Health Care Provider Resources

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

Governor David Ige signed into law April 5, 2018 Act 2, Session Laws of Hawai`i 2018, also known as the “Our Care, Our Choice Act” (OCOCA).  Effective January 1, 2019, Hawai`i 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 health care provider or health care 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.

Compared to other states, Hawai`i is the only state to require a third health care provider to conduct a mental capacity evaluation. Hawai`i enacted its law with strict eligibility requirements both patients and health care providers must meet for the patient to acquire a prescription for aid-in-dying medication. At all times, the patient retains full rights to rescind the request or to not take the medication.

To meet eligibility criteria patients must be:
1. Age 18 or older and a Hawai`i resident;
2. Able to take the prescribed medication themselves;
3. Able to make two oral requests not less than 20 days apart to their attending physician;
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.

Timeline Eligibility Process (For Health Care Providers) – Click image to view larger image, save or print.  Adobe Reader required.

OCOCA provider timelineOCOCA timeline for providers

Health Care Provider Roles and Responsibilities
There are three (3) key health care providers identified in the OCOCA to ensure the patient meets eligibility requirements. The attending physician, consulting physician, and counseling provider (e.g. psychiatrist, psychologist, or licensed clinical social worker). Each provider 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 required.

Attending Physician
The attending physician is a Hawai`i-licensed physician pursuant to chapter 453, Hawai`i Revised Statutes (HRS), 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 physician plays a critical role throughout the eligibility process from initial oral request to writing the prescription and reporting to the DOH. The attending physician’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 20 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 physician is responsible for reporting to the DOH. Currently, we are accepting only paper copies of the required forms and supporting documents. An electronic submission option may be available soon on this site. The mailing address and two reporting requirements are indicated below:

Mail paper copies of completed forms to:
Hawai`i Department of Health
Office of Planning, Policy and Program Development
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.

Report #1:
Within 30 calendar days of writing the prescription, the attending physician must provide the DOH a copy of all the following completed and signed documents. Please do not send forms and documents separately. Forms listed below are required for DOH reporting #1.

1. Attending Physician’s Reporting Form;
2. Consulting Physician’s Confirmation and Verification Form;
3. Counseling Provider’s Statement of Determination Form;
4. Patient’s Written Request for Medication Form; and
5. Any other supporting document if necessary.

Report #2: (if notified of patient’s death):
Within 30 days following notification of the qualified patient’s death from use of a prescribed medication, or any other cause, the attending physician reports to the DOH by completing and mailing only the Attending Physician Follow-Up Form.

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

Attending Physician Reporting Form  Complete within 30 days of the prescription date.  For Report #1:  Please attach and mail the completed patient’s written request form, consulting physician’s form, and counseling provider’s form.

Patient’s Written Request Form   The attending physician provides this form to the patient to complete.  This form serves as the patient’s written request to the attending physician. The patient completes this form after meeting criteria from all three (3) health care providers.

Consulting Physician’s Confirmation and Verification Form The consulting physician completes this form and returns it to the attending physician for DOH reporting #1.

Counseling Provider’s Statement of Determination Form  A psychiatrist, psychologist, or licensed clinical social worker completes this form and returns it to the attending physician for DOH reporting #1.

Final Attestation Form The attending physician 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 physician.  This form is not required to be reported to the DOH.

Attending Physician’s Follow-up Form If notified of the patient’s death, the attending physician completes this form within 30 days and provides a paper copy to the DOH as Report #2.

Consulting Physician
The consulting physician is a Hawai`i-licensed physician pursuant to chapter 453, HRS, 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 physician shall examine the patient and the patient’s relevant medical records and confirm, in writing, the attending physician’s diagnosis and prognosis, and verify that the patient is capable, is acting voluntarily, and has made an informed decision.

Counseling Provider (Psychiatrist, Psychologist or Licensed Clinical Social Worker) 
The counseling provider is a Hawai`i licensed psychiatrist pursuant to chapter 453, HRS, psychologist licensed pursuant to chapter 465, HRS, or licensed clinical social worker pursuant to chapter 467, HRS. 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.

Training Opportunities for Providers. Consider seeking training opportunities within your organization or professional networks to ensure you are fully informed of the OCOCA and its applicability to you as a physician and health care provider. Workshops may provide attendees with opportunities for health care providers to network with potential care teams including psychiatrist, psychologist, licensed clinical social workers, APRNs, nurses, pharmacists, hospice and palliative care team providers. You may also check the University of Hawai`i John A. Burns School of Medicine events calendar here.

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. Or you may also view videos and related educational resources at Compassion and Choices. 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

A disposal medication drop box is located at most CVS pharmacy locations or police stations across the state. Specific locations and information about disposing 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.