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

1. 1

   Coordinate Palliative Care, Home Nursing, and Health Coverage

   • Hospital specialist and palliative care: Coordinate an integrated symptom-management and supportive care plan through the treating consultant at a tertiary government hospital overseen by the Ministry of Health and Sanitation (such as Connaught Hospital in Freetown or regional government hospitals in Bo, Kenema, and Makeni) or an accredited private clinic [2]. Ask the clinical team for a written medical summary detailing diagnosis, pain-control prescriptions, and home nursing requirements [2].
   • Hospice and community home-based care: In the Western Area and major districts, hospital social work and oncology units under the Ministry of Health and Sanitation coordinate referrals to specialist palliative and home-based care providers (such as The Shepherd's Hospice in Freetown and community health nurse teams) for domiciliary symptom management, analgesic supervision, and family caregiver training [2].
   • Health insurance and medical cost planning: If your family member is covered by a private health insurance policy or an employer medical scheme, submit the specialist's clinical report early to pre-authorise inpatient stays, diagnostic imaging, and home care supplies [2] [3].
2. 2

   Record Advance Healthcare Preferences and Designate a Medical Representative

   • Written statement of medical treatment preferences: Sierra Leone does not currently have a standalone statutory living-will regime separate from common-law informed consent rules, so it is essential for your family member to record their treatment wishes in writing while they have full mental capacity [2] [4]. This signed document should state preferences regarding pain and symptom relief, hospital admission versus home care, and whether to withhold invasive life-prolonging interventions when recovery is no longer possible [2].
   • Designating a primary family healthcare spokesperson: In hospital practice across facilities supervised by the Ministry of Health and Sanitation, clinicians consult the patient's designated next of kin when the patient can no longer communicate [2]. Having your family member sign a formal letter naming a primary and alternate medical representative - witnessed by two independent adults and placed in the hospital medical file - prevents disputes among extended relatives [2] [4].
   • Physician confirmation of capacity: When executing both healthcare instructions and legal mandates during serious illness, ask the attending doctor at the Ministry of Health and Sanitation facility or private clinic to record a contemporaneous note confirming that the patient is lucid, oriented, and capable of making autonomous decisions [2].
3. 3

   Execute Powers of Attorney and Bank Mandates While Capacity Is Intact

   • Executing a formal Power of Attorney: Under Sierra Leonean common-law and statutory practice overseen by the Judiciary of Sierra Leone, a person with full mental capacity may execute a Power of Attorney by deed, authorising a trusted attorney-in-fact to manage bank accounts, collect income, pay medical bills, and administer property [4].
   • Registration with the Office of the Administrator and Registrar-General: To ensure legal enforceability - especially where the attorney-in-fact may need to deal with land, leases, or third-party institutions - the Power of Attorney should be drafted by a legal practitioner, signed and witnessed before a Notary Public or Commissioner for Oaths, and registered as a statutory instrument at the Office of the Administrator and Registrar-General in Freetown [4] [6].
   • Direct commercial bank signatory mandates: Commercial banks in Sierra Leone apply strict verification procedures to third-party powers of attorney; while your family member retains capacity, contact each bank directly to complete the bank's own third-party mandate or joint-signatory forms and register the National Identification Number (NIN) issued by the National Civil Registration Authority for both the account holder and the authorised representative [1] [4].
   • Legal limits if capacity is lost: Because standard common-law powers of attorney in Sierra Leone can be affected if the donor subsequently loses mental capacity, completing direct bank mandates and establishing clear trust or joint-account arrangements while capacity is intact avoids the need for complex High Court applications before the Judiciary of Sierra Leone [4].
4. 4

   Activate NASSIT Invalidity Benefits and Workplace Support

   • NASSIT Invalidity Pension or Invalidity Grant: If your family member is an active or past contributor under the age of 60 who has been rendered permanently incapable of gainful employment due to serious illness, apply to the National Social Security and Insurance Trust for an Invalidity Pension (available where the member has at least 60 monthly contributions, including 12 within the 36 months preceding invalidity) or a lump-sum Invalidity Grant if contribution thresholds are not fully met [3].
   • Medical Board assessment: Claims filed with the National Social Security and Insurance Trust must be supported by a comprehensive medical certificate from the treating practitioner and are evaluated by the NASSIT Medical Board to certify permanent incapacity [2] [3].
   • Employer sick leave and medical boarding: For civil servants and formal-sector employees, coordinate with the employer's human resources department regarding paid statutory sick leave, compassionate caregiver leave, or formal medical boarding procedures so that employment terminal benefits and NASSIT entitlements are preserved [2] [3].
5. 5

   Review the Will, Beneficiary Designations, and Property Records

   • Drafting or updating a valid Will: Under the Devolution of Estates Act, 2007 (Act No. 21 of 2007) and the Wills Act rules applied by the Judiciary of Sierra Leone, a will must be in writing and signed by the testator in the simultaneous presence of at least two independent witnesses (who must not be beneficiaries or spouses of beneficiaries) [4] [5]. Note that under the Devolution of Estates Act, 2007, a court may make reasonable financial provision from an estate if a will fails to provide adequately for a dependent spouse, child, or parent [5].
   • Safe custody and statutory registration: A completed will can be lodged for safe custody with the Probate Registry of the High Court under the Judiciary of Sierra Leone or with the Office of the Administrator and Registrar-General under the Administration of Estates framework [4] [6].
   • Updating NASSIT and insurance nominations: Verify that survivor and beneficiary nomination records with the National Social Security and Insurance Trust and private insurers accurately list the spouse and dependent children, supported by civil birth and marriage certificates issued by the National Civil Registration Authority [1, 3, 5].
   • Cross-border assets and consular legalisation: Compile all title deeds, survey plans, and bank records; if any family representatives or assets are located abroad, remember that Sierra Leone is not a party to the Hague Apostille Convention, so powers of attorney executed abroad for use in Sierra Leone must be notarised and legalised through the relevant Sierra Leone embassy or high commission [4] [6].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   National Civil Registration Authority (NCRA) - Civil Status and Identity Services — National Civil Registration Authority (Sierra Leone)
2. [2]
   Ministry of Health and Sanitation - Hospital and Clinical Care Services — Ministry of Health and Sanitation (Sierra Leone)
3. [3]
   NASSIT Scheme Guide - Invalidity Benefits, Medical Board and Dependent Records — National Social Security and Insurance Trust (NASSIT)
4. [4]
   Judiciary of Sierra Leone - High Court and Probate Jurisdiction — Judiciary of Sierra Leone
5. [5]
   The Devolution of Estates Act, 2007 (Act No. 21 of 2007) - Wills and Family Provision — Sierra Leone Legal Information Portal
6. [6]
   The Administration of Estates (Amendment) Act, 2006 — Sierra Leone Legal Information Portal