Cross-Border Terminal Illness & Advance Care Checklist: United Kingdom & Portugal

1. 1

   Palliative and Hospice Care and Cross-Border Healthcare Coordination

   In the United Kingdom, the primary route for symptom management and specialist end-of-life support is through the person's GP or hospital specialist, who can refer the person to local National Health Service (NHS) specialist palliative care teams and community hospices supported by networks such as Hospice UK and Marie Curie [1]. When a person has rapidly deteriorating health needs entering a terminal phase, an appropriate clinician (hospital consultant, GP, or community nurse) can submit the NHS Continuing Healthcare Fast Track Pathway Tool to arrange an urgent, fully NHS-funded care package at home, in a care home, or in a hospice without means testing [1].

   In Portugal, public palliative support is organised through the Rede Nacional de Cuidados Paliativos (RNCP) within the Serviço Nacional de Saúde (SNS), accessible via the family doctor at the local health centre (centro de saúde), hospital palliative care teams (EIHSCP), or community support teams (ECSCP), with 24-hour clinical triage available through SNS 24 (phone 808 24 24 24) and professional directories maintained by the Associação Portuguesa de Cuidados Paliativos (APCP) [2][3]. If the family is considering relocating between the UK and Portugal for care, check UK Global Health Insurance Card (GHIC) or S1 healthcare coordination rules in advance: temporary cover applies only to medically necessary care during a stay, whereas planned cross-border treatment or medical transport requires prior insurer or health authority authorisation.

2. 2

   Written Advance Directives and Living Wills in Both Countries

   Because clinical advance care forms are not automatically transferable between the UK and Portugal, separate written directives should be executed in each jurisdiction while your family member retains full mental capacity.

   • United Kingdom: In England and Wales, the person can execute a written Advance Decision to Refuse Treatment (ADRT, or Living Will) under the Mental Capacity Act 2005 [1]. If the ADRT refuses life-sustaining treatment (such as cardiopulmonary resuscitation, mechanical ventilation, or artificial nutrition and hydration), it must be in writing, signed, witnessed, and state explicitly that the refusal applies even if life is at risk [1]. Ask the treating clinical team to record an emergency care summary using the ReSPECT emergency care and treatment summary process so ambulance crews and out-of-hours clinicians have immediate access to agreed care goals [1].
   • Portugal: The person can execute a formal Diretiva Antecipada de Vontade (DAV, commonly known as a Testamento Vital) and appoint a healthcare proxy (Procurador de Cuidados de Saúde) under Law no. 25/2012 [2]. To make the directive immediately accessible to doctors across the Portuguese health system, file the official form with the Registo Nacional do Testamento Vital (RENTEV), managed by the Serviços Partilhados do Ministério da Saúde (SPMS) via SNS 24, either in person at a local RENTEV desk (health centre or grouping) or by post with a notarised signature [2].
3. 3

   Separate Financial and Healthcare Powers of Attorney

   Banks, property registries, and healthcare providers in Portugal generally do not accept a UK Lasting Power of Attorney directly without complex legalisation, and UK institutions require domestic statutory instruments. Separate powers of attorney should be put in place in both countries while full legal capacity remains.

   • United Kingdom: In England and Wales, the person should execute and register two separate Lasting Powers of Attorney (LPAs) with the Office of the Public Guardian (phone 0300 456 0300): one LPA for Health and Welfare (effective only if mental capacity is lost) and one LPA for Property and Financial Affairs (which can be used once registered, with the person's consent) [4]. If the person resides or owns assets in Scotland, execute a Continuing and Welfare Power of Attorney registered with the Office of the Public Guardian (Scotland), or an Enduring Power of Attorney in Northern Ireland [4].
   • Portugal: For banking, tax administration, and property management in Portugal, the person should execute a formal notarial power of attorney (procuração) before a Portuguese notary (Cartório Notarial through the Ordem dos Notários), a registry office of the Instituto dos Registos e do Notariado (IRN), or a Portuguese consulate in the UK [5]. To protect personal and financial decision-making in the event of future incapacity under Portuguese civil law, the person can also execute an advance mandate for accompaniment (mandato com vista a acompanhamento) so a Portuguese court respects their chosen representative if a formal regime do maior acompanhado is ever required.
4. 4

   Fast-Track Terminal Illness Benefits, Disability Support, and Caregiver Leave

   Both jurisdictions provide expedited financial benefits and statutory employment protections for family caregivers.

   • United Kingdom: Under the Department for Work and Pensions (DWP) Special Rules for End of Life, when a clinician expects death within 12 months, ask the doctor or specialist nurse to complete an SR1 medical report [6]. This fast-tracks claims for Personal Independence Payment (PIP), Attendance Allowance, or Universal Credit without a face-to-face assessment and at enhanced rates [6]. Unpaid carers providing at least 35 hours a week of care can apply for Carer's Allowance, and employees in Great Britain are entitled to up to one week of statutory unpaid Carer's Leave per year [7].
   • Portugal: Through the Instituto da Segurança Social, a person requiring third-party assistance for daily living activities can claim the Complemento por Dependência (assessed in 1st or 2nd degree by the disability verification system, including under the special invalidity protection regime for severe progressive illnesses) [8]. Family members providing regular or permanent care in Portugal can apply for recognition under the Estatuto do Cuidador Informal (via Segurança Social Direta) to access support measures and respite services, while employees under the Portuguese Labour Code (Código do Trabalho) are entitled to statutory family-assistance absences and caregiver leave [3].
5. 5

   Aligning Wills, Estate Administration, and Post-Death Deadlines

   Reviewing wills, tax obligations, and post-death registration rules in advance prevents conflicts between UK freedom of testamentary disposition and Portuguese forced-heirship rules (legítima).

   • Cross-Border Wills Alignment: Coordinate with a cross-border legal adviser or notary so UK and Portuguese wills are aligned without accidentally revoking one another, and check whether an election of national law under the EU Succession Regulation (Regulation (EU) No 650/2012) is relevant to Portuguese assets.
   • United Kingdom Post-Death Steps: Following a death in the UK, use the Tell Us Once service after civil registration to notify HM Revenue & Customs (HMRC), the Department for Work and Pensions (including the DWP Bereavement Service and International Pension Centre), passport offices, and local councils at once [9]. The executor or administrator applies for a Grant of Probate (or Letters of Administration) in England and Wales (or Confirmation in Scotland) to administer UK estates [10].
   • Portugal Post-Death Steps: In Portugal, surviving family members or payers of funeral costs can claim survivor and bereavement benefits from Segurança Social: the lump-sum Subsídio por Morte must generally be claimed within 180 days of the death, the funeral expense reimbursement (Reembolso de Despesas de Funeral) within 90 days, alongside any ongoing Pensão de Sobrevivência [11]. The head of the estate (cabeça-de-casal) can use the Espaço Óbito and the Balcão das Heranças (administered by the Instituto dos Registos e do Notariado (IRN) via the Portal da Justiça) to complete the formal identification of heirs (habilitação de herdeiros) and property partition, and must report the death and estate assets to the Autoridade Tributária e Aduaneira (AT) for Stamp Duty (Imposto do Selo) by the end of the third month following the month of death [5].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Advance decision to refuse treatment (living will) and end of life care — National Health Service (NHS)
2. [2]
   Testamento Vital (Diretiva Antecipada de Vontade - RENTEV) — SNS 24 / Serviço Nacional de Saúde
3. [3]
   Guia Prático do Estatuto do Cuidador Informal e Cuidados de Saúde — SNS 24 / Serviço Nacional de Saúde
4. [4]
   Make, register or end a lasting power of attorney — GOV.UK / Office of the Public Guardian
5. [5]
   Balcão das Heranças e Habilitação de Herdeiros — Portal da Justiça / Instituto dos Registos e do Notariado (IRN)
6. [6]
   Get benefits faster if you are nearing the end of life (Special Rules) — GOV.UK / Department for Work and Pensions
7. [7]
   Carer's Allowance and support for carers — GOV.UK
8. [8]
   Complemento por Dependência — Segurança Social
9. [9]
   Organisations you need to contact and Tell Us Once — GOV.UK
10. [10]
    Applying for probate — GOV.UK
11. [11]
    Subsídio por Morte e prestações por falecimento — Segurança Social