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

1. 1

   Coordinating palliative care, home support, and CNAM health coverage

   The immediate priority is structuring medical follow-up, pain management, and financial coverage for serious illness care with the National Health Insurance Fund [5].

   • Specialist care and pain management units: The specialist physician or treating oncologist (notably at University Hospital Centers, the Salah Azaïz Institute, or contracted private clinics) establishes the therapeutic and palliative care protocol designed to relieve pain and symptoms effectively [5].
   • Full coverage application for Severe or Chronic Illness (APCI): Submit or update the medical application for Fully Covered Conditions (APCI) promptly at the regional or local center of the National Health Insurance Fund to obtain 100% coverage for specific medications, treatment sessions, and hospitalizations [5].
   • Home care and medical equipment: When the ill person prefers to remain at home, the treating physician prescribes nursing visits, oxygen therapy, or medical equipment, for which prior authorization and reimbursement are processed by the National Health Insurance Fund [5].
2. 2

   Recording medical wishes and designating a primary family representative

   While your family member is fully able to express their choices, it is essential to document medical preferences and designate a clear family point of contact for the healthcare team [5] [6].

   • Documenting therapeutic preferences with the treating physician: Under Tunisian medical ethics rules governing informed consent and patient dignity, the ill person may state in writing their preferences regarding the limitation of disproportionate invasive procedures, repeat hospitalizations, and priority comfort care so that these instructions are placed in their medical file [5].
   • Designating a family spokesperson with the healthcare facility: It is advisable to record in writing in the hospital file the contact details of an adult family member designated as the primary family spokesperson, responsible for receiving medical updates and being consulted by doctors if the patient can no longer communicate [5].
   • Organizing an emergency medical folder at home: Keep current prescriptions, the care card or APCI approval issued by the National Health Insurance Fund, recent hospital discharge summaries, and the treating physician's contact details readily accessible at home to assist emergency medical services (SAMU) or on-call doctors [5].
3. 3

   Executing notarial and bank powers of attorney while legal capacity is intact

   To prevent any freeze on bank accounts or disruption to everyday administration if health deteriorates, powers of attorney must be executed while the ill person's mental capacity is completely intact [6].

   • Authentic or legalized power of attorney (Tawkil): Under the Tunisian Code of Obligations and Contracts overseen by the Ministry of Justice, any adult with full civil capacity may have a special or general power of attorney drafted by a civil-law notary (who may travel to the patient's home or hospital bedside) or have their signature legalized at the municipality for routine administrative acts [6].
   • Specific bank and postal mandates: Tunisian commercial banks and Tunisian Post frequently require customers to sign their own internal branch mandate forms or present a detailed notarial power of attorney explicitly specifying the account number and authorized transactions. Complete this step early to ensure uninterrupted payment of medical bills and household expenses [6].
   • Judicial guardianship if capacity is subsequently lost: If no power of attorney was signed in time and the person loses mental capacity, a notary can no longer record their consent; the family must then petition the competent judge under the Ministry of Justice to establish legal guardianship [6].
4. 4

   Activating disability pensions, social assistance, and caregiver support

   A serious illness causing permanent or prolonged inability to work entitles insured persons to financial and social benefits from the institutions supervised by the Ministry of Social Affairs [1] [2] [3] [4].

   • Private-sector and self-employed disability pension (CNSS): If the illness reduces the working capacity of a private-sector employee or self-employed worker by at least two-thirds, an application for an invalidity pension may be filed with the National Social Security Fund together with a detailed medical certificate, wage attestations, and civil status documents [1] [2]. Where constant assistance from another person is required to perform essential daily activities, a supplement for third-party assistance may be added [1] [2].
   • Long-term sick leave and invalidity in the public sector (CNRPS): For civil servants and public-sector employees, entitlements to long-term sick leave with continued pay or retirement on grounds of invalidity are processed in coordination with the public employer and the National Retirement and Social Contingency Fund [3].
   • Disability card and Ministry of Social Affairs programs: For vulnerable individuals or those requiring specialized equipment and support, local social promotion units under the Ministry of Social Affairs process applications for disability cards and social support programs [4].
5. 5

   Advance review of civil status records, testamentary provisions, and property titles

   A preventive check of civil status records and property deeds spares relatives complex judicial rectification procedures later [6].

   • Verifying the family book and civil status records: Check now that names, surnames, and dates match accurately across the National Identity Card, the family book, and the birth extracts of your family member and their relatives so that any clerical errors can be corrected while the person is able to act [6].
   • Drafting a will (Wassiya) and estate organization: Under the Tunisian Personal Status Code administered under the authority of the Ministry of Justice, a person with full legal capacity may execute a will ("Wassiya", within the statutory limit of one-third of the net estate or in accordance with applicable statutory rules) before a notary and review beneficiary clauses on life insurance or savings contracts [6].
   • Property titles and international coordination: Gather real estate ownership deeds (registered land titles or registered contracts), bank statements, and affiliation certificates from the National Social Security Fund or the National Retirement and Social Contingency Fund [1] [3] [6]. If relatives reside abroad or assets are located outside Tunisia, a Tunisian notary can prepare and affix an apostille to the documents required for cross-border coordination [6].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Social Security Benefits for Private-Sector Salaried Workers (CNSS) — Caisse Nationale de Sécurité Sociale (CNSS Tunisie)
2. [2]
   Invalidity Pension and Eligibility Conditions (CNSS) — Caisse Nationale de Sécurité Sociale (CNSS Tunisie)
3. [3]
   Services and Benefits of the National Retirement and Social Contingency Fund (CNRPS) — Ministère des Affaires Sociales - Portail Idarti
4. [4]
   Social Protection, Social Promotion, and Support for Persons with Disabilities — Ministère des Affaires Sociales - République Tunisienne
5. [5]
   Coverage of Severe or Chronic Illnesses (APCI) and Medical Equipment (CNAM) — Caisse Nationale d'Assurance Maladie (CNAM Tunisie)
6. [6]
   Judicial Services, Legal Protection, and Notarial Practice in Tunisia — Ministère de la Justice - République Tunisienne