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

1. 1

   Activating Palliative Care and Home or Hospital Support

   • Specialist symptom management and pain therapy: In San Marino, public pain management and palliative care are coordinated by the Istituto per la Sicurezza Sociale through the UOS Medicina del Dolore, Cure Palliative e Hospice, which provides specialist control of complex pain as well as physical and psychological symptoms associated with advanced oncological or chronic degenerative conditions [1] [2].
   • Integrated home care across the municipalities (Castelli): Upon referral by the primary care physician at the local Health Center (Centro Sanitario) or by a discharging hospital ward, the multidisciplinary team of the Istituto per la Sicurezza Sociale sets up individualized nursing, medical, and home-care plans directly at the ill person's residence, including the provision of medical equipment and assistive devices [1] [2].
   • Continuity of care between home and the State Hospital: When clinical needs require closer inpatient monitoring or temporary respite admissions for the family, the hospital service coordinates seamless transitions between home care and the dedicated wards at the State Hospital in Cailungo under public healthcare coverage [1] [2].
2. 2

   Documenting Medical Treatment Wishes and Naming a Trusted Representative

   • Informed consent and shared care planning: While your family member retains full decision-making capacity, they can work with the physicians of the Istituto per la Sicurezza Sociale and the UOS Medicina del Dolore, Cure Palliative e Hospice to establish a shared care plan (pianificazione condivisa delle cure), specifying which treatments they wish to accept or refuse in later stages of the illness [1] [2].
   • Written advance treatment directives and trusted proxy: The ill person may record written instructions regarding medical interventions (such as artificial nutrition, mechanical ventilation, or invasive resuscitation) and designate a trusted representative (fiduciario) to communicate with medical staff should they later become unable to express their wishes directly [1] [2].
   • Filing directives in the medical record: It is advisable to provide copies of the written care preferences and the representative's contact details both to the primary care physician at the local Health Center and to the specialist team at the State Hospital so they are immediately accessible in the electronic clinical file [1] [2].
3. 3

   Executing Notarial Powers of Attorney, Bank Mandates, and Protective Measures

   • General or special powers of attorney before a Sammarinese notary: Because informal authorizations are insufficient for property transactions or formal legal acts, it is essential that your family member, while retaining full mental capacity, sign a general or special power of attorney (procura generale o speciale) by public deed before a notary licensed in the Republic of San Marino, who will handle mandatory registration with the Ufficio del Registro e Conservatoria [4].
   • Operating mandates on Sammarinese bank accounts: We advise visiting the Sammarinese banks where the ill person holds accounts or deposits (or arranging a home signature collection where offered by the institution) to register the attorney-in-fact's specimen signature or activate a bank operating mandate for paying ongoing household and medical expenses [4].
   • Judicial protection if capacity is lost: If the illness impairs decision-making capacity before a notarial power of attorney has been executed, relatives must apply to the Civil Registry of the Tribunale della Repubblica di San Marino for non-contentious judicial protection measures (volontaria giurisdizione) on behalf of a vulnerable or incapacitated adult [5].
4. 4

   Applying for Disability Benefits, Attendance Allowances, and Caregiver Support

   • Disability assessment and attendance allowances: Patients whose serious illness substantially reduces personal autonomy may apply to the medical boards of the Istituto per la Sicurezza Sociale for formal recognition of disability or incapacity and for associated financial benefits or attendance allowances (indennità di accompagnamento) [2] [3].
   • Home support and territorial social-health services: Through the social and healthcare services of the Istituto per la Sicurezza Sociale, families can request domestic social-care assistance, free loan of orthopedic beds and pressure-relief aids, and dedicated psychological support for both the patient and family caregivers [1] [2].
   • Caregiver leave and employment protections: Employed family members in the Sammarinese public or private sector who care for a relative with a severe disability or progressive illness can verify available paid leave, extraordinary caregiver leave, and pension contribution protections with the Economic Benefits Office of the Istituto per la Sicurezza Sociale [2] [3].
5. 5

   Reviewing the Will, Civil Status Records, and Estate Documentation in Advance

   • Drafting or updating a will in San Marino: While full legal capacity is intact, your family member can draft or update their will (preferably as a public notarial will with a Sammarinese notary) to govern the distribution of assets in accordance with the statutory forced-heirship shares (quote di legittima) of Sammarinese law, simplifying future filings with the Ufficio del Registro e Conservatoria [4].
   • Verifying civil registry records and insurance designations: It is helpful to gather updated family status and civil registry certificates in advance from the Ufficio Stato Civile, Servizi Demografici ed Elettorali in Borgo Maggiore, and to review beneficiary designations on life insurance policies and supplementary pension funds [4] [6].
   • Coordinating cross-border assets or foreign heirs: If the ill person owns real estate, bank accounts, or business interests both in San Marino and in Italy or other countries, or if prospective heirs reside abroad, it is advisable to prepare an updated inventory of Sammarinese bank relationships and consult a notary to align Sammarinese inheritance rules with private international law and the procedural requirements of the Tribunale della Repubblica di San Marino [4] [5].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Pain Medicine, Palliative Care, and Hospice Operational Unit (UOS) — Istituto per la Sicurezza Sociale (ISS) - Repubblica di San Marino
2. [2]
   How-To Guide - Healthcare, Social Security, and Welfare Services — Istituto per la Sicurezza Sociale (ISS) - Repubblica di San Marino
3. [3]
   Retirement, Disability, and Social Security Benefits — Portale Ufficiale della Repubblica di San Marino (gov.sm)
4. [4]
   Public Administration FAQ: Successions and Inheritance Declarations (Registry and Land Conservatory Office) — Portale Ufficiale della Repubblica di San Marino (gov.sm)
5. [5]
   Offices and Court Registries - Civil and Non-Contentious Jurisdiction — Tribunale della Repubblica di San Marino
6. [6]
   Civil Registry, Demographic and Electoral Services Office - Republic of San Marino — Portale Ufficiale della Repubblica di San Marino (gov.sm)