Cross-Border Terminal Illness & Advance Care Checklist: UK & Spain

1. 1

   Coordinate palliative care in Spain and cross-border healthcare coverage with the UK

   • Public palliative care in Spain (SNS and ESAD): In Spain, palliative care is provided free of charge within the National Health System (Sistema Nacional de Salud - SNS) through hospital palliative care units and Home Care Support Teams (Equipos de Soporte de Atención Domiciliaria - ESAD), activated by referral from the primary care doctor or hospital specialist in the relevant autonomous community. The Sociedad Española de Cuidados Paliativos (Spanish Society for Palliative Care, phone +34 659 694 706, email [email protected]) maintains an updated directory of palliative care units and support teams across every province [1].
   • UK-Spain healthcare coordination (S1, GHIC, S2, and Fit-to-fly): If your family member is a UK state pensioner residing in Spain who has registered form S1 with the Spanish National Institute of Social Security (Instituto Nacional de la Seguridad Social - INSS), they are entitled to Spanish public healthcare on the same basis as a local insured resident while also retaining the right to receive NHS care during temporary visits to the United Kingdom [2]. Temporary visitors in Spain use the UK GHIC or UK EHIC card, whereas planned specialist treatment requires prior authorisation via form S2 arranged through NHS Overseas Healthcare Services (phone +44 191 218 1999) [2][3]. If a transfer to an NHS hospital or hospice in the UK is being considered, it is essential to obtain advance Fit-to-fly medical clearance or arrange air ambulance transport and carry a translated clinical summary detailing pain relief and symptom control regimens [2][3].
2. 2

   Execute a Spanish Advance Directive (*Instrucciones Previas*) and a UK Living Will

   • Spanish Advance Directive (Documento de Instrucciones Previas / Testamento Vital): So that decisions regarding life-sustaining treatment, palliative sedation, and end-of-life care are legally binding on medical teams in Spain, the ill person - while retaining full legal capacity - should execute a Documento de Instrucciones Previas (also called Voluntades Anticipadas or Testamento Vital depending on the autonomous community) under Law 41/2002 [4]. Depending on regional rules, it can be signed before a notary, before an official at the regional registry, or before three adult witnesses (at least two of whom must have no family relationship within the second degree or financial link to the grantor), and registered in the regional registry so it is synchronised with the National Registry of Advance Directives (Registro Nacional de Instrucciones Previas - RNIP) of the Ministerio de Sanidad (Spanish Ministry of Health), accessible from any SNS hospital [4].
   • Appointing a healthcare representative and UK Advance Decision (ADRT): In the Spanish directive, it is advisable to expressly appoint a healthcare proxy (representante sanitario) to act as interlocutor with the medical team if the patient loses capacity to express their wishes [4]. If there is any possibility of receiving medical care in the United Kingdom, it is wise to sign in parallel an Advance Decision to Refuse Treatment (ADRT or Living Will) under the Mental Capacity Act 2005 in England and Wales (or an Advance Directive in Scotland), together with an emergency care plan (ReSPECT), providing copies to the GP and close relatives.
3. 3

   Put in place a Spanish Preventive Power of Attorney and a UK Lasting Power of Attorney

   • Why separate powers are required in both countries: A power of attorney granted in the UK cannot be used automatically before Spanish banks, notaries, or public authorities without a Hague Apostille, sworn translation (traducción jurada), and verification of legal equivalence - and the reverse is equally true. It is therefore essential to execute separate instruments in each jurisdiction while the ill person retains full cognitive capacity [5][6].
   • Spanish Poder Preventivo and UK Lasting Power of Attorney (LPA): In Spain, you should contact a notary office through the Consejo General del Notariado (General Council of the Spanish Notariat) to execute a public deed of Preventive Power of Attorney (Poder Preventivo or Poder General con cláusula de subsistencia en caso de incapacidad), authorising the attorney-in-fact to manage Spanish bank accounts, pensions, utilities, tax filings, and real estate without requiring court support proceedings [5]. If the ill person cannot travel for medical reasons, the Spanish notary can attend their home or hospital bed to authorise the deed [5]. In the United Kingdom, you should prepare and register with the Office of the Public Guardian (phone +44 203 518 9639, email [email protected]) a Lasting Power of Attorney (LPA) in both forms - Property and Financial Affairs for UK bank accounts and assets, and Health and Welfare for health and care decisions in England and Wales (or a Continuing and Welfare Power of Attorney with the Office of the Public Guardian in Scotland) [6].
4. 4

   Request an urgent Spanish dependency assessment and UK Special Rules terminal illness benefits

   • Urgent dependency assessment in Spain (SAAD / Ley 39/2006): To activate public home-help hours, telecare, day care, or financial allowances for family caregivers in Spain, submit an application for dependency grading under the System for Autonomy and Care for Dependency (Sistema para la Autonomía y Atención a la Dependencia - SAAD, Law 39/2006), coordinated nationally by the Instituto de Mayores y Servicios Sociales (Institute for Older Persons and Social Services - IMSERSO, phone +34 912 667 713) and administered by the regional or municipal social services [7]. By attaching a palliative medical report confirming a serious prognosis or rapid functional decline, health-centre or hospital social workers can request the fast-track emergency procedure available in that autonomous community [7].
   • UK Special Rules for End of Life (form SR1): In parallel, if your family member has UK social security links and an estimated medical prognosis of 12 months or less, the Department for Work and Pensions (DWP) applies fast-track processing under the Special Rules for End of Life using clinical form SR1 [8]. UK pensioners or insured residents in Spain covered by social security coordination rules can check eligibility and claim exportable disability benefits such as Attendance Allowance or the daily living component of Personal Independence Payment (PIP) through the International Pension Centre and the DWP Exportability Team (phone +44 191 218 7777) [8][9].
5. 5

   Coordinate Spanish and UK wills under the EU Succession Regulation and record funeral wishes

   • Coordinating a Spanish notarial will and a UK Will: When assets are held in both Spain and the United Kingdom, it is generally advisable to execute a Spanish open notarial will (Testamento Abierto Notarial) limited to assets located in Spain alongside a separate British Will covering UK assets, ensuring that neither document inadvertently revokes the other [5][10]. A will signed before a Spanish notary is automatically recorded in the Central Registry of Last Wills (Registro General de Actos de Última Voluntad) of the Ministerio de Justicia (Spanish Ministry of Justice), avoiding the lengthy delay and expense of legalising and translating a UK Grant of Probate to release Spanish bank accounts or transfer property [10].
   • Choice of UK national law (professio iuris) and final wishes: For British nationals residing in Spain, EU Regulation No 650/2012 applies the law of habitual residence by default unless the testator expressly includes a choice-of-law clause (professio iuris) in their will electing the law of their UK nationality (English and Welsh, Scottish, or Northern Irish law), preserving UK testamentary freedom instead of Spain's forced heirship rules (legítimas) [5]. Finally, record clear preferences regarding local burial or cremation in Spain versus repatriation to the UK, and gather any funeral insurance (seguro de decesos) or life insurance policies in both countries [10].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Directory and contact details for palliative care resources in Spain — Sociedad Española de Cuidados Paliativos (SECPAL)
2. [2]
   Healthcare for UK nationals visiting and living in Spain (S1, GHIC and S2) — GOV.UK
3. [3]
   Contact Overseas Healthcare Services — NHS Business Services Authority (NHSBSA)
4. [4]
   National Registry of Advance Directives (Registro Nacional de Instrucciones Previas - RNIP) — Ministerio de Sanidad
5. [5]
   What preventive powers of attorney (poderes preventivos) are and what they allow — Consejo General del Notariado
6. [6]
   Make, register or end a lasting power of attorney — GOV.UK / Office of the Public Guardian
7. [7]
   System for Autonomy and Care for Dependency (Sistema para la Autonomía y Atención a la Dependencia - SAAD) — Instituto de Mayores y Servicios Sociales (IMSERSO)
8. [8]
   Claiming benefits if you have 12 months or less to live (Special Rules for End of Life - SR1) — GOV.UK / Department for Work and Pensions
9. [9]
   Claiming disability and carers benefits abroad — GOV.UK / International Pension Centre
10. [10]
    Central Registry of Last Wills (Registro General de Actos de Última Voluntad) — Ministerio de Justicia