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Advance Directive in Hawaii: Health Care Power of Attorney, Witnesses and the Optional Form
Hawaii's advance health-care directive can name an agent, give instructions, or both. The power of attorney for health care needs two qualified witnesses or a Hawaii notary. Here is how it works under HRS chapter 327E.
By naveen · Updated · How we research our guides
What to know
- A Hawaii power of attorney for health care must be in writing, dated and signed by your parent, and either signed by two witnesses or acknowledged before a notary in Hawaii (HRS 327E-3).
- A witness can't be a health care provider, an employee of a provider or facility, or the agent, and at least one witness must be unrelated and not an heir.
- Unless the document says otherwise, the agent's authority starts only when your parent is determined to lack capacity.
- Without an agent or guardian, family and close friends try to agree on a surrogate; Hawaii's statute sets no ranked list (HRS 327E-5).
- Retirement Checklist puts these documents in order alongside everything else your family needs to settle.
A Hawaii advance health-care directive is a health care instruction, a power of attorney for health care, or both; the power of attorney needs writing, a date, your parent's signature, and two qualified witnesses or a Hawaii notary. By statute, an advance health-care directive "means an individual instruction or a power of attorney for health care." Under HRS 327E-3, your parent can name an agent who may "make any health-care decision the principal could have made while having capacity," and that power "remains in effect notwithstanding the principal's later incapacity." The law, the Uniform Health-Care Decisions Act (Modified), includes an optional form anyone can use.
What is an advance health-care directive in Hawaii?
It's your parent's health care document under HRS chapter 327E: a power of attorney for health care that names an agent, an individual instruction, or both.
| Part | What it does | Signing rule |
|---|---|---|
| Power of attorney for health care | Names an agent to make health care decisions for your parent | Written, dated, signed, and two witnesses or a Hawaii notary (327E-3) |
| Individual instruction | States your parent's own directions about their health care | "The instruction may be oral or written" (327E-3) |
The state's optional form combines them, with places for an agent and alternates, end-of-life choices, artificial nutrition and hydration, pain relief, organ donation and a primary physician. A financial power of attorney is separate and doesn't cover health care; see our Hawaii power of attorney guide. For the general picture, see power of attorney vs. advance directive.
How do you sign a Hawaii advance directive?
Your parent signs and dates the power of attorney for health care in writing, then has two qualified witnesses sign it or acknowledges it before a notary in Hawaii (HRS 327E-3). The statute says it "shall be in writing, contain the date of its execution, be signed by the principal, and be witnessed by one of the following methods":
- signed by at least two individuals, each of whom witnessed your parent sign or acknowledge their signature; or
- "Acknowledged before a notary public at any place within this State."
The optional form's instructions put it this way: the power of attorney "will not be valid for making health-care decisions unless it is either (a) signed by two qualified adult witnesses who are personally known to you and who are present when you sign or acknowledge your signature; or (b) acknowledged before a notary public in the State." The Department of Health's Executive Office on Aging notes, "Electronic signatures are not accepted."
Who can't witness or serve as the agent?
Under HRS 327E-3(c) and (d), a witness can't be:
- a health care provider;
- an employee of a health care provider or facility;
- the agent.
At least one of the two witnesses must also be someone who is neither related to your parent by blood, marriage or adoption, nor entitled to any part of your parent's estate under a will or by operation of law. So a family member can be the second witness, but not both.
For the agent, the rule is narrow: "Unless related to the principal by blood, marriage, or adoption, an agent may not be an owner, operator, or employee of the health-care institution at which the principal is receiving care." Chapter 327E as we read it doesn't bar any other group from serving.
When does the agent start making decisions?
"Unless otherwise specified in a power of attorney for health care, the authority of an agent becomes effective only upon a determination that the principal lacks capacity," and it stops if your parent recovers capacity. The primary physician makes that determination unless the directive says otherwise. The optional form has a box your parent can mark to make the agent's authority take effect immediately.
The agent follows your parent's instructions and known wishes, otherwise their best interest, considering their personal values. The agent "has the same rights as the patient to request, receive, examine, copy, and consent to the disclosure of medical or any other health-care information." A copy of the directive "has the same effect as the original." If a court later appoints a guardian, the guardian can't revoke your parent's directive without express court authority, but absent a court order, the guardian's health care decisions take precedence over the agent's.
Where do you get a Hawaii form?
The optional form is printed in HRS 327E-16: "This form may be modified to suit the needs of the person, or a completely different form may be used that contains the substance of the following form." The Executive Office on Aging links a fillable and a printable Hawaii Advance Health Care Directive form.
The form asks your parent to "Give a copy of the signed and completed form to your physician, to any other health-care providers you may have, to any health-care institution at which you are receiving care, and to any health-care agents you have named." A provider or facility can't require your parent to sign, or not sign, an advance directive as a condition of care.
What happens if your parent has no advance directive?
Hawaii uses a surrogate. Your parent can name one by personally informing the supervising health care provider. Otherwise, under HRS 327E-5, once the primary physician determines your parent lacks capacity and there's no available agent or guardian, the physician tries to locate "interested persons": a spouse (unless legally separated or estranged), a reciprocal beneficiary, any adult child, either parent, an adult sibling or grandchild, or an adult who "has exhibited special care and concern for the patient."
They "shall make reasonable efforts to reach a consensus as to who among them shall make health-care decisions on behalf of the patient." There's no fixed priority order; the surrogate should be the person with a close relationship who is "the most likely to be currently informed of the patient's wishes." If anyone disagrees, or no consensus is reached, an interested person may seek guardianship; see conservatorship and guardianship.
A surrogate your parent didn't choose can withhold or withdraw artificial nutrition and hydration only when two physicians certify it "is merely prolonging the act of dying and the patient is highly unlikely to have any neurological response in the future." The provider must also require a surrogate to sign a written declaration establishing their authority.
How do you revoke a Hawaii advance directive?
Your parent revokes the agent's appointment with a signed writing or by telling the supervising health care provider, and the rest in any way that shows the intent; HRS 327E-4 sets four rules:
- The agent's appointment. Your parent "may revoke the designation of an agent only by a signed writing or by personally informing the supervising health-care provider."
- Everything else. Your parent may revoke all or part of the rest of the directive "at any time and in any manner that communicates an intent to revoke."
- Divorce. A decree of annulment, divorce, dissolution or legal separation revokes the appointment of a spouse as agent, unless the decree or the document says otherwise.
- A newer directive. A later directive that conflicts with an earlier one revokes the earlier one to the extent of the conflict.
What about POLST?
A POLST, Provider Orders for Life-Sustaining Treatment, is a medical order about resuscitation and life-sustaining measures under HRS chapter 327K. "To be valid, a form shall be signed by the patient's provider and the patient, or the patient's provider and the patient's legally authorized representative," and the provider can be a physician, physician assistant or advanced practice registered nurse. The statute says it "is not an advance health-care directive." The Executive Office on Aging adds that "POLST is a portable medical order that takes effect immediately once it is signed."
Frequently asked questions
Does an advance directive need to be notarized in Hawaii?
No, if two qualified witnesses sign instead. Under HRS 327E-3, a power of attorney for health care must be either signed by two witnesses or acknowledged before a notary public in Hawaii. Either method works. Your parent signs and dates it in writing; electronic signatures aren't accepted on the Department of Health's form.
Can a family member witness a Hawaii advance directive?
One can. A witness can't be a health care provider, an employee of a provider or facility, or the agent. At least one of the two witnesses must be neither related to your parent by blood, marriage or adoption nor entitled to inherit from them, so a relative can witness only alongside an unrelated, non-heir witness.
Where can I get a Hawaii advance directive form?
The optional form is printed in HRS 327E-16, and the Department of Health's Executive Office on Aging links a fillable and a printable version. Your parent can modify it or use a different form with the same substance. An attorney can also prepare one. Make sure the doctor and agent get copies.
Who makes medical decisions in Hawaii if there's no advance directive?
A surrogate. Your parent can name one by telling the supervising health care provider. Otherwise, interested persons, including a spouse or reciprocal beneficiary, adult children, parents, adult siblings or grandchildren, and close friends, try to agree on one person. There's no ranked list; if they can't agree, someone may seek guardianship.
Is an advance directive from another state valid in Hawaii?
Yes, if it met Hawaii's rules or the rules where it was signed. Under HRS 327E-3, an advance health-care directive is valid in Hawaii if it complies with chapter 327E or "if it was executed in compliance with the laws of the state where it was executed." A supervising provider who knows of a directive must note it in the medical record and ask for a copy.
Can my parent change their mind after signing?
Yes. Your parent can revoke the agent's appointment by a signed writing or by personally telling the supervising health care provider, and revoke the rest of the directive in any way that communicates the intent. Your parent is presumed to have capacity to revoke. Telling the doctor keeps the medical record current.
Getting started
An advance directive only helps if it's signed while your parent can sign it, with two qualified witnesses or a notary, and the right people have copies; in Hawaii it's also the way to avoid relying on a family consensus. The plan this site builds asks four questions, including which state your parents live in, and puts the steps that matter most for your family in order. It's free and takes about 90 seconds.
Related guides
Sources
- HRS chapter 327E, Uniform Health-Care Decisions Act (Modified): definitions (327E-2), signing, witnesses and agents (327E-3), revocation (327E-4), surrogates (327E-5), guardians (327E-6) and the optional form (327E-16); published by the Hawaii State Legislature.
- HRS chapter 327K, Provider Orders for Life-Sustaining Treatment: POLST.
- Hawaii Department of Health, Executive Office on Aging, Advance Healthcare Directive: guidance and links to the form.
- Hawaii Department of Health, Executive Office on Aging, POLST: how POLST works.
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