Kōkua Mau is a neutral source for information on the Our Care, Our Choice Act
Overview of The Law:
The Our Care, Our Choice Act (OCOCA) is a Hawaii law that permits terminally ill adult patients with capacity to make 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. Hawaii is the seventh jurisdiction to enact such a law. Read the full Hawaii bill here (pdf file).
2023 UPDATE: The Our Care, Our Choice Act (authorizing Medical Aid in Dying for terminally ill patients) has been updated to improve access. Important changes to the law went into effect on June 2, 2023 and include:
- APRNs are now able to be the Attending or Consulting Provider
- Psych APRNs & MFTs are able to be the Mental Health Provider
Additionally, there have been important changes to the waiting periods. We are grateful for these improvements to the law.
To be Eligible to Request an OCOCA Prescription, an Individual Must:
- Be an adult (18 years old or older).
- Be a Hawaii 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, 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 physician fees. Check with your health insurance company about their rules regarding costs associated with the prescription or related physician 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 giving patients information about the Act or even providing a referral. In that case, please refer to the Department of Health website (http://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 Physician Should Discuss:
- The patient’s understanding of his/her 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 physician must follow several steps which are carefully defined in the law, including:
- The patient must make two oral requests, not less than 20 days apart, directly to his or her physician (the attending physician)
- The patient must also make one request in writing, “Request For Medication To End My Life” form (PDF), which must be signed by the patient and two witnesses, and provided directly to his or her attending physician. The law does not say specifically when the written request must be made.
- The patient must discuss the request with his/her attending physician to make sure the request is voluntary.
- The patient must then see a second physician (a consulting physician) who can confirm the patient’s diagnosis, prognosis, and ability to make medical decisions.
- The patient must also see a counselor (psychiatrist, psychologist or clinical social worker) 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”. Consultation with counselor via Telehealth is permissible.
The Law Requires that the Patient and Attending Physician 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 physician 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 drug in a public location.
If the patient still wishes to proceed and the attending physician agrees, the attending physician 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 physician cannot hand a written prescription directly to the patient or their representative.
The law is not specific about which drug(s) can be prescribed.
Within forty-eight hours prior to taking the drug, the patient must sign a “Final Attestation Form” (PDF) which confirms they are taking the drug voluntarily, are under no obligation to take the drug, 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 Hawaii after the first 2 years by five presenters. Presenters: Laura Arcibal, HI Dept of Health, Jodi Shaw, Kaiser Permanente, Michelle Cantillo, Hawaii 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).