Hawaii Medical Aid in Dying: The Our Care, Our Choice Act Explained

When Hawaii enacted the Our Care, Our Choice Act (OCOCA) in 2018, it became one of a small number of states to formally authorize medical aid in dying (MAID). The law took effect in January 2019. It allows terminally ill, mentally capable adults who are residents of Hawaii to request a prescription for medication they can self-administer to end their lives peacefully.

The original law was among the most restrictive in the country. A 2023 legislative reform — Act 43 — significantly changed the access landscape. Here is a current, practical breakdown of how the law works.

Who Qualifies Under Hawaii's MAID Law

To be eligible under the current OCOCA, a person must:

• Be an adult (18 years or older) who is a resident of Hawaii
• Have a terminal illness with a prognosis of six months or less to live, as confirmed by two independent licensed providers
• Be mentally capable of making and communicating an informed healthcare decision
• Be able to self-administer the medication (the law does not permit assisted administration by another person)
• Make the request voluntarily, free from coercion

The law does not require the person to be a citizen, only a resident. It does not apply to people with a disability or chronic condition unless that condition is also terminal within six months.

What Act 43 Changed (2023)

The original OCOCA had a 20-day mandatory waiting period between the two required oral requests. That timeline was widely criticized because many patients with a prognosis of six months or less either died naturally or lost cognitive capacity before the prescription could be dispensed — making the law effectively inaccessible for the people it was designed to help.

Act 43, signed into law in 2023, made three significant changes:

1. Shortened waiting period. The mandatory wait between the first and second oral requests was reduced from 20 days to 5 days. Providers can waive the waiting period entirely if the patient is imminently dying and the wait would preclude access to the medication.

2. Expanded provider eligibility. Under the original law, the attending and consulting providers had to be physicians. The shortage of physicians on Hawaii's neighbor islands made this a significant barrier for residents outside Oahu. Act 43 expanded eligibility to include qualified Advanced Practice Registered Nurses (APRNs) as both attending and consulting providers. This is especially meaningful for residents on Maui, the Big Island, Kauai, and Molokai.

3. Mental health evaluation retained. Hawaii remains distinctive in requiring a mental health evaluation in addition to the two clinical assessments of terminal diagnosis. A psychiatrist, psychologist, Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), or psychiatric APRN must evaluate the patient to confirm mental capability and verify that the request is not driven by untreated depression or coercion.

The Request Process Step by Step

1. Two oral requests. The patient makes two verbal requests to their attending provider, separated by at least five days (or less if the provider waives the wait due to imminent death).
2. Second provider consultation. A consulting provider independently confirms the terminal diagnosis and prognosis.
3. Mental health evaluation. A qualified mental health professional confirms decision-making capacity and absence of coercion.
4. Written request. The patient submits one formal written request on a Department of Health-approved form, signed in front of two witnesses. At least one witness cannot be a relative by blood, marriage, or adoption, cannot be an estate beneficiary, and cannot be employed by the healthcare facility providing care.
5. Prescription. Once all requirements are satisfied, the attending provider writes the prescription. The patient fills it at a pharmacy and stores it for use at a time of their choosing.

The medication is self-administered. No provider is present unless the patient specifically requests support for the process.

Death Certificate Documentation

Under Hawaii's MAID law, the death certificate lists the underlying terminal illness as the cause of death — not the medication or the act of self-administration. The death is not classified as suicide for legal, insurance, or estate purposes.

This matters practically: life insurance policies with suicide exclusions generally do not apply to MAID deaths in Hawaii, though families should review specific policy language with the insurer or an attorney.

What MAID Means for Funeral Planning

A MAID death does not create any special complications for funeral arrangements. The attending provider signs the death certificate indicating the terminal illness as cause of death. The body is released to the family or funeral home in the same manner as any other natural death.

The right to control disposition — who has authority to direct cremation, burial, or other arrangements — follows the same HRS §531B-4 priority hierarchy as any other death. If the person dying had specific wishes about their funeral arrangements, those should be documented in a notarized HRS §531B-5 Written Instrument, not just communicated verbally or noted in a will.

Advance Directives and MAID Are Different

An Advance Health Care Directive (AHCD) and the MAID law serve distinct purposes and operate under different frameworks. An AHCD governs what happens if you become incapacitated and cannot communicate your healthcare wishes — it designates an agent to make decisions for you. The OCOCA governs an active, conscious, voluntary choice by a mentally capable person who is still fully competent.

Someone using the MAID process should also have a complete AHCD and POLST in place to address scenarios where they lose capacity before they choose to use the medication. These documents work together, not as substitutes for one another.

Planning Ahead

If a family member is facing a terminal diagnosis and wants to understand all their options — including how the MAID law interacts with hospice, advance directives, and funeral planning — the Hawaii Funeral Laws and Consumer Rights Guide addresses both the clinical and the practical dimensions of end-of-life planning in Hawaii.

The guide covers the POLST form, the Written Instrument to Control Disposition, how the burial-transit permit process works when a death is anticipated, and what families need to do in the days immediately following a MAID death to stay within the 72-hour regulatory window.

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