MAID

Hawaiʻi Department of Health
The Hawai’i Department of Health Website provides the official information on the Our Care, Our Choice Act (OCOCA), including eligibility requirements, required forms, and current state regulations.

Hawaiʻi End-of-Life Options (HELO)
HELO is a Hawaiʻi nonprofit dedicated to educating patients, families, and healthcare professionals about end-of-life options, including Medical Aid in Dying, advance care planning, and palliative care resources.

Life & Death Wellness
Co-founded by Dr. Charlotte Charfen, Life & Death Wellness is a nonprofit organization dedicated to education and support surrounding serious illness, dying, death, and grief. Educational resources, including presentations on the Our Care, Our Choice Act, are available through the organization.

Academy of Aid-in-Dying Medicine
AADM provides educational resources for patients, loved ones, and healthcare professionals, including information on the Medical Aid in Dying process, medication preparation, and how to locate experienced providers and end-of-life doulas.

Compassion & Choices
A national nonprofit organization providing education, advocacy, and resources on Medical Aid in Dying, advance care planning, and other end-of-life options.

Disclaimer: The external resources listed above are provided for educational purposes only. Inclusion on this website does not constitute an endorsement of any organization or guarantee the accuracy of information contained on external websites. Patients should refer to each organization’s website for the most current information.

A patient must be:

• A Hawai`i resident, age 18 or older
• Diagnosed with a terminal illness, with a prognosis of six (6) months or less to live
• Mentally capable of making an informed decision
• Physically able to take the prescribed medication

A person does NOT qualify if:

• they are not able to make their own medical decisions (e.g. end-stage dementia)
• they have progressive disease but is not yet considered terminal (i.e. less than six months to live)
• they are unable to take the medication voluntarily on their own, either by swallowing or by pushing a syringe into a feeding or rectal tube to administer the medication
• they are not a resident of the state of Hawai’i

If you are unsure if you or a loved one meets these criteria, please reach out to a knowledgeable physician who has educated themselves about the law and using this option.

Below is an overview of the steps in the MAID process in Hawai’i. You can click here to download a copy of this as a PDF document, with links to the necessary forms.

Starting the process and the 5-day waiting period

• To begin, you must make your first oral request to a doctor or a qualified Advanced Practice Registered Nurse (APRN). This request must be documented in your medical record.

• If your current provider does not participate, they are still legally required to record your request—don’t hesitate to ask them. You can then have your records sent to the provider handling the process.

• If you choose Dr. Charfen, you can make your first oral request directly to her. Once your request is documented, the 5-day waiting period begins.

Three Providers are needed

• 1. Attending Provider: This is the main provider responsible for overseeing the process and, ultimately, writing the prescription once all steps are complete.
• 2. Consulting Provider: A second doctor or qualified APRN confirms the diagnosis, prognosis, and that the patient is mentally capable of making the request. This provider completes a simple state form. Your primary care or specialist may often take this role, even if they don’t serve as the Attending Provider.
• 3. Counseling Provider: A psychiatrist, psychologist, licensed clinical social worker, or licensed marriage and family therapist confirms the patient is mentally competent and not suffering from untreated severe depression or other issues affecting their decision-making.

• All providers must be licensed in Hawai’i.

Finishing the process

• Complete the written request form, with two witness signatures (of which only one can be a relative) and return it to your attending provider as soon as possible.
• Schedule your second follow-up appointment with whomever is your attending provider, on or after day 5 from your first documented verbal request. Give your second oral request to that attending provider.

Once at least 5 days have passed, and the second request has been made, your attending provider is then legally able to write you the prescription for the medication, as long as all other criteria and evaluations have occurred.

The patient can stop this process at any point and is never under any obligation to fill the medication prescription once it has been written, or take it once it is dispensed.

Enrolling in hospice care while pursuing MAID is optional but encouraged. Hospice provides compassionate, specialized end-of-life care and offers logistical benefits for qualifying for MAID. If you’re on hospice and choose to use the medication, police do not need to be called at the time of death. You can also stop hospice services at any time if it’s not the right fit for you.

The cost of the Medical Aid in Dying process varies depending on insurance coverage, the providers involved, and the compounding pharmacy selected.

Dr. Charfen accepts many Hawaiʻi insurance plans, including Medicare, United, and HMSA, which may cover portions of the evaluation and consultation process. Patients are responsible for any non-covered services, deductibles, copays, or coinsurance.

For patients without applicable insurance coverage, the following self-pay fees apply:

• Attending Physician Initial Consultation: $350
• Attending Physician Follow-up Consultation: $350
• Consulting Physician Evaluation: $250

If financial hardship is a concern, please let us know. Sliding scale fees or waivers may be available for qualifying patients.

Mental health evaluations, when required, are provided by independent clinicians. Fees vary by provider, and some may accept insurance or offer reduced-cost or pro bono services. We are happy to provide referrals.

Medication costs are separate and typically range from $400–$600, depending on the compounding pharmacy. Dr. Charfen commonly works with ElixRx in Kailua, Oʻahu, although patients may choose any participating compounding pharmacy.

All forms can be found on the Hawai’i Department of Health website, but they are also linked here for your convenience:

Patient Required Forms:

• Patient Written Request Form can be completed anytime after the first oral request has been made. It is wise to do it as soon as possible and return it to your attending physician. There is a mandatory 48-hour waiting period before prescribing by law once this is received, so the sooner this is done, the better.
• Final Attestation Form is only required if you decide to take the medication. Do not fill this out until 48 hours before the chosen date of ingestion. This form protects your loved ones and your provider should someone call your decision into question.

Attending Provider Forms:

• Attending Provider Reporting Form should be completed by the attending within 30 days of writing the prescription and mailed into the state.
• Attending Provider Follow Up Form only gets completed after a qualified patient dies even if they did not ingest the medication.

Consulting Provider Form:

• Consulting Provider Confirmation and Verification Form is required to be sent to your attending physician from your consulting physician after your evaluation. It is a very simple 2 page form. Many physicians who may not be comfortable taking on the attending role, find the consulting role and the paperwork less responsibility.

Counseling Provider Form:

• Counseling Provider Statement of Determination Form is required to be sent to your attending physician from your counseling provider after your evaluation. We are the only state in the US with a MAID law that requires this extra step. Luckily, this is also a simple form and many providers will do this part over the phone or via video.

Coming Soon