Terminal Illness & End-of-Life Planning in São Tomé and Príncipe: 5-Step Official Checklist

1. 1

   Coordinating palliative care and hospital or home medical support

   • Hospital and district clinical coordination: The family should coordinate an ongoing care, pain-control, and symptom-management plan with the attending medical team at the Ayres de Menezes Hospital (in São Tomé), the Dr. Manuel Quaresma Dias da Graça Hospital (in Príncipe), or district health centers, requesting detailed medical reports on the diagnosis and clinical progression [4] [5].
   • Medical boards and medical evacuation: When a serious condition requires specialized treatment unavailable in the archipelago, the attending physician may refer the case to the Health Medical Board (Junta Médica de Saúde) to evaluate eligibility for medical evacuation under bilateral healthcare cooperation agreements or social security coverage [4] [5].
   • Organizing home care: To maintain comfort at home, it is advisable to keep an updated folder with all prescriptions, medical reports, district health team contacts, and civil identification documents ready for any urgent hospital visit [1] [5].
2. 2

   Advance medical directives, informed consent, and healthcare proxy

   • Written declaration of clinical preferences: Although São Tomé and Príncipe does not operate a dedicated electronic living will registry, the person who is ill may exercise the right to informed consent by signing a written declaration - with an in-person signature notarized at the Notarial Office (Cartório Notarial) - setting out instructions regarding invasive treatments, hospitalization, and comfort care [3].
   • Appointing a family medical spokesperson: While fully lucid, the person who is ill should formally designate a trusted family member as primary spokesperson before the attending physicians and hospital administration, asking that this appointment be placed in the medical file [3] [5].
   • Authorization to access medical records: It is advisable to sign an explicit written authorization enabling the designated family representative to request medical reports, laboratory results, and clinical certificates needed for medical boards or social security claims [3] [4].
3. 3

   Executing a public power of attorney at a notary office and bank mandates

   • Notarial public power of attorney: While the person who is ill enjoys full civil capacity and discernment, they should appear before the Notarial Office supervised by the Directorate-General of Registries and Notary (Direção-Geral dos Registos e do Notariado) to execute a public power of attorney (procuração pública) granting specific powers for administrative management, tax representation, property administration, and banking operations to a trusted attorney-in-fact [1] [3].
   • Notarial attendance at home or in hospital: If the person who is ill has severely restricted mobility but remains fully lucid, the family may request that an authorized officer from the Notarial Office attend the home or hospital ward to verify the grantor's capacity and record the public instrument [3].
   • Validating bank account mandates: Because commercial banks in São Tomé and Príncipe normally require in-person registration of powers of attorney on customer signature records, it is advisable to present the public power of attorney directly at the patient's bank branch to validate account operation powers while the account holder can confirm the mandate [3].
4. 4

   Claiming sickness or disability benefits and caregiver support

   • Sickness allowance and disability pension: If the person who is ill is an insured worker under the contributory scheme and suffers a permanent reduction of working capacity exceeding two-thirds (66%) due to a non-occupational illness expected to last at least three years, they may apply for a disability pension (pensão de invalidez) or sickness allowance (subsídio de doença) from the National Social Security Institute (Instituto Nacional de Segurança Social) [4] [5].
   • Supporting documentation and proof of life: Applications submitted to the National Social Security Institute must include the National Identity Card (Bilhete de Identidade), beneficiary card, medical certificate or Health Board determination, and contribution record. Pensioners must also comply with periodic proof-of-life (prova de vida) requirements established by the institution [4] [5].
   • Workplace documentation for family caregivers: Working family members who assist the person who is ill during medical appointments, hospitalizations, or medical board assessments should request hospital attendance certificates to justify absences with their employer [5].
5. 5

   Preventive preparation of wills, insurance beneficiaries, and property records

   • Public or sealed will: To organize succession in advance within the disposable portion (quota disponível) permitted under Santomean civil law (which protects the forced share reserved for statutory heirs such as a spouse, descendants, or ascendants), the person who is ill may execute a public will (testamento público) or have a sealed will (testamento cerrado) approved at the Notarial Office, with central registration maintained by the Central Registry Office (Conservatória dos Registos Centrais) [2] [3].
   • Updating civil and land registry documents: It is prudent to verify the validity of the National Identity Card of the person who is ill and close relatives, obtain updated birth and marriage certificates from the Directorate-General of Registries and Notary, review insurance policies, and confirm property titles at the Land Registry Office (Conservatória do Registo Predial) [1] [2].
   • Cross-border coordination of assets or heirs: Where there are assets, bank accounts, or heirs residing abroad, powers of attorney or public instruments executed at the Notarial Office must be legalized through the Ministry of Foreign Affairs, Cooperation and Communities and the relevant consular mission to take full legal effect abroad [2] [3].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Citizen Civil Registry and Identification Services — Direção-Geral dos Registos e do Notariado de São Tomé e Príncipe (DGRN)
2. [2]
   Central Registry Office - Registration of Wills, Public Deeds and Civil Status — Direção-Geral dos Registos e do Notariado de São Tomé e Príncipe (DGRN)
3. [3]
   Notarial Office - Public Powers of Attorney, Wills and Extrajudicial Acts — Direção-Geral dos Registos e do Notariado de São Tomé e Príncipe (DGRN)
4. [4]
   Pension Scheme - Disability Pension, Incapacity Requirements and Qualifying Periods — Instituto Nacional de Segurança Social de São Tomé e Príncipe (INSS)
5. [5]
   Social Security Allowances and Benefits - Sickness Allowance and Family Protection — Instituto Nacional de Segurança Social de São Tomé e Príncipe (INSS)