Hawaii: Living Will and Advance Health-Care Instruction Requirements

Hawaii's Uniform Health-Care Decisions Act (Modified), chapter 327E,
calls the adult's own direction an individual instruction. An advance
health-care directive may contain that instruction, a health-care power of
attorney, or both. This page covers the instruction.

Requirements one by one

An individual instruction may be oral or written

Under § 327E-3(a), an adult or emancipated minor may give an individual
instruction orally or in writing. It may take effect only if a condition the
person specifies later occurs. The instruction-only rule states no signature,
date, witness, or notary requirement.

That is different from a combined directive that also appoints an agent. The
power-of-attorney part must be written, signed, dated, and either witnessed by
two qualified people or acknowledged before a Hawaii notary (§ 327E-3(b)).
Those agent-appointment formalities do not convert an oral individual
instruction into an invalid instruction.

Hawaii presumes that an individual has capacity to make or revoke a directive
(§ 327E-11). § 327E-2 defines capacity as understanding the significant
benefits, risks, and alternatives and making and communicating a health-care
decision.

The maker chooses when the instruction operates

Hawaii imposes no universal diagnosis or number-of-physicians trigger. If a
written directive does not choose another decision method, the primary
physician determines whether the person lacks or has recovered capacity and
whether another condition affecting the instruction exists (§ 327E-3(f)).

The optional form in § 327E-16 offers a no-prolongation choice for any of
three situations: an incurable and irreversible condition expected to cause
death relatively soon; unconsciousness with no expected recovery to a
reasonable degree of medical certainty; or likely treatment risks and burdens
outweighing expected benefits. A person may modify the form or use a different
one.

Treatment, feeding, and pain choices stay separate

An individual instruction may address any health care. § 327E-2 expressly
includes DNR orders and directions to provide, withhold, or withdraw artificial
nutrition and hydration, subject to generally accepted health-care standards.

The optional form lets the person choose whether to prolong life. Artificial
nutrition and hydration follows that choice unless the person separately marks
that it must be provided regardless of condition. Pain or discomfort treatment
can also be requested even if it hastens death (§ 327E-16).

Revocation uses an intent-to-communicate rule

Under § 327E-4(b), the person may revoke all or part of an individual
instruction at any time and in any manner that communicates intent. No witness,
writing, destruction, or delivery formula is mandatory for the treatment
instruction.

A provider, agent, guardian, or surrogate who learns of the revocation must
promptly tell the supervising provider and the institution providing care. A
later conflicting directive revokes the earlier one only to the extent of the
conflict (§ 327E-4(c), (e)).

Chapter 327E states no registry filing or registration step for validity. A
copy of a written directive or revocation has the same effect as the original
under § 327E-12.

Providers record, comply, or assist transfer

Under § 327E-7, the supervising provider records a known directive,
revocation, and any relevant capacity or condition determination. Providers and
institutions must comply with the instruction and a reasonable interpretation
made by an authorized decision-maker.

They may decline for conscience reasons, because the requested care is medically
ineffective, or because it conflicts with generally accepted standards. A
declining provider or institution must give prompt notice, continue care until
transfer, and make reasonable efforts to assist transfer unless assistance is
refused. Good-faith compliance or reliance receives the immunity stated in
§ 327E-9.

What trips people up

• Witnesses belong to the agent appointment, not the instruction. A
  treatment instruction alone may be oral or written under § 327E-3(a).
• There is no fixed two-physician rule. The maker can define a condition;
  the primary-physician default applies only when the written directive does not
  provide another method.
• Artificial feeding does not automatically follow the end-of-life choice.
  The optional form lets the person require nutrition and hydration regardless
  of the main prolong-life selection.
• Chapter 327E has no pregnancy override. Neither the operative chapter nor
  its optional form states a pregnancy, viability, or live-birth rule.

Common questions

Can I give an instruction verbally?
Yes. § 327E-3(a) expressly permits an oral individual instruction.

Must I use Hawaii's statutory form?
No. § 327E-16 says the sample may be modified or replaced by a different
form containing its substance.

Will Hawaii recognize an instruction made elsewhere?
Yes. § 327E-3(j) recognizes an advance directive that complies with Hawaii
law or the law of the state where it was executed.

Can a provider require me to sign or revoke one before treating me?
No. § 327E-7(h) bars making execution or revocation a condition of health
care.

Statutes and sources

• Haw. Rev. Stat. §§ 327E-2 and 327E-3 — definitions, oral/written
  instruction, conditional effect, combined-form distinction, primary-physician
  default, and interstate validity. Hawaii State Legislature (accessed
  2026-07-31).
• Haw. Rev. Stat. § 327E-4 — revocation and later conflicting directives.
  Same official source (accessed 2026-07-31).
• Haw. Rev. Stat. §§ 327E-7 and 327E-9 — provider record, compliance,
  refusal, transfer, and immunity rules. Same official source (accessed
  2026-07-31).
• Haw. Rev. Stat. §§ 327E-11 and 327E-12 — capacity presumption and effect
  of copies. Same official source (accessed 2026-07-31).
• Haw. Rev. Stat. § 327E-13 — mercy-killing, assisted-suicide, euthanasia,
  and standard-of-care boundaries. Same official source (accessed 2026-07-31).
• Haw. Rev. Stat. § 327E-16 — optional form and its end-of-life,
  nutrition/hydration, and pain-relief choices. Same official source (accessed
  2026-07-31).