Before writing an OCOCA prescription, an attending provider must make an initial determination of whether a patient is a qualified individual.

An individual patient is qualified if he or she:

• Is an adult (18 years of age or older)

• Is a Hawaii Resident
  • Residency requirement includes but not limited to:
  • Hawaiʻi driver's license or civil identification card
  • Registration to vote in Hawaiʻi
  • Evidence that the person owns or leases property in Hawaiʻi
  • Filing of a Hawaiʻi tax return for the most recent tax year.

• Has a terminal disease and a 6 month prognosis

• Has the capacity to make her or his own medical decisions

• Is making an informed decision

• Is making a fully voluntary request for the OCOCA prescription and the request does not arise from coercion or undue influence

• Is physically and mentally able to self-administer the medication, meaning a conscious and physical act of administering and ingesting the medication to bring about death
• Has submitted the signed, dated and witnessed request form

The attending provider must receive, from the patient directly and not through a designee, two oral requests separated by not less than 5 days (unless provider waives the waiting period), and a written request. The law does not specify when the written request should be submitted.

All written and oral requests must be recorded in the medical record. (There is no specific language required in the documentation.)

The attending provider must refer the patient to a consulting provider.

The attending provider must refer the patient for counseling by a licensed psychiatrist, psychologist, or clinical social worker APRNPsych or clinical nurse specialist licensed under chapter 457 with psychiatric or mental health training, or marriage and family therapist in order to 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.

The attending provider must discuss with the patient about the importance of:

• Having another person present when the medication is ingested

• Not ingesting the medication in a public place or place open to public view or access

• Notifying next of kin of a request for OCOCA prescription (failure to do so is not reason to deny the patient the OCOCA prescription)

• Participating in a hospice program

• Maintaining the medication in safe and secure location until self-administered. (Although this is not in the law, we recommend it as best practice.)

During discussions with the patient, the attending provider must remind the patient that he or she may rescind their request for OCOCA prescription at any time in any manner.

To confirm that the patient is making an informed decision, the attending physician must discuss the following with the patient:

• The patient’s diagnosis and prognosis

• The risks associated with taking the medication

• Probable result of taking the medication

• The possibility that the patient may at any time choose not to fill the OCOCA prescription or may obtain the medication and choose not to take it

• Feasible alternatives or additional treatment options, such as comfort care, hospice care, palliative care, pain control, voluntarily stopping eating and drinking

The attending provider must comply with all documentation requirements and submit all necessary forms.

In addition, the attending provider must:

• Offer the patient an opportunity to withdraw/rescind the request before writing the OCOCA prescription

• Verify the patient is making an informed decision immediately before writing the OCOCA prescription

• Confirm all requirements are met and that appropriate steps are carried out before writing the OCOCA prescription

• Fulfill all documentation requirements

• Within thirty calendar days of writing a prescription, the attending provider shall submit a copy of the patient's written request, as well as copy of all the documentation required to the Department of Health

Medical record documentation requirements  

• All oral requests

• All written requests

• The attending provider’s diagnosis and prognosis, that the patient is capable, acting voluntarily, and has made an informed decision

• The consulting provider’s diagnosis and prognosis and verification that the qualified patient is capable, acting voluntarily, and has made an informed decision

• The counselor's statement of determination 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 ability to make an informed decision

• The attending provider’s offer to the patient to rescind the request at the time of the second oral request

• A statement by the attending provider indicating that all requirements have been met and indicating the steps taken to carry out the request, including identification of the medication prescribed.

• Give the requesting patient the Final Attestation for a Request for Medication to End My Life form and instruct the patient about completing it

• Within thirty calendar days following notification of the patient's death from use of a prescribed medication, or any other cause, the attending provider shall submit any follow-up information to the documentation required to the department of health.

The consulting provider must:

• Examine the patient and his or her relevant medical records

• Confirm in writing and submit to the attending provider, the diagnosis and terminal prognosis of the patient and;

• Verify that the individual has capacity to make medical decisions; is acting voluntarily; and, is making an informed decision

A consulting provider must:

• Be qualified by specialty or experience to make a diagnosis and prognosis regarding the patient’s terminal disease

A counselor is a licensed psychiatrist, psychologist, clinical social worker, APRN-Psych, clinical nurse specialist licensed under chapter 457 with psychiatric or mental health training, or marriage & family therapist

Only a provider who meets the statutory definition of attending provider may write the OCOCA prescription.

Under the law, an attending provider is the provider who has responsibility for:

• The health care of the requesting patient AND

• Treatment of the requesting patient’s terminal disease

All forms can be found on the Hawaii DOH OCOCA page:

https://health.hawaii.gov/opppd/ococ/

Direct link to the forms (as of July 2024)

https://health.hawaii.gov/opppd/ococ/health-care-provider-and-patient-forms/

Within 30 calendar days of writing an OCOCA prescription, the attending provider must submit the following completed, signed, and dated forms and documentation to the Hawaiʻi Department of Health by USPS:

• A copy of the qualifying individual’s written request

• All required documentation found on Attending Provider’s Checklist

Within 30 calendar days of a qualified individuals’ ingestion of the medication obtained under the terms of the Act, or death from any other cause, the attending provider shall submit any follow-up information to the documentation required

The death certificate shall list the terminal disease as the immediate cause of death.

All patients approaching the end of life should discuss their preferences for end-of-life care, complete an advance directive, select a surrogate, and be offered a POLST form to protect those wishes.

For patients choosing the Our Care, Our Choice Act—to request, receive and ingest the aid-in-dying medication - a POLST form should be completed to reflect this choice. For those patients we recommend selecting:

A: Do Not Attempt Resuscitation

B: Comfort-Focused Treatment

C: No Artificial Nutrition