United States – End of Life Issues

What end of life care options are available in United States, and how does the system work?

The United States operates a wide-ranging and well-resourced end of life care system, though its structure differs substantially from universal, government-funded models such as those found in Canada or Australia. Care is delivered through a combination of federal health insurance programmes — principally Medicare and Medicaid — alongside private insurance plans and direct out-of-pocket spending. The principal clinical pathways available to those nearing the end of life are palliative care, hospice care, and, in a growing number of jurisdictions, medical aid in dying.

While both palliative and hospice care centre on the comfort and quality of life of those with serious illness, hospice care is a specific subset of palliative care reserved for individuals in the final weeks or months of their lives. Services may be delivered across a range of settings, including hospitals, nursing facilities, dedicated outpatient palliative care clinics, or the patient’s own home.

Today, more than half of all Americans who die annually receive some form of hospice or palliative care support. More than two-thirds of all US hospitals — and over 85% of mid- to large-size institutions — report having a dedicated palliative care team. Because the American system is heavily insurance-driven, the care a patient can access and the financial burden they face depend substantially on the type and extent of cover they hold. Expats who are not enrolled in Medicare or Medicaid will in most cases depend on private insurance, making it essential to verify policy terms well before a health crisis develops.

What is palliative care in United States, and who is eligible for it?

Palliative care aims to improve quality of life for people living with serious illness, as well as for those who support them, and it is available to individuals of any age — not exclusively to older adults. Crucially, palliative care can begin at the point of diagnosis or at any later stage of a person’s illness, and it can run in parallel with other curative or disease-modifying treatments.

The range of conditions that may prompt referral to palliative care is broad and includes heart failure, chronic obstructive pulmonary disease, cancer, dementia, Parkinson’s disease, and many others. By design, palliative care is interdisciplinary: the team typically brings together physicians, nurses, social workers, chaplains, and other specialists who collaborate with the patient, their family, and other treating clinicians to deliver medical, emotional, social, and practical support.

A key distinction between palliative care and hospice care is that palliative care does not require a person to discontinue treatments aimed at curing or managing their illness — it is complementary to, rather than a replacement for, ongoing medical care. This makes it suitable for people at all stages of serious illness, not only those approaching death. The National Hospice and Palliative Care Organization (NHPCO) maintains a searchable directory to help patients and families locate palliative care services in their area.

Are there hospices in United States, and how do you access them?

Hospice care is an increasingly common choice for Americans at the end of life. Its central purpose is the care, comfort, and quality of life of a person with a serious illness who is in the final phase of their life, rather than pursuing curative treatment. Hospice encompasses symptom management, skilled nursing, emotional and spiritual support, and frequently extends bereavement care to loved ones and carers. Services may be provided in the patient’s home, a hospital, a dedicated hospice facility, or an assisted living setting.

To qualify for hospice, a physician must determine that the patient’s life expectancy is six months or fewer if the illness runs its normal course. Care is typically delivered by an interdisciplinary team comprising doctors, nurses, home health aides, social workers, chaplains, and other professionals. Upon enrolling in hospice, a patient generally agrees to forgo treatments intended to cure the underlying illness or prolong life; if they subsequently wish to pursue such treatments, they may be required to withdraw from hospice services.

Hospice access begins with a referral from a treating doctor, or families may contact a hospice provider directly. The Medicare Care Compare tool on Medicare.gov enables patients and their families to search by location for Medicare-certified hospice providers. It is possible for individuals to transition into and out of hospice as their circumstances and wishes change, and research suggests that some people live longer after shifting their focus from curative to comfort-based care.

Is palliative or hospice care covered by public health insurance in United States, or does it need to be funded privately?

Hospice care is a covered benefit under Medicare Part A, provided the patient has received a terminal diagnosis and a physician has certified a life expectancy of six months or less. Medicare Part A covers two initial 90-day benefit periods, followed by an unlimited number of 60-day periods. The programme covers the vast majority of hospice services at no cost to the patient; however, patients may be required to pay up to $5 per prescription for symptom-management medications, and a coinsurance charge applies for inpatient respite care.

Beyond Medicare, hospice care is also covered by Medicaid and by most private insurance plans, which generally use Medicare’s eligibility criteria as a benchmark. Eligible military veterans may be able to access palliative care services through the Department of Veterans Affairs. For those not covered by either Medicare or Medicaid — a category that includes many expats holding non-immigrant visas — private health insurance becomes the principal funding route, and the extent of coverage varies considerably between plans.

Medicare also covers palliative care either alongside active treatment for a medical condition or as part of end-of-life care for those with advanced illness, though patients may still encounter out-of-pocket costs for hospital stays, physician services, and prescription drugs. Medicaid, charitable organisations, and state-run assistance schemes may offer supplementary financial or practical support. Expats should carefully review their specific plan’s terms with their insurer, as coverage for non-curative care can diverge significantly from standard medical benefits.

What legal documents should expats have in place before the end of life in United States — such as a living will, advance directive, power of attorney, or healthcare proxy — and how do these work?

The United States provides a well-developed set of legal instruments designed to safeguard a person’s wishes at the end of life. Because healthcare and estate law is regulated at the state level, the specific names, prescribed forms, and procedural requirements differ from state to state; nonetheless, the principal documents are widely recognised in practice across the country. Expats residing in the US should arrange these as early as possible after settling in.

• Advance Directive / Living Will: A written document in which you set out your preferences regarding medical treatment in the event that you lose the ability to communicate. This may encompass decisions about life-sustaining equipment, resuscitation, artificial nutrition, and organ donation. Every state has its own prescribed form.
• Healthcare Proxy / Durable Power of Attorney for Healthcare: This document designates a named individual — referred to as your “agent” or “proxy” — to make medical decisions on your behalf if you become incapacitated. It is legally distinct from a general power of attorney.
• POLST (Physician Orders for Life-Sustaining Treatment): A physician-signed medical order that converts your care preferences into actionable clinical instructions for emergency responders and healthcare teams. It is especially important for those living with serious illness.
• Durable Power of Attorney (Financial): This authorises a trusted person to manage your financial affairs should you become incapacitated. Without such a document in place, a court-ordered guardianship process may be necessary.
• Last Will and Testament: This specifies how you wish your assets to be distributed after your death, and may also appoint an executor and, where relevant, guardians for minor children.

All documents should be prepared with the help of a licensed US attorney practising in estate planning or elder law. Keep originals in an accessible location and provide copies to your healthcare providers, named agents, and family members. The CaringInfo programme of the NHPCO provides free, state-specific advance directive forms.

Are documents such as advance directives or powers of attorney made in another country legally recognised in United States?

This is a nuanced area, and the answer depends on the state in question. As a general rule, US states may give effect to a foreign advance directive or power of attorney if it was validly executed under the law of the country in which it was made, as long as it does not conflict with state law or public policy. There is, however, no single federal rule that guarantees such recognition, and many healthcare providers will be unfamiliar with foreign-format documents.

In practical terms, the most reliable course of action is to execute new US-format documents — using the relevant state form — as soon as you have established a meaningful presence in the country. If you already hold documents prepared in another jurisdiction, ask a US attorney to review them and advise whether they should be supplemented or replaced. Documents drafted in a language other than English should always be accompanied by a certified translation.

For financial powers of attorney executed abroad, US financial institutions such as banks and investment firms may impose internal compliance standards that are more demanding than the minimum legal requirements. It is prudent to enquire directly with your US bank about what documentation it will accept before relying on a foreign power of attorney for financial transactions.

What are the laws around euthanasia or assisted dying in United States?

Euthanasia — in which a physician directly administers a lethal medication — remains unlawful throughout the United States. However, Medical Aid in Dying (MAiD), also known as “Death with Dignity” or “physician-assisted dying,” has been legalised in a growing number of states. Under MAiD legislation, a terminally ill adult who is mentally competent may request a prescription for medication that they themselves can choose to self-administer to bring about a peaceful death.

As of early 2025, ten states permit medical aid in dying: Oregon, Washington, California, Montana, Vermont, Colorado, Hawaiʻi, New Jersey, New Mexico, and Maine, as well as the District of Columbia. To be eligible, a patient must generally have a terminal illness with a prognosis of six months or fewer, be mentally capable of making the decision, and be able to self-administer the prescribed medication.

Each state’s MAiD law incorporates its own eligibility criteria, mandatory waiting periods, and protective safeguards. Residency requirements are a particularly significant consideration for expats: certain states stipulate that the patient must be a resident of that state in order to access MAiD. Oregon, notably, removed its residency requirement in 2023. The Hospice and Palliative Nurses Association recognises that some terminally ill patients may consider MAiD as an end-of-life option where it is lawfully available, and notes that suffering alone is not a qualifying criterion under US law. Expats living in states that have not enacted MAiD legislation do not have access to this option, regardless of personal preference.

What are the local customs, traditions, and religious practices around death and dying in United States?

The United States is an exceptionally diverse nation, and practices surrounding death and dying reflect that diversity in full. There is no single overriding tradition; the country’s pluralism means that virtually every religious and cultural approach found globally is practised within some segment of the population.

Widely observed mainstream customs include a funeral service held at a church, funeral home chapel, or a secular venue, followed by either burial or cremation. A period of “visitation” or “viewing” — during which family and friends gather to pay their respects, often before an open casket — remains traditional in many communities, particularly in the South and Midwest. Memorial services held without the body present are also well established and growing in popularity.

Christianity, across its many denominations, remains the most widely practised faith in the United States, and Christian customs such as burial rites, prayers, and wakes are common. Jewish communities typically observe halachic traditions that call for prompt burial — often within 24 hours of death — and generally prohibit cremation in traditional practice. Muslim communities similarly favour swift burial and the ritual washing of the body in accordance with Islamic rites. Catholic communities frequently hold a Funeral Mass. Secular and non-religious services have also become increasingly prevalent, often designed to celebrate and reflect the individuality of the person who has died.

Expats will find that most US funeral homes are accustomed to accommodating a wide array of religious and cultural requirements. Being specific with the funeral director about any relevant traditions — whether concerning the preparation of the body, the timing of burial, or the nature of the service — will help ensure that arrangements are handled appropriately.

What must you do when someone dies in United States? Who do you notify, how quickly, and in what order?

The steps that must be taken immediately following a death in the United States are shaped by state law, but the general sequence is broadly consistent across the country. Prompt action matters: delays can create complications for death certification, estate administration, and funeral planning.

1. Call emergency services or a medical professional: If the death is sudden or unexpected, dial 911 without delay. If the death was anticipated — for instance, under hospice care at home — contact the hospice nurse or the person’s physician, who will attend to pronounce the death officially.
2. Contact the treating physician or hospice provider: The attending physician or hospice medical director is responsible for certifying the cause of death and completing the medical portion of the death certificate. No further administrative steps can proceed until this is done.
3. Engage a licensed funeral home: A funeral director must be appointed to take legal custody of the body. They will arrange transportation of the remains, liaise with the relevant authorities, and manage the filing of the death certificate. Selecting a funeral home first is advisable, as the director will help guide the family through subsequent steps.
4. Notify the relevant state vital records office: Death certificates in the United States are registered at the state level through the local registrar of vital statistics. The funeral director ordinarily handles this submission on behalf of the family, generally within 72 hours of death, though precise timelines differ by state.
5. If the deceased is a foreign national, notify their home country’s embassy or consulate: Contact the relevant consulate as soon as practicable. Consular officers can advise on required documentation, the options available for repatriation, and any country-specific procedures. Many consulates maintain 24-hour emergency lines for exactly these situations.
6. Notify the Social Security Administration (SSA): If the deceased was receiving Social Security benefits, the SSA must be informed immediately so that payments can be stopped. Funeral homes commonly report deaths to the SSA, but family members should verify that this step has been completed.
7. Notify banks, insurers, and other relevant institutions: Financial institutions, life insurance companies, pension providers, and any government benefit programmes such as Medicaid should be informed without delay. Obtain a sufficient number of certified copies of the death certificate — typically at least 8 to 10 — as these will be needed for a range of administrative purposes.
8. Initiate probate proceedings where required: Engage a probate attorney to begin the estate administration process, particularly if the deceased held real property, had significant financial assets, or left a will that requires court validation.

How is a death officially registered in United States, and what documents are needed?

Death registration in the United States is handled at the state level, with each state maintaining its own vital records office responsible for issuing certified death certificates. There is no unified national death register, though the CDC’s National Center for Health Statistics collects aggregated data from all states. This differs from countries with centralised civil registration systems, such as France’s état civil or the UK’s General Register Office.

A US death certificate consists of two components. The medical section — recording the cause, manner, and date of death — is completed by the attending physician, hospice medical director, coroner, or medical examiner. The demographic section — covering the deceased’s name, date of birth, address, marital status, and similar personal details — is completed by the funeral director using information supplied by the family.

The following information and documentation is typically required:

• The deceased’s full legal name, including any maiden name
• Date, time, and location of death
• Date and place of birth
• Social Security Number (SSN), if one was held
• Last known address and state of residence
• Marital status and, if applicable, the spouse’s name
• Name and contact information for the next of kin or informant
• Details of the planned disposition (burial, cremation, etc.)

The funeral director submits the completed death certificate to the local registrar, usually within 72 hours of the death, though this deadline varies by state. Certified copies may then be purchased from the relevant state or county vital records office — fees are typically in the range of $10–$25 per copy (as of 2024–2025; confirm current rates with the relevant office). Multiple certified copies will be needed for estate, insurance, and other administrative processes.

What happens if a foreign national dies in United States — what are the specific steps for notifying their home country’s embassy or consulate, and what role does the consulate play?

When a foreign national dies on US soil, the death falls under the jurisdiction of the state in which it occurred. US authorities will issue a local death certificate through the state’s vital records system, and all local administrative and funeral procedures apply in the normal way. The deceased’s home country consulate or embassy plays a parallel and equally critical role in supporting the family and facilitating any repatriation of the remains.

The family or next of kin should reach out to the relevant consulate or embassy as quickly as possible — most maintain emergency telephone lines that operate around the clock, seven days a week. Consular staff can advise on the documentation requirements specific to the home country, furnish a list of local legal professionals and funeral service providers, and assist with the paperwork required to repatriate the body or cremated ashes. The consulate does not, however, organise or finance funeral services or transportation.

Most consulates will need to be formally notified of the death before they can issue documentation. Depending on the deceased’s nationality, the consulate may issue its own consular death certificate or register the death in the home country’s records — a step that can be important for pension entitlements, inheritance matters, and other administrative procedures in the country of origin. Requirements vary significantly by country, so it is important to consult the specific consulate’s guidance directly.

If the deceased held a passport in the consulate’s custody, or if their immigration or visa status has implications for the estate, consular officers can provide relevant guidance on those matters too. When making contact, it is helpful to have the following information to hand: the deceased’s full name, date of birth, passport number, US address, the circumstances of death, and the contact details of the next of kin.

How are funerals typically arranged in United States, and what are the usual options for burial or cremation?

Funerals in the United States are almost universally arranged through a licensed funeral home, which serves as the central point of coordination for all aspects of the process — from collecting and preparing the body to registering the death and organising the memorial service. The National Funeral Directors Association (NFDA) represents the funeral industry and offers consumer guidance for those navigating their options.

The main choices available for final disposition are:

• Traditional burial: The body is embalmed — usually required if a viewing is planned — placed in a casket, and interred in a cemetery. Families select a burial plot, a headstone or grave marker, and typically a grave liner or burial vault, which most cemeteries mandate.
• Cremation: Now the most frequently chosen option in the United States, cremation involves the reduction of the body at a licensed crematory. The resulting cremated remains — commonly referred to as “ashes” or “cremains” — are returned to the family, who may inter, scatter (subject to local regulations), or retain them. Direct cremation, which involves no viewing or ceremony, represents the most economical choice.
• Green / natural burial: Increasingly offered at dedicated cemeteries and green burial grounds across the country, this approach involves burial without embalming in a biodegradable container or shroud. It appeals to those motivated by environmental concerns, cost considerations, or personal values.
• Body donation: Individuals who wish to contribute to medical education or research may donate their bodies to a medical school or research institution. This generally needs to be arranged in advance during the person’s lifetime.

The US Federal Trade Commission’s Funeral Rule provides important consumer protections, including the right to receive an itemised price list, the right to choose only the specific services you want, and safeguards against misleading practices by funeral providers.

What are the approximate costs of a funeral in United States, and are there any state or insurance-based funds that can help cover them?

Funerals in the United States rank among the most expensive in the world. A conventional full-service funeral with burial typically costs between $8,000 and $12,000 or more (as of 2024–2025), once cemetery fees, a grave liner, a headstone, and various incidentals are factored in. Direct cremation — the simplest available option — typically starts at around $1,000 to $3,000, though prices differ substantially by region and provider. Always request a written, itemised price list from any funeral home before making commitments.

Public funding for funeral costs is limited. The Social Security Administration provides a one-time lump-sum death payment of $255 to a surviving spouse or eligible child (as of 2025) — a figure that has not been revised upward in decades and makes only a negligible contribution to actual funeral costs. Some individual states operate modest funeral assistance programmes for qualifying low-income households; contact your state’s Department of Social Services for details of what may be available in your area.

Where the deceased held a life insurance policy, the death benefit can typically be used to meet funeral expenses. Some funeral homes also offer pre-paid funeral plans that allow individuals to fix today’s prices for arrangements made at a future date. Military veterans may be entitled to burial benefits administered by the Department of Veterans Affairs, which can include burial in a national cemetery at no charge. FEMA has previously offered temporary funeral assistance during major declared disasters such as the COVID-19 pandemic, but this is not a permanent standing programme.

Expats should give serious consideration to travel insurance policies that include a repatriation-of-remains benefit, or to international life insurance with a dedicated funeral benefit clause, as standard domestic insurance products are unlikely to cover the considerable costs involved in transporting remains to another country.

What is the process for repatriating the remains of a foreign national from United States to another country?

Repatriating the remains of a foreign national from the United States is a multi-step undertaking that involves the US funeral home, the home country’s consulate, airlines, and potentially customs authorities at both ends. The process demands careful coordination and can take anywhere from a few days to several weeks, depending on the circumstances of the death and the destination country.

A licensed funeral home must prepare the body for international transport, which in most cases includes embalming — a condition imposed by the majority of airlines for the shipment of human remains. The body must be placed in an approved hermetically sealed casket or shipping container. Transport coordination must be handled by a “known shipper” — generally the funeral home itself — that has been approved by the Transportation Security Administration (TSA).

The documents typically required for repatriation from the United States include:

• The US death certificate issued by the state where the death occurred
• An embalmer’s affidavit confirming that the body has been prepared for international transport
• A transit permit from the state health authority
• Consular documentation from the home country (specific requirements vary by nationality)
• Airline cargo paperwork and customs declarations

Repatriating a body is a costly undertaking. Total expenses can range from $5,000 to over $20,000, depending on the destination country, the distance involved, and local fees, and encompass the funeral home’s services, embalming, the specialised shipping container, and international air freight charges. Repatriating cremated ashes is considerably less expensive. The United States Postal Service is the only courier legally permitted to ship cremated remains domestically; international shipment of ashes requires specialist carriers and specific documentation. Travel insurance that includes a repatriation-of-remains benefit can absorb a significant portion of these costs, and expats are strongly advised to hold such cover as a matter of routine.

What happens to the estate of someone who dies in United States — how does probate or estate administration work, and are there inheritance taxes?

Estate administration in the United States is governed principally by state law, which means the precise procedures depend on the state in which the deceased was domiciled at the time of death. The process generally involves presenting the will — if one exists — for validation by the relevant state probate court, appointing an executor or personal representative, notifying creditors, settling debts and any applicable taxes, and then distributing the remaining assets to the named beneficiaries.

Probate can be a protracted process — commonly six to twelve months for a straightforward estate, and potentially several years for more complex situations. Many states offer simplified or expedited procedures for smaller estates. Certain categories of asset — such as those held in joint tenancy with right of survivorship, accounts with named beneficiaries (such as retirement funds and life insurance policies), or assets placed in a living trust — may pass to beneficiaries outside the probate process entirely.

On the question of taxation: a federal estate tax exists in the United States, but it applies only to estates whose value exceeds a substantial threshold. As of 2025, the federal estate tax exemption stands at approximately $13.61 million per individual. This figure is expected to change after 2025 when the relevant provisions of the Tax Cuts and Jobs Act are due to expire — consult a US tax professional or the IRS for the most current information. Estates beneath the applicable threshold owe no federal estate tax. Several states levy their own estate or inheritance taxes at lower thresholds — for example, Oregon’s estate tax threshold is $1 million (as of 2024) — while others impose no such tax at all.

Different rules apply to foreign nationals. Non-resident aliens — those who were not domiciled in the United States — are subject to US estate tax only on assets situated in the US, such as US real estate, shares in US companies, and US bank accounts, and the exemption available to non-residents is just $60,000, far below the threshold that applies to US citizens and domiciliaries. Expats who hold substantial US-based assets should obtain specialist legal and tax advice tailored to their circumstances.

If an expat dies without a will in United States, what happens to their assets under local intestacy laws?

When a person dies in the United States without a will — a situation described in law as dying “intestate” — their estate is distributed in accordance with the intestacy statutes of the state where they were domiciled at the time of death. Each state maintains its own intestacy provisions, but the general approach follows a defined hierarchy of family relationships.

As a rule, a surviving spouse receives a substantial or majority share of the estate, with any remainder going to children. Where there are no children, the spouse may inherit the entire estate. If neither a spouse nor children survive the deceased, assets pass to parents, then to siblings, and further down the family tree according to the applicable state rules. Unmarried partners — regardless of how long-standing the relationship — typically receive nothing under intestacy law, and the same applies to stepchildren who were not formally adopted by the deceased.

For expats, the interaction between US intestacy law and the laws of their home country can become particularly complicated, especially when assets are held in more than one country. Generally, US courts apply the law of the state of domicile to personal property, but the law of the location of the property — the lex situs — to real estate. This means a foreign national who owned a home in Florida and investment assets in the United Kingdom could find their estate subject simultaneously to two separate legal systems. A properly drafted will — prepared with legal advice from practitioners in each relevant jurisdiction — is the most effective way to prevent this complexity and ensure that a person’s wishes are honoured.

Frequently asked questions

Can a foreign national access Medicare or Medicaid-funded hospice care in the United States?

Medicare is generally available to US citizens and lawful permanent residents (green card holders) aged 65 or over, or to younger individuals with qualifying disabilities, provided they have contributed to the system through employment. The majority of foreign nationals holding temporary visas — including tourist, student, and work visas — are not eligible for Medicare or Medicaid and must rely on private health insurance to fund their care. If you are uncertain about your eligibility status, seek guidance from the Centers for Medicare and Medicaid Services (CMS) or a qualified benefits adviser.

Will my foreign health insurance or travel insurance be accepted for end of life care in the United States?

Certain international health insurance plans and travel insurance policies are accepted by US hospitals and hospice providers, but this cannot be assumed. Unlike arrangements within the EU, the United States has no reciprocal healthcare agreements with most other countries. Before seeking care, contact your insurer to confirm what is covered and whether prior authorisation is required. Pay particular attention to whether your policy covers end of life care, hospice services, and repatriation of remains, since many standard travel insurance products specifically exclude these elements.

Do legal documents such as advance directives need to be in English to be valid in the United States?

No federal law mandates that advance directives be written in English, and some states and healthcare systems are equipped to work with documents in other languages. However, in an emergency situation, medical staff are most likely to act on documents they can read and interpret immediately. It is therefore strongly advisable to have any advance directive or healthcare proxy translated into English by a certified translator, and to have a US-format document prepared with the assistance of a local attorney specifically for use within the US healthcare system.

How long does repatriation of remains from the United States typically take?

Timelines vary depending on the cause of death, the destination country, and how promptly the necessary documentation can be assembled. In straightforward cases involving natural causes where no autopsy is required, repatriation can sometimes be completed within five to ten business days. Where an autopsy is required — as may be the case with sudden, unexplained, or suspicious deaths — the process can extend considerably, sometimes to several weeks. Engaging both the US funeral home and the destination country’s consulate as early as possible is essential to keeping delays to a minimum.

What support is available to bereaved family members in the United States?

Bereavement support is a standard element of hospice care in the United States, with programmes typically offering counselling to family members for up to 13 months following the death. Individual and family grief counselling — both before and after the patient’s death — is included within the Medicare hospice benefit. Additional support is available through hospitals, faith communities, and non-profit organisations such as the Hospice Foundation of America. For expats who are geographically separated from their own family networks, these services can be a particularly important resource.

Is a US will valid for assets in another country?

A US will may be recognised in other countries under the Hague Convention on the Law Applicable to Succession or through bilateral legal frameworks, but recognition is not automatic and varies from one jurisdiction to another. Many countries require a locally executed will for property held within their borders. If you hold assets in more than one country, obtaining legal advice from practitioners in each relevant jurisdiction will help ensure that your estate can be administered efficiently in accordance with your wishes. An attorney with experience in international estate planning can help coordinate overlapping requirements across multiple countries.

What happens to the assets of an expat who dies without a will and has no family in the United States?

If a person dies intestate and no eligible heirs can be identified, their assets may ultimately pass to the state government through a process known as “escheat,” which occurs after a legally prescribed waiting period and a reasonable search for heirs. Each state has its own escheat legislation. The typical process requires the state to make genuine efforts to locate any surviving relatives before taking ownership of the assets. This outcome reinforces the importance of having a valid, up-to-date will that clearly identifies beneficiaries and includes current contact information for each of them.

Can an expat on a work visa access Medical Aid in Dying in a state where it is legal?

The answer depends on the specific state’s legislation. Some states require that the patient be a resident of that state in order to access MAiD; others have no formal residency requirement — Oregon, for example, removed its residency condition in 2023. Beyond residency, there are additional stringent eligibility requirements, including a confirmed terminal diagnosis with a prognosis of six months or fewer, demonstrated mental competency, and the physical ability to self-administer the prescribed medication. Anyone considering this option should consult both a physician and a legal adviser practising in the relevant state, as the requirements are detailed and may be subject to legislative change.