Patients, Family Members, and Care Support Resources
Governor David Ige signed into law on 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 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.
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. 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.
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 physician.
- 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 physician 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
Patient’s may download recommended forms accessible below (and located on the right side of this page:
- Patient’s Written Request for Medication Form (includes declaration from two independent witnesses and written consent); and
- Final Attestation Form
Refer to the “General Process Steps for Patients” section below and seek guidance from your attending physician on the recommended patient forms.
General Roles of the Health Care Providers. There are three (3) key health care providers involved in the eligibility process. These providers are the attending physician, consulting physician, and counseling provider (either a psychiatrist, psychologist, or licensed clinical social worker). The 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 physician verifies that the patient is a Hawai`i 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 met the eligibility criteria. Patient’s must provide all the required requests (two oral requests and one written request) to the same attending physician. Talk with the attending physician to ensure oral requests are documented accordingly.
2. The consulting physician confirms the attending physician’s diagnosis and prognosis. He or she will examine the patient and his or her medical records and confirm, in writing, the attending physician’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 psychiatrist, psychologist or licensed clinical social worker. He or she is responsible for determining that 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 which 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. Health care providers may require more than one visit with you or pharmaceutical supplies may or may not be available in the state.
Step 1: Patients must make their first and second oral requests not less than 20 days apart with a Hawai`i licensed physician (the attending physician).
Step 2: Consider enrolling in hospice 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 physician will verify your Hawai`i residency and conduct the initial examination. He or she will refer you to two additional health care providers.
Step 4: Complete visits with the two additional health care providers referred by your attending physician. Discuss with each health care provider whether you met the eligibility criteria. Both providers are required to report back to the attending physician in writing.
Step 5: Complete and sign the Patient’s Written Request Form and provide it to your attending physician after meeting the eligibility requirements of all three (3) health care providers. Download and print the patient’s written request form located on this site or inquire with your attending physician.
Step 6: Know that the attending provider must observe two waiting periods before writing the prescription. The two waiting periods are:
• Between the date of receipt of the qualified patient’s written request and writing of the prescription not less than 48 hours have passed; and
• Between the first and second oral request not less than 20 days have passed.
Step 7: Once both waiting periods are met (and eligibility criteria is met by all three (3) health care providers), your attending physician 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 writing the prescription or availability of the medication. Talk with your attending physician and/or pharmacist.
Step 8: Your attending physician 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.
Step 9: Keep a copy of the Final Attestation Form with you and provide a copy to an individual who can return it to your attending physician.
Step 10: Designate an individual to take care of follow-up actions after death including disposing 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 physician or consider disposing medications at designated medication drop boxes located at specific CVS pharmacies or police stations across the state as listed here: Drug Take Back
Frequently Asked Questions For Patients (click image below to enlarge, print, or save)
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.