Patients, Family Members, and Care Support Resources

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.

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 5 days apart to their Attending Provider;
  4. Able to provide one written request after meeting eligibility criteria from all three (3) healthcare 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.

 

Guidance for Patients. The DOH strongly encourages patients who are interested in end-of-life care options under the OCOCA to do the following:

  • Start early and talk with your Attending Provider.
  • Enroll in hospice to ensure all end-of-life care options are available to you including follow-up actions after death are cared for respectfully, timely, and appropriately.
  • Become familiar with the eligibility requirements and work closely with your Attending Provider and his or her care team.

 

Community Resources for Patients to Consider. Local hospice and palliative care providers specialize in end-of-life care options and resources that may be able to assist you with your specific needs. 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. Or you may also view videos and related educational resources at Compassion and Choices.

 

General Roles of the Health Care Providers. There are three (3) key healthcare providers involved in the eligibility process. These providers are the Attending Provider, Consulting Provider, and Counseling Provider. The Attending Provider’s role is crucial for the patient to meet eligibility requirements under the OCOCA.  Here’s a general description of each role:

  1. The Attending Provider (physician or APRN) verifies that the patient is a Hawaii state resident and will make the initial diagnosis and prognosis. He or she will refer the patient to two other providers and confirm with the two providers whether the patient meets the eligibility criteria. Patients must provide all the required requests (two oral requests and one written request) to the Attending Provider. Talk with the Attending Provider to ensure oral requests are documented accordingly.
  2. The Consulting Provider (physician or APRN) confirms the Attending Provider’s diagnosis and prognosis. He or she will examine the patient and his or her medical records and confirm, in writing, the Attending Provider’s diagnosis. He or she will confirm whether the patient is making an informed decision, is capable (e.g., has the mental capacity), and acting voluntarily.
  3. The Counseling Provider is either a psychologist, psychiatrist, licensed clinical social worker (LCSW), licensed marriage and family therapist (LMFT), or Advanced Practice Registered Nurse (APRN) with a psychiatric or clinical nurse specialization. He or she is responsible for determining that the patient is capable (e.g., has the mental capacity) and does not appear to be suffering from undertreatment or nontreatment of depression or other conditions that may interfere with the patient’s ability to make an informed decision.

 

General Process Steps for Patients. The steps below are not intended to be an exact representation of the process. It is merely a guide of the patient’s process.

Step 1: Patients must make their first and second oral requests not less than 5 days apart with a Hawaii licensed Provider (the Attending Provider).

Step 2: Consider enrolling in hospice or palliative care to ensure you are informed of all the end-of-life care options available to you and to be informed of follow-up actions after death.

Step 3: Your Attending Provider will verify your Hawaii residency and conduct the initial examination. He or she will refer you to two additional healthcare providers.

Step 4: Complete visits with the two additional health care providers referred by your Attending Provider. Discuss with each health care provider whether you met the eligibility criteria. Both providers are required to report back to the Attending Provider in writing.

Step 5: Complete and sign the Patient’s Written Request for Medication and Declaration of Witnesses Form and provide it to your Attending Provider after meeting the eligibility requirements of all three (3) health care providers. Download and print the Patient’s Written Request for Medication and Declaration of Witnesses Form located on this site or inquire with your Attending Provider.

Patient’s may download forms accessible below:

  1. The Patient’s Written Request for Medication and Declaration of Witnesses Form (includes declaration from two independent witnesses and written consent); and
  2. Final Attestation Form

Step 6: Unless the waiting period is waived, the Attending Provider must observe two waiting periods before writing the prescription.

  • Between the first and second oral requests, not less than 5 days have passed.
  • Not less than 48 hours shall elapse between the date of the Attending Provider’s receipt of this completed written request and the taking of steps to make available a prescription.

Step 7: Your Attending Provider can write you a prescription for aid-in-dying medication. Please note that our local pharmacies may not have aid-in-dying medications in the state which may cause a delay in the availability of the medication.

Step 8: Your Attending Provider will request that you complete a Final Attestation Form within 48 hours prior to self-ingesting the prescribed medication. Access the Final Attestation Form on the right side of this webpage. Keep a copy of the Final Attestation Form with you and provide a copy to an individual who can return it to your Attending Provider.

Step 9: Designate an individual to take care of follow-up actions after death including disposing of all unused medications by personally taking the unused medication to the nearest qualified facility that properly disposes of controlled substances lawfully. Inquire with your Attending Provider or consider disposing of medications at designated medication drop boxes located across the state as listed here:  Drug Take Back

 

Click here for Frequently Asked Questions (FAQS) for Patients

 

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 a question or comments about any of these sites, please contact them directly on their website.