17 Steps to Obtain a Medical Aid-in-Dying Prescription in Hawai‘i

1. Terminally ill, mentally capable adult resident of Hawai’i with 6 months or less to live, “the patient,” makes an appointment with their doctor, the “Prescribing Physician” (referred to in the Our Care Our Choice Act as the “Attending Physician”).
2. Patient makes their first oral request for medical aid in dying to the prescribing physician, the first of two doctors who must evaluate them for medical aid-in-dying eligibility.
3. Prescribing physician evaluates the patient to determine their eligibility for medical aid in dying, namely, that the patient:
• Has a terminal diagnosis with a prognosis of six months or less to live;
• Is capable of making their own healthcare decisions (this is the first of three medical professionals who must evaluate this capacity);
• Is making a voluntary request; and
• Is making an informed decision, which includes notification of all feasible alternatives or additional treatment opportunities, including hospice, palliative care, and comfort care. 
4. Prescribing physician refers the patient to a second physician known as the  “Consulting Physician.” 
5. Patient makes an appointment with the consulting physician.
6. Consulting physician examines the patient and the patient’s relevant medical records and confirms, in writing, the prescribing physician’s diagnosis of terminal disease and prognosis of six months or less to live, and verifies that the patient has medical decision making capacity and is acting voluntarily. 
7. Psychologist, psychiatrist, or licensed clinical social worker evaluates the patient and confirms that the patient has medical decision making capacity and does not have any mental health conditions that may interfere with the patient’s ability to make an informed medical decision.
8. Prescribing physician advises the patient to inform their family/next of kin of the prescription request.
• Patient must wait at least 20 days before making their second oral request to their prescribing physician.
9. Patient makes a second appointment with their prescribing physician.
10. Patient makes their second oral request to their prescribing physician for medical aid in dying.
11. Prescribing physician informs the patient that they may rescind the request at any time and in any matter and gives the patient an opportunity to rescind the prescription request.
12. Patient must find two qualified witnesses to sign their written request for a prescription. One of the witnesses cannot be:
• A relative of the qualified patient by blood, marriage, or adoption;
• A person who is entitled to any portion of the patient’s estate;
• An owner, operator, or employee of a healthcare facility where the patient is receiving medical treatment or is a resident; or 
• The patient’s prescribing physician.
13. Patient signs the written request in the presence of both witnesses.
14. Patient gives the signed written request to their prescribing physician
15. Prescribing physician counsels the patient to avoid taking the medication when alone or in a public place.
16. Prescribing physician must wait 48 hours after receiving the written request, then writes prescription for medical aid-in-dying medication.
17. Pharmacist fills prescription. (This can take an additional 7-14 days.)

*After a prescription is obtained, the patient is required to sign a final attestation form 48 hours or less before they take the medication.

**If a doctor decides not to support an eligible patient under the Our Care, Our Choice Act, they should document the first oral request and transfer it upon request. We also encourage doctors to refer patients to doctors who will support them, so they are not abandoned.