MAID

The Hawai’i Department of Health Website has a thorough review of the law and all its logistics. It is also the source to download state documents which you and your chosen physician will need, including the written request and final attestation form. You can also review the text of HB650, which amended the law on June 1, 2023, shortening the waiting period to 5 days and allowing additional types of providers to support patients in the process.

Compassion & Choices is the oldest and most active national nonprofit organization involved in improving care, expanding options and empowering everyone to chart their end-of-life journey. They have a library of resources, not only on Medical Aid in Dying, but many other end-of-life options and supportive tools.

Dr. Charfen is the co-founder of a nonprofit organization called Life & Death Wellness, whose goal is to support and educate around matters throughout all of life, but especially at the end. Please visit the site to watch her educational presentation on the OCOCA act in particular, or click here. You can also read more about her experiences on her website’s media and blog pages.

Another resource for patients, loved ones, and health care providers comes from a group called American Clinicians Academy on Medical Aid in Dying. They provide educational information and videos about the process, preparing the medication, and finding supportive physicians and end-of-life doulas in your area.

DISCLAIMER: Dr. Charfen provides web resources and links to organizations “as is” without any warranty of any kind.  Provision of these web resources and links do not imply approval of the listed websites, warrant the accuracy of any information contained in those websites, constitute endorsement of the entities and its contents to whose sites the links are made, or endorse any of the opinions expressed on any of these external websites. These websites operate under the auspices and at the direction of their respective owners. If you have a question or comments about any of these sites, please contact them directly from their websites.

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.

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 process will vary depending on the consultant’s ability to use your insurance, charge a fee, or offer to do this pro bono. The medication costs will vary according to the compounding pharmacy chosen.

Dr. Charfen’s tips and practice fees:

• Dr. Charfen accepts some insurances, including Medicare and HMSA, which may cover parts of the process.
• If finances are a concern, she offers a sliding scale fee for those who qualify and strives to assist patients regardless of their situation.
• If your primary or specialty provider is willing to help, parts of the process may be covered under advance care planning, so it’s worth discussing with them.

If you do not have accepted insurance

• Dr. Charfen charges $350 for the initial consultation as the Attending Physician, which includes the first oral request, patient evaluation, and record review.

• The second Attending consultation, after the 5-day waiting period, also costs $350 and covers the second oral request, evaluation, completing paperwork, and writing the prescription.

• The fee for serving as the Consulting Physician is $250, covering record review, evaluation (in-person or telemedicine), and completing required forms.

Mental Health Provider fees:

• These will vary based on the provider.
• Some providers have offered to do this pro bono, accepted insurance and also charged fees.
• Dr. Charfen will provide you with a list of mental health providers who are open to working with Medical Aid in Dying patients if requested. 

Medication Costs:

• Medication costs typically range from $400 to $600, depending on the pharmacy.
• Since no compounding pharmacies on the Big Island currently provide this service, Dr. Charfen recommends ElixRx in Kailua, Oahu, which last charged $450.
• The choice of pharmacy is ultimately yours.

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