Hawaii Living Will Requirements

Introduction

Key Things to Know

1. 1

   Hawaii's optional advance-directive form has witnesses sign a single combined declaration, covering both their personal knowledge of you and their unrelated, non-inheriting status, rather than splitting these into two separate declarations the way some states' forms do. Underneath that detail, this is still your living will: a written statement of which medical treatments you want or want withheld if you cannot speak for yourself. It is not a document that names who decides for you.

2. 2

   A living will is not a last will and testament. A living will governs medical care while you are alive but unable to communicate; a last will and testament governs who inherits your property after you die. Most people preparing one eventually want the other too.

3. 3

   Hawaii does not have a stand-alone living-will form. Chapter 327E folds the treatment-wishes declaration and the health care power of attorney into one combined Advance Health-Care Directive.

4. 4

   Section 327E-3's witnessing and notarization language is written for the power-of-attorney half of the statute; standing alone, a bare treatment-wishes instruction has no separate signature formality of its own in the code's literal text. Follow the same rule anyway: Hawaii's own optional form holds both halves to one shared signature block, so you can sign before two qualified adult witnesses or before a notary public, both routes equally valid, notarization is not a backup option.

5. 5

   Artificial nutrition and hydration gets its own numbered paragraph on Hawaii's optional form. By default it follows your general treatment choice, but you can check a separate box requiring it regardless of that choice.

6. 6

   Hawaii law does not include a pregnancy-exclusion clause. Nothing in Chapter 327E changes, suspends, or voids your directive if you are pregnant.

7. 7

   You can revoke your treatment-wishes instructions at any time, in any manner that communicates your intent to revoke, a deliberately loose standard the law applies only to this treatment-wishes half. Revoking an agent's designation instead follows a separate, stricter rule; see Hawaii Healthcare Power of Attorney for that mechanic.

8. 8

   Hawaii has no state registry for advance directives, unlike some other states. Keep copies with your physician, your named agent, and somewhere accessible at home.

9. 9

   Electronic signatures are not accepted for a Hawaii Advance Health-Care Directive, per the Department of Health's own guidance.

Hawaii Requirements for Living Will

• Hawaii Uniform Health-Care Decisions Act (Hawaii Revised Statutes Chapter 327E)

  Hawaii does not have a legally separate living-will statute. Hawaii Revised Statutes Chapter 327E, the Uniform Health-Care Decisions Act (Modified), creates one combined instrument, the Advance Health-Care Directive, defined as either an individual instruction (treatment wishes), a power of attorney for health care (agent designation), or both together in one document.

• Individual Instruction Authorization (Hawaii Revised Statutes Section 327E-3(a))

  An adult or emancipated minor may give an individual instruction about their own health care, oral or written, and may limit it to take effect only if a specified condition arises. This section authorizes you to state your own treatment wishes directly, without naming an agent.

• Capacity Determination (Hawaii Revised Statutes Section 327E-3(f))

  Unless your directive specifies otherwise, whether you lack or have recovered capacity is determined by your primary physician, per Section 327E-3(f). Section 327E-11 separately confirms every adult is presumed to have capacity.

• Revocation Rights (Hawaii Revised Statutes Section 327E-4)

  You may revoke all or part of your advance health-care directive, other than your agent designation, at any time and in any manner that communicates an intent to revoke, as long as you have capacity. Revoking your agent's designation requires a signed writing or personally informing your health care provider, a stricter standard.

• Witness Requirements (Hawaii Revised Statutes Section 327E-3(c)-(d))

  If you use witnesses instead of a notary, Hawaii requires two adult witnesses. A witness may not be your agent, a health care provider, or an employee of a health care provider or facility. At least one witness must not be related to you by blood, marriage, or adoption and must not be entitled to any part of your estate. Witnessing is not mandatory; notarization is an equally valid, independently sufficient alternative.

• Notarization Alternative (Hawaii Revised Statutes Section 327E-3(b)(2))

  Acknowledging your directive before a notary public anywhere in Hawaii is not a fallback for people who cannot find witnesses. Section 327E-3(b) makes notarization and two-witness signing two independently sufficient, co-equal ways to execute a valid directive.

• Life-Prolonging Procedures (Hawaii Revised Statutes Section 327E-16)

  This exact three-condition end-of-life language, an incurable and irreversible condition expected to cause death within a relatively short time, permanent unconsciousness, or risks and burdens outweighing expected benefits, appears in the optional statutory form at Section 327E-16.

• Pain Relief Provisions (Hawaii Revised Statutes Section 327E-16)

  The pain-relief election, a checkbox directing that treatment to alleviate pain be given even if it hastens death, is Section 327E-16, Part 2, paragraph (8).

• Organ Donation (Hawaii Revised Statutes Section 327-4)

  Hawaii's Uniform Anatomical Gift Act lets you authorize organ and tissue donation. Hawaii's own optional Section 327E-16 statutory form includes a dedicated Part 3 for organ donation alongside its treatment-wishes and agent-designation sections, so most people handle both in the same document.

• Healthcare Provider Compliance (Hawaii Revised Statutes Section 327E-7)

  A health care provider must comply with your individual instruction and reasonable interpretations of it, unless the provider objects for reasons of conscience or the instruction requires care contrary to the provider's or institution's policy or generally accepted standards, in which case the provider must still give continuing care and help transfer you to a provider who will comply.

• Out-of-State Recognition (Hawaii Revised Statutes Section 327E-3(j))

  The out-of-state recognition rule, that a directive valid under Hawaii law or under the law of the state where it was executed is valid here, is subsection (j) of Section 327E-3.

• Patient Self-Determination Act Compliance (42 U.S.C. Section 1395cc(f))

  Federal law requires Medicare- and Medicaid-participating hospitals, nursing homes, and other facilities to inform patients in writing of their right under Hawaii law to make an advance directive, including stating their own treatment wishes.

• HIPAA Authorization (45 CFR Section 164.508)

  Federal HIPAA regulations govern how your health care agent can be authorized to access your protected health information once the agent-designation portion of your combined directive is in effect. This authorization supports the agent-decision-maker half of your directive; it does not change or expand your own treatment-wishes instructions.

• Advance Mental Health Care Directive Interaction (Hawaii Revised Statutes Chapter 327G)

  Chapter 327G is a separate Hawaii statute from Chapter 327E. It lets a competent adult make a distinct advance mental health care directive, stating preferences about psychiatric medication, electroconvulsive treatment, and facility admission, and name a mental-health decision agent. Chapter 327G expressly allows this directive to be combined with your Chapter 327E Advance Health-Care Directive, but it is not automatically part of it. Your general health care instructions under Chapter 327E do not by themselves cover mental health treatment decisions to the same extent.

• Surrogate Decision-Making (Hawaii Revised Statutes Section 327E-5)

  If you have no agent or guardian, or your agent is not reasonably available, Hawaii lets interested persons, such as a spouse, adult child, or parent, select a surrogate decision-maker following the statute's priority process. A surrogate who was not designated by you may only authorize withholding or withdrawing artificial nutrition and hydration if your primary physician and a second independent physician both certify that continuing it merely prolongs dying with no reasonable chance of neurological recovery.

• Artificial Nutrition and Hydration (Hawaii Revised Statutes Section 327E-2 and Section 327E-16)

  The definition of 'health care' at Section 327E-2 expressly includes artificial nutrition and hydration. The specific election mechanic, a separate numbered paragraph on the optional form that follows your general choice unless you check a box requiring it regardless, is Section 327E-16, Part 2, paragraph (7).

• Immunity Provisions (Hawaii Revised Statutes Section 327E-9)

  A health care provider or institution acting in good faith and in accordance with generally accepted health care standards is not subject to civil or criminal liability, or professional discipline, for complying with, or declining to comply with, a health care decision, or for relying on an advance health-care directive it reasonably believed was valid and unrevoked. An agent, guardian, or surrogate acting in good faith has the same protection.

• Prohibition Against Suicide, Mercy Killing, or Euthanasia (Hawaii Revised Statutes Section 327E-13)

  Death resulting from withholding or withdrawing health care under Chapter 327E is not suicide or homicide for any purpose and does not impair an insurance or annuity policy. The chapter does not authorize mercy killing, assisted suicide, or euthanasia, except that this prohibition does not apply to actions taken under Hawaii's separate Our Care, Our Choice Act (Chapter 327L).

• Our Care, Our Choice Act Interaction (Hawaii Revised Statutes Chapter 327L)

  Hawaii's Our Care, Our Choice Act lets a mentally capable, terminally ill adult with six months or less to live voluntarily request prescription medication to end their life. This is a separate legal process from your Advance Health-Care Directive: it requires your own contemporaneous, repeated request at the time under its own procedure, and is not something you can elect or pre-authorize through your living-will instructions.

• No State Advance Directive Registry (Hawaii)

  Unlike some other states, Hawaii has no state-run registry for advance health-care directives. Instead, give copies of your signed directive to your physician, any treating health care institution, and your named agent, and keep a copy somewhere accessible at home.