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

1. 1

   Coordinate Specialist Palliative Care, Home Care, and Inpatient Units

   Activate specialist palliative care resources through the public health service of your autonomous community:

   • Referral to public palliative care units and home support teams: Ask the specialist medical team or the primary care physician at the local health center (centro de salud) for a referral to the palliative care resources of your autonomous community within the National Health System (Sistema Nacional de Salud), coordinated at state level by the Ministerio de Sanidad (Ministry of Health) [1]. Depending on the autonomous community, care is delivered through hospital Palliative Care Units (Unidades de Cuidados Paliativos) and Home Care Support Teams (Equipos de Soporte de Atención Domiciliaria - ESAD, or PADES in Catalonia, PALCA in the Basque Country, and equivalent units under SERMAS in Madrid or SAS in Andalusia) for pain management, psychosocial support, and home monitoring [1].
   • Directory of specialist units and Advance Care Planning: To locate hospital units, home support teams, and residential care centers in each province, consult the Sociedad Española de Cuidados Paliativos (Spanish Society for Palliative Care - SECPAL), which also provides guidance on Advance Care Planning (Planificación Anticipada de Cuidados - PAC) together with the clinical and social work team [2].
2. 2

   Execute and Register an Advance Directive (Living Will)

   While your family member retains full decision-making capacity, they can execute a written Advance Directive (Documento de Instrucciones Previas, also called Voluntades Anticipadas or Testamento Vital depending on the autonomous community), regulated nationwide by Article 11 of Law 41/2002 on patient autonomy and Royal Decree 124/2007 [1][3]:

   • Scope of medical instructions and healthcare proxy: In this document, the ill person sets out binding instructions on the medical care and treatments they wish to accept or refuse (such as limitation of therapeutic effort, mechanical ventilation, cardiopulmonary resuscitation, or palliative sedation), appoints a representative (representante) as interlocutor with the medical team, and may record wishes regarding organ donation or disposition of the body [1][3].
   • Formal execution and national registration: Depending on the applicable regional law, the document is executed through one of three channels: before a notary (without the need for witnesses), before registry officials at the Autonomous Registry of Advance Directives (Registro Autonómico de Instrucciones Previas) or designated healthcare facility units, or before three adult witnesses with full legal capacity (at least two of whom must not be related within the second degree or share a financial relationship with the declarant) [1][3]. Once registered in the relevant regional registry, it is synchronized electronically with the National Registry of Advance Directives (Registro Nacional de Instrucciones Previas - RNIP) of the Ministerio de Sanidad so that it can be accessed via the electronic health record in any hospital across Spain [1][3].
3. 3

   Execute a Public Deed of Preventive Power of Attorney Before a Notary

   Because ordinary bank authorizations and standard powers of attorney become invalid or frozen if a loss of legal capacity occurs, it is essential that your family member visit a notary office (notaría) while retaining full discernment to execute a Preventive Power of Attorney (Poder Preventivo) by public deed (escritura pública), following the guidelines of the Consejo General del Notariado (General Council of Notaries) and the Civil Code reform introduced by Law 8/2021 [4][5].

   There are two main forms that the notary tailors to each situation:

   • General power of attorney with a subsistence clause (Poder general con cláusula de subsistencia): Takes effect immediately upon signing and remains valid even if the grantor subsequently requires support in exercising legal capacity [4][5].
   • Strict preventive power of attorney (Poder preventivo en sentido estricto): Takes effect only at a future point when loss of capacity is certified in accordance with the medical or notarial criteria specified in the deed itself [4][5].
   • Scope and Civil Registry notification: A preventive power of attorney can cover both financial and banking administration (managing accounts, collecting pensions, paying care expenses, or disposing of assets) and personal and healthcare matters, and the notary notifies the Civil Registry (Registro Civil) ex officio to avoid the need for judicial support proceedings (curatela) [4][5].
4. 4

   Apply for Urgent Dependency Assessment, Caregiver Leave, and Disability Benefits

   Apply early for the social and employment entitlements available to the ill person and family caregivers:

   • Fast-track Dependency Assessment (Valoración de Dependencia por vía de urgencia - Law 39/2006): Through municipal or regional social services integrated into the System for Autonomy and Care for Dependency (Sistema para la Autonomía y Atención a la Dependencia - SAAD), coordinated by the Instituto de Mayores y Servicios Sociales (Institute for Older Persons and Social Services - IMSERSO), submit an application for recognition of the degree of dependency (Grade I, II, or III), attaching the medical report confirming the advanced stage of the illness to request priority or social-emergency processing [6][7]. The Individual Care Program (Programa Individual de Atención - PIA) grants access to home help services, day centers, telecare, or a financial allowance for family care [6][7].
   • Social Security disability benefits and statutory caregiver leave: If the ill person is employed, they can apply for temporary incapacity leave (incapacidad temporal) or a permanent disability pension (incapacidad permanente absoluta or gran invalidez, which includes a supplement to remunerate a caregiver) through the Instituto Nacional de la Seguridad Social (National Institute of Social Security - INSS) [8]. Employed family caregivers are entitled under Articles 37.3.b, 37.6, and 46.3 of the Workers' Statute (Estatuto de los Trabajadores) to 5 days of paid leave for serious illness or hospitalization of relatives up to the second degree, as well as to request working-time adaptation or reduction (between one-eighth and one-half of working hours) or unpaid caregiver leave (excedencia) to care for a relative up to the second degree [8].
5. 5

   Review the Will, Insurance Policies, and Documentation for Succession Procedures

   While your family member retains full testamentary capacity, it is advisable to review or execute an open notarial will (testamento abierto notarial) before a notary of the Consejo General del Notariado, which simplifies future estate administration and avoids a costly intestate declaration of heirs (declaración de herederos abintestato) [4]. Gather in an accessible folder the valid DNI or NIE, literal birth and marriage certificates (or domestic partnership registration), property deeds, bank contracts, life or funeral insurance policies (seguros de vida o de decesos), and written burial or cremation preferences.

   Keeping these documents organized streamlines the mandatory post-death procedures:

   • Social Security survivor benefits (Muerte y Supervivencia): Apply to the Instituto Nacional de la Seguridad Social (via its electronic portal or at a CAISS office) for the death grant (Auxilio por defunción, 5-year claim window) and widowhood, orphanhood, or family survivor pensions [8][9].
   • Certificates of Last Will and Life Insurance (Modelo 790): Once at least 15 working days (días hábiles) have elapsed after the date of death, apply to the Ministerio de la Presidencia, Justicia y Relaciones con las Cortes (Ministry of the Presidency, Justice and Relations with the Courts) using Form 790 (Modelo 790, code 006) and the literal death certificate for both the Certificate of Acts of Last Will (Certificado del Registro General de Actos de Última Voluntad) and the Certificate of Death-Coverage Insurance Contracts (Certificado de Contratos de Seguros de Cobertura de Fallecimiento) [10].
   • Inheritance Tax and Municipal Capital Gains Tax: Settle Inheritance and Gift Tax (Impuesto sobre Sucesiones y Donaciones) with the tax agency of the relevant autonomous community (or the state tax agency AEAT where non-resident state rules apply) and the municipal urban land value tax (plusvalía municipal / IIVTNU) within the statutory 6-month deadline from death, bearing in mind that a 6-month extension can be requested within the first 5 months of that period [4][10].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   National Registry of Advance Directives (Registro Nacional de Instrucciones Previas - RNIP) — Ministerio de Sanidad
2. [2]
   Advance Care Planning and Palliative Care Resources in Spain — Sociedad Española de Cuidados Paliativos (SECPAL)
3. [3]
   Royal Decree 124/2007 Regulating the National Registry of Advance Directives — Boletín Oficial del Estado (BOE)
4. [4]
   Preventive Powers of Attorney and Notarial Self-Protection Documents — Consejo General del Notariado
5. [5]
   Wills, Preventive Powers of Attorney, and Personal Autonomy Before a Notary — Consejo General del Notariado
6. [6]
   Law 39/2006 on the Promotion of Personal Autonomy and Care for Persons in a Situation of Dependency — Boletín Oficial del Estado (BOE)
7. [7]
   Dependency Portal: System for Autonomy and Care for Dependency (SAAD) — Instituto de Mayores y Servicios Sociales (IMSERSO)
8. [8]
   Death and Survivor Benefits (Prestaciones por Muerte y Supervivencia) — Instituto Nacional de la Seguridad Social (Seguridad Social)
9. [9]
   Death Grant (Auxilio por Defunción): Requirements and Application — Instituto Nacional de la Seguridad Social (Seguridad Social)
10. [10]
    Certificate of Acts of Last Will (Certificado de Actos de Última Voluntad - Modelo 790) — Ministerio de la Presidencia, Justicia y Relaciones con las Cortes