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

1. 1

   Coordinate Specialist Palliative Care at Home and in Inpatient Units

   In Romania, initiating specialist medical and palliative care begins with a medical recommendation issued by the treating oncologist, hospital specialist, or family doctor (medic de familie) [1]:

   • Publicly reimbursed palliative care via CNAS: inpatient palliative care (hospital wards or palliative care beds), outpatient care, and home care (îngrijiri paliative la domiciliu) are reimbursed through the Casa Națională de Asigurări de Sănătate (National Health Insurance House - CNAS) and the county or Bucharest health insurance houses (casele de asigurări de sănătate județene sau a Municipiului București), within statutory service packages and funding ceilings [1]. For home care, the physician issues a standardised referral form submitted to the territorial health insurance house to approve the reimbursement decision, after which the family selects an accredited provider under contract with the insurance house [1].
   • Charitable and NGO palliative networks: alongside the public network, patients can access specialist services run by accredited non-governmental organisations. As an illustrative example from public sources, the foundation HOSPICE Casa Speranței provides free specialist palliative care services (inpatient units, mobile home care teams, and outpatient clinics) for adult patients with incurable diagnoses in Bucharest, Brașov, and surrounding areas [2]. Clarvia provides these details solely for informational orientation and does not endorse, approve, or rank the providers mentioned.
2. 2

   Record Written Informed Consent and Designate the Patient's Legal Healthcare Representative

   Romania does not operate a separate national registry for a standardised living will (testament biologic), but the ill person's right to make decisions regarding treatment and end-of-life care is governed by the Patients' Rights Law no. 46/2003 (Legea drepturilor pacientului nr. 46/2003), overseen by the Ministerul Sănătății (Ministry of Health) [3]:

   • Recording treatment preferences and refusals: while your family member has mental capacity (discernământ), they may ask the medical team to record their therapeutic preferences in their clinical observation chart (foaia de observație clinică), including acceptance or refusal of specific medical interventions or the cessation of an intervention, confirming their decision in writing after receiving full medical information [3].
   • Written designation of a healthcare representative (reprezentant legal): under Law no. 46/2003, the patient should designate in writing a trusted person (legal representative for medical matters) to receive information regarding diagnosis and prognosis and to give or withhold consent for medical interventions if the patient subsequently loses the capacity to express their wishes [3]. Keep a copy of this signed declaration in the hospital medical file and at home for the palliative care team.
3. 3

   Execute Authentic Notarial Powers of Attorney and Bank Mandates While Full Capacity Exists

   For a family member to legally manage bank accounts, pension collection, bill payments, dealings with public authorities, or property administration, a special or general authentic power of attorney (procură autentică) must be executed while the ill person retains full mental capacity (discernământ deplin) [4]:

   • Notarial power of attorney and RNNEPR registration: within Romania, a power of attorney is authenticated by any public notary belonging to the Uniunea Națională a Notarilor Publici din România (National Union of Public Notaries of Romania - UNNPR), and all powers of attorney are recorded in the National Notarial Register of Powers of Attorney and their Revocation (Registrul Național Notarial de Evidență a Procurilor și a Revocării acestora - RNNEPR) [4]. If the patient cannot travel for medical reasons, you can request a mobile visit by the public notary to the patient's home or healthcare facility within that territorial district [4].
   • Commercial bank mandates and consular authentication: many commercial banks in Romania require either specific clauses in the notarial power of attorney (explicitly listing IBAN account numbers and permitted transactions) or the signing of the bank's own account mandate form (împuternicire pe cont). If the grantor or representative is abroad, notarial powers of attorney and declarations can be authenticated at Romanian diplomatic missions or consular offices by prior appointment through the consular portal (eConsulat.ro) of the Ministerul Afacerilor Externe (Ministry of Foreign Affairs - MAE) [5].
4. 4

   Access Oncology Caregiver Leave and Statutory Carer Rights

   Employed family members who are insured in the public health system and meet the minimum contribution requirement (6 months within the last 12 months) can access statutory leave and financial support [1]:

   • Leave and allowance for caring for an oncology patient (concediu și indemnizație pentru îngrijirea pacientului cu afecțiuni oncologice): insured employees may claim up to 45 calendar days per year per patient to care for and accompany an oncology patient aged over 18 to surgical interventions and treatments prescribed by a specialist physician, with the patient's written consent for one accompanying person per treatment [1]. The medical leave certificate is issued by the attending specialist based on a certificate of used days from the health insurance house (under Casa Națională de Asigurări de Sănătate rules), and the gross allowance equals 85% of the calculation basis [1].
   • Statutory carer's leave (concediu de îngrijitor) and disability assessment: under the Labour Code (Codul muncii), any employee is entitled upon request to up to 5 working days of carer's leave per calendar year to provide personal care or support to a relative or household member suffering from a serious medical condition. Additionally, where the illness causes severe loss of autonomy, the specialist physician can issue the medical report (referat medical) needed for severe disability classification (including entitlement to a personal assistant or companion allowance, indemnizație de însoțitor) through the county or Bucharest sector General Directorate of Social Assistance and Child Protection (DGASPC).
5. 5

   Organise the Will, Pension Rights, Civil Status Documents, and Succession Procedure

   While the ill person retains full legal capacity, they can organise their estate and prepare key documents to streamline post-death formalities for the family [4]:

   • Authentic notarial will and vital documents: the patient may execute a notarial will (testament autentic) before a public notary - registered in the National Notarial Register of Liberalities (RNNEL) administered by the Uniunea Națională a Notarilor Publici din România - respecting the statutory reserved share (rezerva succesorală) of forced heirs [4]. Gather original civil status documents (identity card, birth and marriage certificates), the pension decision, property deeds, bank contracts, and life insurance policies, and note funeral or cremation wishes.
   • Death grant (ajutor de deces) and survivor's pension (pensie de urmaș): after a death, applications for the death grant and survivor's pension are submitted through the Casa Națională de Pensii Publice (National House of Public Pensions - CNPP, via the local territorial pension house) [6]. The death grant is paid to a single person who presents the original death certificate and proof of bearing the funeral expenses, while the surviving spouse and eligible children may claim a survivor's pension under Law no. 360/2023 [6].
   • Notarial succession procedure and 2-year tax exemption: where heirs agree on their shares and assets, the estate is settled through the notarial succession procedure (procedura succesorală notarială) before a public notary in the judicial district of the deceased's last domicile [4]. Under the Fiscal Code administered by the Agenția Națională de Administrare Fiscală (National Agency for Fiscal Administration - ANAF), heirs are exempt from real estate transfer tax if the succession is completed within 2 years of the date of death; after the 2-year deadline, a 1% tax on the value of inherited real estate applies and is withheld by the notary upon issuing the certificate of heir (certificat de moștenitor) [7].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Medical leave, social health insurance allowances, and reimbursed medical and palliative care — Casa de Asigurări de Sănătate a Municipiului București (CASMB / CNAS)
2. [2]
   Free specialist palliative care services for adult patients — HOSPICE Casa Speranței
3. [3]
   Law no. 46/2003 on Patients' Rights (Legea drepturilor pacientului) — Ministerul Sănătății
4. [4]
   Notarial succession procedure and national notarial registers — Uniunea Națională a Notarilor Publici din România (UNNPR)
5. [5]
   Notarial acts (powers of attorney and declarations) at diplomatic missions and consular offices — Ministerul Afacerilor Externe (MAE)
6. [6]
   Death grant (ajutorul de deces) and social insurance benefits — Casa Națională de Pensii Publice (CNPP)
7. [7]
   Tax on income from the transfer of personal real estate by inheritance (successions) — Agenția Națională de Administrare Fiscală (ANAF)