Hawaii Advance Directive Requirements: Everything the Statute Demands

Hawaii's Advance Health-Care Directive statute — HRS Chapter 327E, based on the Uniform Health-Care Decisions Act — sets specific requirements that must all be met for the document to be legally enforceable. Miss one, and the hospital treats the directive as if it never existed.

Here is every requirement the statute imposes, without the legal jargon.

Who Can Create One

You must be an adult (18 or older) with capacity at the time of signing. Capacity means you understand what an advance directive is, what decisions it covers, who you are naming as your healthcare agent, and the consequences of the instructions you are giving.

A diagnosed condition — including early-stage dementia, a terminal illness, or a psychiatric disorder — does not automatically remove capacity. The question is whether you understand the document at the moment you sign it. If there is any doubt, sign in the presence of your primary care physician so they can document a capacity assessment in your medical record.

What the Document Must Contain

The directive can include one or both of:

Healthcare agent designation: The name of the person authorized to make medical decisions when you lack capacity, plus at least one alternate agent. Include full legal names and contact information.

Individual instructions: Your specific treatment preferences — what treatments you want, what you refuse, and under what conditions. These instructions bind your healthcare agent and your care team.

Hawaii does not require you to use the statutory form from HRS Section 327E-16. You can draft your own document. But it must clearly express your intent to create an advance health-care directive and must meet the execution requirements below.

Execution Requirements

Option 1: Two Witnesses

Both witnesses must be present when you sign. The disqualification rules under HRS Section 327E-3:

• Your designated healthcare agent (or alternate) cannot witness
• No healthcare provider can witness
• No employee of a healthcare facility where you receive care can witness
• No operator of a community care facility or residential care home where you live can witness
• At least one witness must not be related to you by blood, marriage, or adoption
• At least one witness must have no claim to your estate (by will, trust, or intestacy)

Both witnesses sign the document after watching you sign. If either witness is later found to be disqualified, the entire directive is void — not just the agent designation, but the treatment instructions too.

Option 2: Notarization

A notary acknowledgment replaces both witnesses. The notary confirms your identity, verifies you are signing voluntarily, and applies their seal. The acknowledgment block must specify the correct Hawaii county: City and County of Honolulu, County of Maui, County of Hawaii, or County of Kauai.

What Does Not Count

Hawaii does not accept electronic signatures on advance directives. Digital signatures, DocuSign, Adobe Sign, and other electronic execution methods will be rejected by healthcare facilities during intake. Print the document and sign with wet ink.

When the Directive Takes Effect

The healthcare agent's authority activates when your primary physician determines you lack capacity to make your own healthcare decisions. Until that determination, you direct your own care — the directive sits dormant.

Your individual treatment instructions also activate upon a determination of incapacity, but they apply even if you did not designate an agent. A directive with treatment instructions only is valid and enforceable.

Agent Authority and Limits

Once activated, your healthcare agent can:

• Consent to, refuse, or withdraw any medical treatment
• Access your medical records
• Communicate with your healthcare team
• Arrange facility transfers

Your agent must follow any instructions you wrote into the directive. Where the directive is silent, the agent makes decisions based on what they believe you would have wanted, or — if your wishes are unknown — in your best interest.

Your agent cannot request medical aid in dying under the Our Care, Our Choice Act. That requires your own personal, direct request while you are mentally capable. Your agent also cannot override a valid POLST order that you signed with your physician.

Revocation

You can revoke your advance directive at any time under HRS Section 327E-4. Three methods:

1. Written revocation — sign a document stating you revoke the directive
2. Physical destruction — tear up or destroy the original
3. Verbal revocation — tell your healthcare provider you revoke it (they must document this in your medical record)

A new advance directive automatically revokes any prior directive to the extent they conflict. You do not need to formally revoke the old one — executing a new one supersedes it.

Revocation is effective immediately upon communication to your healthcare provider. You can revoke even if you lack the capacity to execute a new directive, as long as you can communicate the intent to revoke.

Provider Obligations

Healthcare providers who receive a copy of your directive must include it in your medical record. A provider who refuses to comply with your directive must make reasonable efforts to transfer you to a provider who will comply.

Providers acting in good faith on a valid directive are immune from civil and criminal liability under HRS Section 327E-9.

No Filing or Registration Required

Hawaii does not require you to file your advance directive with any court, government office, or registry. The document is effective upon execution. Distribution to your healthcare agent, physician, and likely hospital is your responsibility.

The Hawaii Advance Directive & Living Will Kit covers all of these requirements with a witness screening checklist, an execution verification system, and county-specific notary guidance — ensuring every statutory requirement is met before you sign.

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