By Chris Haring
Discover insights from Hawai’i’s 2023 aid-in-dying report highlighting patient demographics, usage statistics, legislative updates, and ongoing challenges.
The Hawai’i Department of Health has published its annual Our Care, Our Choice Act (OCOCA) Report, providing an overview of the utilization and impact of the state’s aid-in-dying law. Covering the period from January 1, 2023, through December 31, 2023, the report includes data from attending, consulting, and counseling providers.
The annual report on Hawaii’s Death with Dignity law offers raw data in several categories
During this reporting period, 91 qualified patients received aid-in-dying prescriptions. Out of these, 51 died directly resulting from the ingestion of the prescribed medication, with 25 others dying without utilizing their prescriptions. Notably, the average time from the first oral request to the written prescription was 38 days, and the average waiting period between the first and second oral requests was 24 days.
Cancer was the predominant underlying illness, with other prevalent conditions including neurodegenerative diseases like ALS (amyotrophic lateral sclerosis), lung diseases such as pulmonary fibrosis and COPD (chronic obstructive pulmonary disease), and various forms of heart disease.
The majority of those who received aid-in-dying prescriptions were Caucasian, with a less robust representation of Asian, Hispanic/Latino, and Pacific Islander individuals. A significant majority (73 of 91 – 80%) were hospice patients at the time of their request, and while their ages varied widely, most who died of self-administering the life-ending medication (46 of 51 – 90%) were 65 and older, consistent with trends observed in other states with similar laws.
The patients’ education levels also showed diversity, ranging from high school diplomas to advanced degrees. While most patients had some form of insurance, there were variations in the type of coverage, including Medicare, private insurance, and military/TRICARE.
A 2023 amendment reduced barriers to medical aid in dying for Hawai’ians
Effective June 1, 2023, HB650 allows advanced practice registered nurses (APRN) to act as attending, consulting, or mental health providers (with psychiatric or mental health training) and enables licensed marriage and family therapists (LMFT) to serve as mental health providers. Additionally, the mandatory waiting period between a patient’s first and second oral requests is now five days, and a provider can issue a waiver if they determine that the patient is unlikely to survive the waiting period.
These amendments have been crucial in addressing the challenges posed by healthcare provider shortages, especially in rural areas. According to the Hawai’i Physician Workforce Report, the state faces a significant shortage of primary care providers.
The Hawaii Department of Health shared an ongoing concern regarding required mental health evaluations
Despite substantial progress, the report highlights ongoing challenges, particularly in accessing mental health providers for the required evaluations. Hawai’i remains the only state mandating a third healthcare provider to conduct a mental capacity evaluation, and shortages in rural areas can complicate access.
The 2023 Our Care, Our Choice Act report reveals both the progress made and the challenges that remain in providing terminally ill patients in Hawai’i with access to medical aid in dying. The amendments made in 2023 have already shown positive impacts by reducing barriers and expanding provider roles.
Visit our State Report Navigator for historical context, previous years’ reports on Hawai’i’s Our Care, Our Choice Act, and yearly data from other aid-in-dying states.