THIRTY-SECOND LEGISLATURE, 2023
STATE OF HAWAII
A BILL FOR AN ACT
relating to health.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that in 2018, the State passed the Our Care, Our Choice Act to ensure that all terminally ill individuals have access to the full-range of end-of-life care options. The Our Care, Our Choice Act allows mentally capable, terminally ill individuals with six months or less to live to voluntarily request and receive prescription medication that allows the person to die in a peaceful, humane, and dignified manner.
The legislature further finds that Hawaii's unique geography and the State's shortage of physicians create barriers to access for qualified terminally ill individuals. Finding a physician may be burdensome, especially for individuals on the neighbor islands. Hawaii gives advanced practice registered nurses full scope of practice licensure; however, they do not have authority to administer medical aid in dying, thereby further limiting access to care for many individuals. Furthermore, evidence from other states that authorize medical aid in dying demonstrates that even with full access to a supportive health care facility and providers, a high percentage of terminally ill individuals die while waiting to complete the regulatory requirements to qualify for medication under the respective state laws. Hawaii has the longest mandatory waiting period amongst all ten medical aid in dying authorized states and the District of Columbia. Many patients are not surviving the mandatory twenty days.
The purpose of this Act is to amend the Our Care, Our Choice Act to:
(1) Authorize advanced practice registered nurses to practice medical aid in dying in accordance with their scope of practice and prescribing authority;
(2) Authorize advanced practice registered nurses with a psychiatric or clinical nurse specialization in addition to psychiatrists, psychologists, and clinical social workers, to provide counseling to a qualified patient;
(3) Reduce the mandatory waiting period between oral requests from twenty days to five days; and
(4) Provide an expedited pathway for terminally ill qualified patients who are not expected to survive the mandatory waiting period.
SECTION 2. Section 327L-1, Hawaii Revised Statutes, is amended as follows:
1. By adding one new definition to be appropriately inserted and to read:
""Advanced practice registered nurse" means a registered nurse licensed to practice in the State who has met the qualifications of chapter 457 and who, because of advanced education and specialized clinical training, is authorized to assess, screen, diagnose, order, utilize, or perform medical, therapeutic, preventive, or corrective measures, including prescribing medication."
2. By amending the definition of "attending provider" to read:
""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."
3. By amending the definitions of "consulting provider" and "counseling" to read:
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.
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, [
or] clinical social worker licensed
pursuant to chapter 467E, or advanced practice registered nurse with a psychiatric
or clinical nurse specialization licensed under chapter 457, and a patient
for the purpose of determining that the patient is
and that the patient does not appear to be suffering from undertreatment or nontreatment of depression or
other conditions [ which] that may interfere with the patient's
ability to make an informed decision pursuant to this chapter."
SECTION 3. Section 327L-2, Hawaii Revised Statutes, is amended to read as follows:
§327L-2[ ]] Oral and written requests for
medication; initiated. [ An] Except
as otherwise provided in section 327L‑11(c), an adult who is capable,
is a resident of the State, and has been determined by an attending provider
and consulting provider to be suffering from a terminal disease, and who has
voluntarily expressed the adult's wish to die, may, pursuant to section 327L-9,
(1) Two oral requests, a minimum of [
five days apart; and
(2) One written request,
for a prescription that may be self-administered for the purpose of ending the adult's life in accordance with this chapter. The attending provider shall directly, and not through a designee, receive all three requests required pursuant to this section."
SECTION 4. Section 327L-9, Hawaii Revised Statutes, is amended to read as follows:
Written and oral requests. [ To] Except as otherwise provided
in section 327L-11(c), to receive a prescription for medication that a
qualified patient may self-administer to end the qualified patient's life
pursuant to this chapter, a qualified patient shall have made an oral request
and a written request, and reiterate the oral request to the qualified
patient's attending provider not less than [ twenty] five days
after making the initial oral request.
At the time the qualified patient makes the second oral request, the
attending provider shall offer the qualified patient an opportunity to rescind
SECTION 5. Section 327L-11, Hawaii Revised Statutes, is amended to read as follows:
§327L-11[ ]] Waiting periods. [ Not] (a) Except as otherwise provided in subsection
(c), not less than [ twenty] five days shall elapse between
the qualified patient's initial oral request and the taking of steps to make
available a prescription pursuant to section 327L-4(a)(12).
(b) Not less than forty-eight hours shall elapse between the qualified patient's written request and the taking of steps to make available a prescription pursuant to section 327L‑4(a)(12).
(c) If the qualified patient's attending provider attests that the qualified patient will, within a reasonable medical judgment, die within fifteen days after making the initial oral request, the five-day waiting period shall be waived and the qualified patient may reiterate the oral request to the attending provider at any time after making the initial oral request."
SECTION 6. Section 327L-19, Hawaii Revised Statutes, is amended by amending subsection (e) to read as follows:
"(e) For the purposes of this section:
means to deliver a separate statement in writing to a health care provider
specifically informing the health care provider [
prior to] before
the health care provider's participation in actions covered by this chapter of
the health care facility's policy regarding participation in actions covered by
"Participation in actions covered by this chapter" means [ to
perform] the performance of duties of an attending provider pursuant
to section 327L-4, the consulting provider function pursuant to section 327L-5,
or the counseling referral function or counseling pursuant to section 327L-6. The term does not include:
(1) Making an initial determination that a patient has a terminal disease and informing the patient of the medical prognosis;
(2) Providing information about this chapter to a patient upon the request of the patient;
(3) Providing a patient, upon the request
of the patient, with a referral to another [
(4) Entering into a contract with a patient as the patient's attending provider, consulting provider, or counselor to act outside of the course and scope of the health care provider's capacity as an employee or independent contractor of a health care facility."
SECTION 7. If any provision of this Act, or the application thereof to any person or circumstance, is held invalid, the invalidity does not affect other provisions or applications of the Act that can be given effect without the invalid provision or application, and to this end the provisions of this Act are severable.
SECTION 8. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 9. This Act shall take effect on July 1, 2023.
Kupuna Caucus; Our Care, Our Choice Act; Advanced Practice Registered Nurses; Mandatory Waiting Period
Authorizes advanced practice registered nurses to practice medical aid in dying or provide counseling to a qualified patient. Amends the mandatory waiting period between oral requests and the provision of a prescription.
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.