Hawai‘i Physician Gov. Signs Law Significantly Improving Terminally Ill Patients’ Access to Medical Aid in Dying

Jun 9, 2023 Hawaii Hawaii Medical Aid in Dying Act

Updated Law Cuts Nation’s Longest Waiting Period from 20 to 5 Days, Allows Providers to Waive it if Need Be, Allows More Providers to Participate

Compassion & Choices praised Hawai‘i Governor Josh Green, M.D., for signing legislation last week to significantly improve access to its 2018 law allowing terminally ill adults to obtain a prescription medication to gently end unbearable suffering. Physician Gov. Green is the first healthcare provider to sign a medical-aid-aid in-dying law in any jurisdiction. The Hawai‘i law took effect immediately upon signing on June . 

Dr. Charles Miller, oncologist (ret.)
Dir., Medical Aid-in-Dying Program
Kaiser Permanente Hawai‘i

“Thank you to Gov. Green, a Hawai‘i Island ER physician for 20 years, and Hawai‘i lawmakers for reviewing the evidence and data and recognizing the importance of ensuring that terminally ill adults in Hawai‘i have equitable access to medical aid in dying,” said Kim Callinan, president and CEO of Compassion & Choices. “Hawai‘i lawmakers have joined New Mexico, California, Washington and Oregon in setting a new model for medical-aid-in-dying laws: one that maintains appropriate safeguards, while eliminating unnecessary barriers, resulting in more compassionate and accessible laws.”

The updated law, Act 43, SLH 2023, builds upon recommendations in the 2020, 2021 and 2022 legislative reports by the Hawai‘i Department of Health to improve access to the 2018 Our Care, Our Choice Act. The new provisions in the law are:

1. Allowing qualified advanced practice registered nurses (APRNs) to be attending healthcare providers, who evaluate if the patient is eligible to use the law and prescribe medical aid in dying, and consulting healthcare providers, who must confirm the attending provider’s evaluation that the patient is eligible. The original law allowed only physicians to be attending and consulting providers. New Mexico enacted an original medical-aid-in-dying law in 2021, which in most cases, allows APRNs and physician assistants (PAs) to be either the attending or consulting provider, but one of them must be a physician (MD or DO), and Washington enacted a revised medical-aid-in-dying law this year allowing APRNs and PAs to be either the attending or consulting provider, but a physician would still have to be one of the other providers.
2. Allowing licensed APRNs and clinical nurse specialists with psychiatric or mental health training and licensed marriage and family therapists to provide mental health counseling to a qualified patient to determine if they are able to make an informed decision before they get a prescription. The original law only allowed psychiatrists, psychologists and licensed clinical social workers to provide mental health counseling. Allowing APRNs to participate as providers under the Our Care, Our Choice Act helps address the disparity in access to providers willing to participate in the law, particularly in rural areas and on neighboring islands
3. Reducing the mandatory waiting period between the two oral requests required for a qualified patient to obtain a prescription for medication from 20 days to five days. Hawai‘i’s 20-day waiting period was the longest of any medical-aid-in-dying law nationwide, Washington enacted a revised medical-aid-in-dying law this year reducing its waiting period from 15 days to 7 days, while California enacted a revised medical-aid-in-dying law in 2021 reducing its waiting period from 15 days to 48 hours and New Mexico enacted an original medical-aid-in-dying law in 2021 with a 48-hour waiting period between when a prescription for aid-in-dying medication is written and when it can be filled.
4. Waives the mandatory minimum waiting period for terminally ill qualified patients who are not expected to survive the five-day waiting period. Two of the largest healthcare systems in Hawai‘i found that a significant number of eligible patients run out of time during the waiting period, and as a result, they die with needless suffering. Oregon’s revised medical-aid-in-dying law enacted in 2019 allows a waiver of its 15-day waiting period between the two requests for aid-in-dying medication if the patient is expected to die during it and New Mexico’s original medical-aid-in-dying law enacted in 2021 allows a waiver of the 48-hour waiting period between when a prescription for aid-in-dying medication is written and when it can be filled.