Our Care Our Choice Act in Hawaii

The Our Care, Our Choice Act (OCOCA) is a Hawaiʻi law that permits terminally ill adult patients with capacity to make their own medical decisions to be prescribed an aid-in-dying medication if certain conditions are met.

Signed into law by Governor David Ige on April 5, 2018, the law went into effect on January 1, 2019, and was subsequently amended effective June 1, 2023. Hawaiʻi is the seventh US jurisdiction to enact such a law. View the Our Care, Our Choice Act in its entirety here.

To be Eligible to Request an OCOCA Prescription, an Individual Must:

• Be an adult (18 years old or older).
• Be a Hawaiʻi resident.
• Have a medically confirmed terminal illness with less than six months to live.
• Be able to make medical decisions for themselves as determined by health professionals.
• Voluntarily request a prescription without influence from others.
• Be able to self-administer (eat, drink, and swallow) the prescription.

Participation is Voluntary for Patients and Health Care Providers

Participation in the Our Care, Our Choice Act is voluntary for individual patients, health providers (physicians, APRNs, nurses, pharmacists, etc.) as well as health systems, health plans, hospitals, medical offices, nursing homes, long-term care facilities, pharmacies and hospices. Insurance providers are not required to cover the prescription or related provider fees. Check with your health insurance company about their rules regarding costs associated with the prescription or related provider fees.

If the patient’s provider or the organization where the patient receives care is not participating in the Our Care, Our Choice Act, the patient may request basic information or ask for a referral.

Some providers may not be comfortable giveing patients information about the Act or provide a referral. In that case, please refer to the Department of Health website (https://health.hawaii.gov/opppd/ococ/) and others who provide information about the Our Care, Our Choice Act and to find participating providers.

Prior to Discussing the Prescription, We Recommend a Patient and Their Provider Should Discuss:

• The patient’s understanding of her/his diagnosis and prognosis
• The patient’s hopes and fears
• The benefits of palliative care and hospice care
• Options for pain control and symptom management

The Process for Requesting the OCOCA Prescription

If a terminally-ill patient meets the requirements to receive the OCOCA prescription, the patient and his or her attending provider must follow several steps which are carefully defined in the law, including:

• The patient must make two oral requests, not less than 5 days apart, directly to her or his provider (the attending provider.)*
• The patient must also make one request in writing, using the “Request For Medication To End My Life” form (PDF), which must be signed by the patient and two witnesses, and provided directly to her/his attending provider. The law does not say specifically when the written request must be made.
• The patient must discuss the request with her/his attending provider to make sure the request is voluntary.
• The patient must then see a second provider (the consulting provider) who can confirm the patient’s diagnosis, prognosis, and ability to make medical decisions.
• The patient must also see a mental health counselor (licensed psychiatrist, psychologist, clinical social worker, APRNPsych or clinical nurse specialist licensed under chapter 457 with psychiatric or mental health training, or marriage and family therapist) who can determine “that the patient is capable 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.”
• All OCOCA provider consultations may be conducted via Telehealth
• *This 5-day waiting period may be waived if, in the provider’s medical opinion, the patient will not survive it.

The Law Requires that the Patient and Attending Provider Discuss All of the Following:

• Potential risks associated with taking the medication to be prescribed
• Probable result of taking the medication to be prescribed
• Possibility that the patient may choose not to obtain the medication or may obtain the medication but may decide not to use it
• Feasible alternatives or additional treatment opportunities, including but not limited to comfort care, hospice care, and pain control
• Recommendation of attending provider that the patient notify next of kin
• The importance of having another person present when the qualified patient self-administers the medication prescribed
• That the patient will not take the medication in a public location.

If the patient still wishes to proceed and the attending provider agrees, the attending provider may provide the medication by either dispensing it directly to the patient or by delivering the OCOCA prescription to a participating pharmacist. By law, the provider cannot hand a written prescription directly to the patient or their representative.

The law is not specific about which medication(s) can be prescribed.

Within forty-eight hours prior to taking the medication, the patient must sign a “Final Attestation Form” (PDF) which confirms they are taking the medication voluntarily, are under no obligation to take the medication, and may rescind the request at any time. Upon the patient’s death, the completed form shall be delivered by the qualified patient’s health care provider, family member, or other representative to the attending provider to be placed in the patient’s medical records. All PDF files are managed and hosted by the Department of Health (DOH) accessible on the right-hand side of their webpages under “healthcare provider and patient forms“.

4/29/2021 Kōkua Mau Virtual Monthly Meeting: An Update on Hawaii’s Our Care Our Choice Act

Our April 2021 Kōkua Mau meeting features an update on the Our Care Our Choice Act in Hawaiʻi after the first 2 years by five presenters. Presenters: Laura Arcibal, Hawaiʻi Department of Health, Jodi Shaw, Kaiser Permanente, Michelle Cantillo, Hawaiʻi Pacific Health, Erin Hamilton, Bristol Hospice, Caryn Ireland, Consultant with Compassion & Choices. Time code for each presenter at ‘show more’ in our YouTube channel.

DISCLAIMER: Nothing on this web page is intended to be, and should not be interpreted as, specific medical or legal advice regarding this complex piece of legislation and related medical issues. This information may serve as a guideline for providers who are seeking general information about participation in the Our Care, Our Choice Act (OCOCA).