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

1. 1

   Coordinate Palliative Care, Home Nursing, and National Health Coverage

   • Hospital and community supportive care: Coordinate primary and specialist medical care through Belau National Hospital in Koror and the community health centers overseen by the Ministry of Health and Human Services [1] [6]. Ask the attending physician for a comprehensive written clinical summary (Diagnosis and Treatment Plan) and arrange outpatient pain management, chronic-disease home visits, or medical equipment support through the Bureau of Public Health and Home Health services [1].
   • National Healthcare Financing Program (HealthCare Fund and MSA): Verify your family member's active enrollment in the Palau National Health Insurance (NHI) and their individual Medical Savings Account (MSA) administered by the Republic of Palau Social Security Administration under Title 41 of the Palau National Code (41 PNC) [4]. The pooled National Health Insurance account covers up to 80 to 90 percent of eligible inpatient care at Belau National Hospital and approved off-island medical referrals, while the individual Medical Savings Account can be drawn down to pay co-payments, outpatient prescriptions, and supportive care costs [4].
   • Off-island medical referral coordination: If specialized oncology or palliative procedures require referral to an accredited tertiary hospital outside Palau (such as in the Philippines, Taiwan, Guam, or Hawaii), submit the treating physician's referral request to the Medical Referral Committee at the Ministry of Health and Human Services before travel so coverage limits are pre-authorized [1] [4].
2. 2

   Record Advance Healthcare Directives and Designate a Healthcare Proxy

   • Informed consent and treatment preferences: Under the health and patients' rights framework administered by the Ministry of Health and Human Services (34 PNC), an adult patient with full mental capacity has the right to give or withhold informed consent to invasive surgical or life-prolonging interventions and to specify comfort-focused care goals (including Do-Not-Resuscitate or non-intubation orders) in consultation with their attending physician at Belau National Hospital [1] [6].
   • Written Advance Healthcare Directive and Medical Proxy: While your family member retains full decision-making capacity, have them execute a written Advance Healthcare Directive and Healthcare Power of Attorney naming a trusted primary adult medical representative (and an alternate) authorized to make clinical and off-island referral decisions if your family member later becomes unable to communicate [1] [3].
   • Hospital chart filing and capacity verification: Ask the attending physician at Belau National Hospital to document your family member's current mental capacity (sound mind and orientation) in the medical chart and place signed copies of the Advance Healthcare Directive and Healthcare Proxy directly in the Medical Records Office of the Ministry of Health and Human Services [1].
3. 3

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

   • Durable or General Power of Attorney: Under Palauan civil and common-law principles recognized by the Palau Supreme Court (1 PNC § 303), an adult principal with full legal capacity may execute a written General or Durable Power of Attorney (POA) appointing an attorney-in-fact to manage bank accounts, business licenses, tax filings with the Ministry of Finance, and personal property [3] [5]. To ensure the instrument remains valid if the ill person later loses mental capacity, include explicit durable language (this Power of Attorney shall not be affected by the subsequent disability or incapacity of the principal) and have the signature acknowledged before a commissioned Notary Public or the Office of the Clerk of Courts at the Palau Supreme Court [3].
   • Banking and revenue mandates: Commercial banks operating in Koror (including FDIC-insured U.S. branch banks and local institutions) frequently require their own internal power-of-attorney or joint signatory forms in addition to a general notarized Power of Attorney [3] [5]. Arrange for your family member to sign bank mandate forms and update account beneficiary designations while able to appear in person or verify identity directly with bank officers.
   • Cross-border authentication (Apostille): Because the Republic of Palau is a party to the 1961 Hague Apostille Convention, a Power of Attorney executed in Palau for use in the United States or another Apostille jurisdiction (or executed abroad for use in Palau) should be authenticated with an Apostille through the Ministry of State or the Palau Supreme Court Clerk of Courts [3] [5].
4. 4

   Activate Disability Benefits, Medical Savings Accounts, and Caregiver Support

   • Social Security Disability Insurance (SSDI) pension: If the life-limiting illness prevents your family member from engaging in substantial gainful employment and is expected to last at least 12 months or result in death, file a disability pension claim with the Republic of Palau Social Security Administration in Koror (41 PNC) [4]. Once certified by a medical examination from a physician at Belau National Hospital and approved by the Social Security Board, the contributor receives a monthly disability benefit calculated under the statutory benefit formula [1] [4].
   • Civil Service Pension Plan and public assistance grants: If your family member is a current or former public servant, check eligibility for occupational or non-occupational disability retirement with the Civil Service Pension Plan, and verify whether severe functional impairment qualifies for monthly severe-disability or home-bound assistance grants administered in coordination with the Ministry of Health and Human Services [1] [4].
   • Statutory sick leave and family caregiver leave: Formal-sector and national government employees in Palau should coordinate accumulated paid sick leave and annual leave with their employer, or apply for unpaid family medical caregiver leave supported by a medical certificate from Belau National Hospital [1].
5. 5

   Organize Wills, Customary Property Dispositions (Telungalek), and Vital Records

   • Executing a valid Will under 25 PNC: Under Title 25 of the Palau National Code (25 PNC, Decedents' Estates) overseen by the Palau Supreme Court, a person of sound mind aged 18 or older may execute a written Last Will and Testament signed by the testator in the presence of at least two competent attesting witnesses [3]. Executing a clear written will while capacity is intact minimizes post-death disputes over individually owned land, leaseholds, business shares, and personal property [3].
   • Aligning statutory wills with Palauan customary obligations (Siukang) and constitutional land rules: Under Article XIII, Section 8 of the Constitution of the Republic of Palau and 39 PNC, only Palauan citizens may hold fee-simple title to land in Palau [3]. Because clan and lineage land (Telungalek and Kebliil property) is governed by customary tenure whereas individual land listed on a Certificate of Title issued by the Land Court can be devised to Palauan citizen heirs by will or recorded deed of transfer, it is advisable for your family member to clarify their wishes with senior lineage members (Rubak) and record any lifetime land transfers or directives with the Palau Supreme Court and the Land Court [3].
   • Consolidating civil status and beneficiary records: Verify that your family member's birth certificate, marriage certificate, children's birth records, and passport are up to date with the Vital Statistics Office at the Ministry of Health and Human Services and the Office of the Clerk of Courts at the Palau Supreme Court (34 PNC § 4005) [1] [2] [3], and update named beneficiaries on accounts with the Republic of Palau Social Security Administration and commercial insurers [4].

   Step	Deadline	Authority
   1. Palliative care & HealthCare Fund (MSA)	Immediately upon diagnosis	Ministry of Health and Human Services & Republic of Palau Social Security Administration
   2. Advance Healthcare Directive & Proxy	While full mental capacity is intact	Ministry of Health and Human Services (Belau National Hospital Medical Records)
   3. Durable Power of Attorney & bank mandates	Before any decline in legal capacity	Notary Public / Palau Supreme Court (Clerk of Courts) & commercial banks
   4. Social Security Disability pension claim	Upon medical certification of inability to work	Republic of Palau Social Security Administration
   5. Will execution, land titles & vital records	While capacity is intact	Palau Supreme Court (Trial Division / Land Court) & Ministry of State

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Ministry of Health and Human Services - Belau National Hospital and Public Health Services — National Government of the Republic of Palau
2. [2]
   Civil Registration and Vital Statistics (CRVS) Country Profile: Palau — UNICEF Data / Pacific Civil Registrars Network
3. [3]
   Palau Supreme Court - Office of the Clerk of Courts, Trial Division, and Land Court — Judiciary of the Republic of Palau
4. [4]
   Social Security Programs Throughout the World: Asia and the Pacific - Palau (Disability and Healthcare Fund) — U.S. Social Security Administration / International Social Security Association
5. [5]
   Ministry of State and Ministry of Finance - Executive Branch Directories — National Government of the Republic of Palau
6. [6]
   World Health Organization Country Profile: Republic of Palau Health System — World Health Organization (WHO)