Office of Planning Policy and Program Development

The Our Care, Our Choice Act (End of Life Care Option)

Effective January 1, 2019, Hawaii state residents with a terminal illness and six (6) months or less to live can now voluntarily request medical aid-in-dying medication to end their life.

No healthcare provider or healthcare facility shall be under any duty, whether by contract, statute, or any other legal requirement, to participate in the OCOCA and may choose to opt-out.

To meet eligibility criteria patients must be:
1. Age 18 or older and a Hawaii state resident;
2. Able to take the prescribed medication themselves;
3. Able to make two oral requests not less than five (5) days apart to their Attending Provider;
4. Able to provide one written request after meeting eligibility criteria from all three (3) health care providers; and
5. Mentally capable to make an informed decision.

At all times, the patient retains full rights to rescind the request or to not take the medication.

 

Click to see the OCOCA Timeline Basic Graphic (For Health Care Providers)

 

Health Care Provider Roles and Responsibilities
There are three (3) key healthcare providers identified in the OCOCA to ensure the patient meets eligibility requirements. The Attending Provider, Consulting Provider, and Counseling Provider (e.g., psychologist, psychiatrist, licensed clinical social worker (LCSW), licensed marriage and family therapist (LMFT), Advanced Practice Registered Nurse (APRN) with a psychiatric or clinical nurse specialization) should document their examination and/or evaluation in writing in the medical record and on the applicable form reportable to the DOH. Applicable forms for both providers and patients are accessible below and on the right side of page. Adobe Reader is required.

Attending Provider
The Attending Provider is a Hawaii-licensed physician or APRN, who has the responsibility for the care and treatment of the patient’s terminal illness. Please refer to the “Timeline Eligibility Process” for guidance.
The Attending Provider plays a critical role throughout the eligibility process from the initial oral request, to writing the prescription, and reporting to the DOH. The Attending Provider‘s role is to:

1. Conduct the initial patient diagnosis and prognosis;
   2. Refer the patient to the two additional providers;
   3. Document the patient’s two oral requests not less than five (5) days apart;
   4. Confirm and verify the patient’s eligibility with the two additional providers;
   5. Inform the patient of his or her rights to rescind the request at any time;
   6. Receive the patient’s completed written request form;
   7. Write the prescription for aid-in-dying medication;
   8. Conduct any follow-up reporting actions; and
   9. Review, confirm, and provide all reportable documentation to the DOH.

 

Reporting Requirements: The Attending Provider is responsible for reporting to the DOH. Currently, we are accepting only paper copies of the required forms and supporting documents. The mailing address and two mail-in submission requirements are indicated below:

 

Mail paper copies of completed forms to:
Hawaii Department of Health
Office of Planning, Policy, and Program Development
ATTN: OCOCA/CONFIDENTIAL
1250 Punchbowl St., Rm.120
Honolulu, HI 96813

 

You may contact the DOH at (808) 586-4188 if there are any questions. Do not email or fax any patient information, forms, or documents.

1^st submission to DOH (includes 4 forms)
Within 30 calendar days of writing the prescription, the Attending Provider must provide the DOH a copy of all the following completed forms listed below. Please do not send forms and documents separately.

1. Attending Physician Reporting Form;
2. Consulting Provider Confirmation and Verification Form;
3. Counseling Provider’s Statement of Determination Form;
4. The Patient’s Written Request for Medication and Declaration of Witnesses Form; and
   * Any other supporting documents, if necessary.

 

2^nd submission to DOH (includes 2 forms)

If the Attending Provider is notified of the patient’s death:
Within 30 days following notification of the qualified patient’s death from the use of prescribed medication or any other cause, the Attending Provider reports to the DOH by completing the Attending Provider Follow-up Form and mailing both the:

5. Final Attestation Form
6. Attending Provider Follow-up Form

* Any other supporting documents, if necessary.

 

Overall, the Attending Provider must mail in a minimum of (4) completed forms:

1. Attending Provider’s Reporting Form;
2. Consulting Provider’s Confirmation and Verification Form;
3. Counseling Provider’s Statement of Determination Form;
4. Patient’s Written Request for Medication and Declaration of Witnesses Form

If the Attending Provider is notified of the patient’s death, then (2) more forms must be mailed in.

1. Final Attestation Form
2. Attending Provider’s Follow-up Form

 

Provider and Patient Forms Below (Click link to save and print)

Attending Provider Reporting Form  Complete within thirty (30) days of the prescription date.  For submission to DOH, please also attach and mail the completed Consulting Provider’s Form, and Counseling Provider’s Form, and Patient’s Written Request for Medication and Declaration of Witnesses Form.

Patient’s Written Request for Medication and Declaration of Witnesses Form

The Attending Provider provides this form to the patient to complete.  This form serves as the patient’s written request to the Attending Provider. The patient completes this form after meeting criteria from all three (3) health care providers.

Consulting Provider’s Confirmation and Verification Form The Consulting Provider completes this form and returns it to the Attending Provider for DOH submission.

Counseling Provider’s Statement of Determination Form  A psychologist, psychiatrist, licensed clinical social worker (LCSW), licensed marriage and family therapist (LMFT), Advanced Practice Registered Nurse (APRN) with a psychiatric or clinical nurse specialization completes this form and returns it to the Attending Provider for DOH submission.

Final Attestation Form The Attending Provider may provide this form to the patient to complete either at the patient’s first oral request or second oral request.  The patient completes this form within 48 hours prior to self-ingesting the prescribed aid-in-dying medication and should designate an individual to return it to the Attending Provider.

Attending Provider’s Follow-up Form If notified of the patient’s death, the Attending Provider completes this form within 30 days and provides a paper copy to the DOH submission.

 

Consulting Provider
The Consulting Provider is a Hawaii-licensed physician or APRN, who is qualified by specialty or experience to make a professional diagnosis and prognosis regarding the patient’s illness. Before a patient is qualified, a Consulting Provider shall examine the patient and the patient’s relevant medical records and confirm, in writing, the Attending Provider’s diagnosis and prognosis, and verify that the patient is capable, is acting voluntarily, and has made an informed decision.

Counseling Provider
The Counseling provider is a Hawaii-licensed Psychiatrist, Psychologist, Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), and Advanced Practice Registered Nurse (APRN) with a psychiatric or clinical nurse specialization. Counseling means one or more consultations, which may be provided through telehealth, for determining that the patient is capable, and that the patient does not appear to be suffering from undertreatment or nontreatment of depression or other conditions which may interfere with the patient’s ability to make an informed decision.

 

Community Resources to Consider
The DOH recommends encouraging patients to enroll in hospice to ensure all end-of-life care options are available to the patient including guidance on advanced care directives and POLST (“Provider Orders for Life-Sustaining Treatment”). Hospice and palliative care resources are available to assist you and your patient should you receive an inquiry on the OCOCA. You may contact Kōkua Mau or view their website here: Kōkua Mau

A list of local hospice and palliative care community organizations is provided here as a resource. In 2020 – 2021, the Department participated in webinars hosted and recorded by Compassion and Choices which may be accessed here.

 

Additional Information on Disposal of Unused Medication

Disposal medication drop boxes are located throughout the state. Specific locations and information about disposing of unused medications can be found here:  Drug Take Back

 

DISCLAIMER: The DOH provides web resources and links to organizations “as is” without any warranty of any kind. Provision of these web resources and links do not imply approval of the listed websites, warrant the accuracy of any information contained in those websites, constitute endorsement of the entities and its contents to whose sites the links are made, or endorse any of the opinions expressed on any of these external websites.  These websites operate under the auspices and at the direction of their respective owners.  If you have any question or comments about any of these sites, please contact them directly on their website.