(a) The attending provider shall:

Terms Used In Hawaii Revised Statutes 327L-4

  • Attending provider: means a physician licensed pursuant to chapter 453 or advanced practice registered nurse licensed pursuant to chapter 457 who has responsibility for the care of the patient and treatment of the patient's terminal disease. See Hawaii Revised Statutes 327L-1
  • Capable: means that in the opinion of the patient's attending provider or consulting provider, psychiatrist, psychologist, or clinical social worker, a patient has the ability to understand the patient's choices for care, including risks and benefits, and make and communicate health care decisions to health care providers. See Hawaii Revised Statutes 327L-1
  • Consulting provider: means a physician licensed pursuant to chapter 453 who is qualified by specialty or experience to make a professional diagnosis and prognosis regarding the patient's disease or advanced practice registered nurse licensed pursuant to chapter 457 who is qualified by specialty or experience to diagnose and prescribe medication. See Hawaii Revised Statutes 327L-1
  • Counseling: means one or more consultations, which may be provided through telehealth, as necessary between a psychiatrist licensed under chapter 453, psychologist licensed under chapter 465, clinical social worker licensed pursuant to chapter 467E, advanced practice registered nurse or clinical nurse specialist licensed under chapter 457 with psychiatric or mental health training, or marriage and family therapist licensed pursuant to chapter 451J, and a patient for the purpose of determining that the patient is capable, and that the patient does not appear to be suffering from undertreatment or nontreatment of depression or other conditions that may interfere with the patient's ability to make an informed decision pursuant to this chapter. See Hawaii Revised Statutes 327L-1
  • Informed decision: means a decision by a qualified patient to request and obtain a prescription to end the qualified patient's life pursuant to this chapter. See Hawaii Revised Statutes 327L-1
  • Patient: means a person who is under the care of an attending provider. See Hawaii Revised Statutes 327L-1
  • Prescription: means prescription medication or medications that the qualified patient may self-administer to end the qualified patient's life pursuant to this chapter. See Hawaii Revised Statutes 327L-1
  • Qualified patient: means a capable adult who is a resident of the State and has satisfied the requirements of this chapter in order to obtain a prescription to end the qualified patient's life pursuant to this chapter. See Hawaii Revised Statutes 327L-1
  • Terminal disease: means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months. See Hawaii Revised Statutes 327L-1
(1) Make the initial determination of whether a patient has a terminal disease, is capable of medical decision-making, and has made the request for the prescription voluntarily;
(2) Require that the patient demonstrate residency pursuant to § 327L-13;
(3) To ensure that the patient is making an informed decision, inform the patient of the:

(A) Patient‘s medical diagnosis;
(B) Patient’s prognosis;
(C) Potential risks associated with taking the medication to be prescribed;
(D) Probable result of taking the medication to be prescribed;
(E) Possibility that the individual may choose not to obtain the medication or may obtain the medication but may decide not to use it; and
(F) Feasible alternatives or additional treatment opportunities, including but not limited to comfort care, hospice care, and pain control;
(4) Refer the patient to a consulting provider for medical confirmation of the diagnosis, and for a determination that the patient is capable and acting voluntarily;
(5) Refer the patient for counseling;
(6) Recommend that the patient notify next of kin;
(7) Counsel the patient about the importance of having another person present when the qualified patient self-administers the prescription prescribed pursuant to this chapter and of not self-administering the prescription in a public place;
(8) Inform the patient that a qualified patient may rescind the request at any time and in any manner, and offer the qualified patient an opportunity to rescind the request at the time of the qualified patient’s second oral request made pursuant to § 327L-9;
(9) Verify, immediately prior to writing the prescription for medication under this chapter, that the qualified patient is making an informed decision;
(10) Fulfill the medical record documentation requirements of section 327L-12;
(11) Ensure that all appropriate steps are carried out in accordance with this chapter prior to writing a prescription for medication to enable a qualified patient to end the qualified patient’s life pursuant to this chapter; and
(12) Either:

(A) Dispense medications directly, including ancillary medications intended to facilitate the desired effect to minimize the patient’s discomfort; provided that the attending provider is authorized to dispense controlled substances pursuant to chapter 329, has a current Drug Enforcement Administration certificate, and complies with any applicable administrative rules; or
(B) With the qualified patient’s written consent:

(i) Contact a pharmacist of the qualified patient’s choice and inform the pharmacist of the prescription; and
(ii) Transmit the written prescription personally, by mail, or electronically to the pharmacist, who shall dispense the medication to either the qualified patient, the attending provider, or an expressly identified agent of the qualified patient.
(b) Notwithstanding any other provision of law, an attending provider may sign the qualified patient’s death certificate. The death certificate shall list the terminal disease as the immediate cause of death.

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