital medical record department so that any Do-Not-Resuscitate (DNR) or palliative-only care order is properly documented in the clinical chart by the medical team [1].
3. 3

   Execute Financial and Legal Powers of Attorney and Bank Mandates

   • General or Special Power of Attorney (Mukhtar-nama): Under the Powers of Attorney Act, 1882 and the Registration Act, 1908, your family member can execute a Special Power of Attorney (for specific banking or administrative acts) or a General Power of Attorney (for broader asset and property management) while they retain full mental capacity [2]. Any Power of Attorney authorizing the sale, mortgage, or transfer of immovable real estate in Pakistan must be executed on appropriate stamp paper, witnessed by two adults, and compulsorily registered with the local Sub-Registrar of Properties [2].
   • Digital Power of Attorney for overseas relatives: If the person granting or receiving the mandate is abroad, the National Database and Registration Authority (NADRA) and the Ministry of Foreign Affairs (MOFA) operate an official online Digital Power of Attorney portal featuring biometric verification and consular video interviews [2] [3].
   • Bank account mandates and biometric exemptions: Because Pakistani banks require NADRA biometric verification for account operations, your family member should visit or contact their bank while able to register a formal bank mandate, joint signing authority, or medical exemption for thumb-impression verification, and ensure their pensioner verification status with the National Database and Registration Authority (NADRA) is up to date [3].
4. 4

   Activate Disability, Invalidity, and Caregiver Support Benefits

   • Private-sector Invalidity Pension (EOBI): If your family member is an insured private-sector employee who becomes permanently incapacitated due to severe illness, they can apply for an Invalidity Pension or Old-Age Grant through the Employees' Old-Age Benefits Institution (EOBI), supported by a medical board assessment confirming permanent inability to work [4].
   • Disability assessment and social protection: Under federal and provincial disability rights frameworks coordinated with the Ministry of Human Rights (MOHR) and social welfare departments, individuals with severe functional impairment can undergo assessment by a District Medical Board to obtain a Special CNIC (disability emblem) through NADRA, unlocking public medical concessions and social protection support [5].
   • Civil service medical boarding and leave: If the ill person is a federal or provincial government employee, they may apply for medical leave, a medical board invalidation pension, or medical reimbursement grants under civil service rules, while employed family caregivers can request statutory casual, earned, or compassionate leave from their employer [1] [4].
5. 5

   Review Wills, Civil Records, and Cross-Border Estate Documents

   • Reviewing wills (Wasiyat) and succession rules: In Pakistan, succession for Muslims is governed by Islamic personal law (Shariat Application Acts), under which a testator may generally bequeath up to one-third of their net estate by will (Wasiyat) to non-heirs without the consent of legal heirs, while the remaining two-thirds passes according to fixed Quranic shares; non-Muslim citizens are governed by the Succession Act, 1925 [2] [3]. Preparing a clear, witnessed written will and a complete inventory of assets prevents disputes.
   • Verifying NADRA Family Registration Certificate (FRC): While your family member has full capacity, obtain and verify an updated Family Registration Certificate (FRC) from the National Database and Registration Authority (NADRA) to ensure that all spouses, children, and parents are accurately linked by CNIC number [3] [6]. Discrepancies in NADRA family tree records are the single most common cause of delay in post-death NADRA Succession Certificate applications [6].
   • Organizing property titles and cross-border nominations: Gather original property title deeds (fard, registry, allotment letters), bank account statements, Central Depository Company (CDC) share details, and National Savings certificates, and update nominee designations on life insurance and provident funds [2] [6]. If assets or family members are located outside Pakistan, coordinate cross-border powers of attorney and Apostille legalization through the Ministry of Foreign Affairs (MOFA) [2].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Ministry of National Health Services, Regulations and Coordination - Official Portal — Ministry of National Health Services, Regulations and Coordination (NHSRC)
2. [2]
   Online Power of Attorney (PoA) Procedure and Legal Verification Guidelines — Ministry of Foreign Affairs (MOFA)
3. [3]
   NADRA Digital Proof of Life and Identity Verification for Pensioners — National Database and Registration Authority (NADRA)
4. [4]
   Employees' Old-Age Benefits Institution - Invalidity and Old-Age Pension Benefits — Employees' Old-Age Benefits Institution (EOBI)
5. [5]
   Rights and Protection Framework for Persons with Disabilities in Pakistan — Ministry of Human Rights (MOHR)
6. [6]
   Family Registration Certificate (FRC) and Succession Planning Requirements — National Database and Registration Authority (NADRA)