ADVANCE HEALTH-CARE DIRECTIVE

(Living Will / Durable Power of Attorney for Health Care)

State of Hawaiʻi

Drafted for compliance with the Hawaiʻi Uniform Health-Care Decisions Act, Haw. Rev. Stat. chapter 327E

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Operative Provisions
   3.1 Appointment of Primary Health-Care Agent
   3.2 Appointment of Alternate Agents
   3.3 General Grant of Authority
   3.4 Specific Health-Care Instructions
   3.5 Anatomical Gifts & Disposition of Remains
   3.6 HIPAA Authorization
   3.7 Effect of Copies; Portability
4. Representations & Warranties
5. Covenants & Restrictions
6. Default & Remedies
7. Risk Allocation
8. Dispute Resolution
9. General Provisions
10. Revocation Procedures
11. Execution Block (Signature, Witnesses, Notary)

1. DOCUMENT HEADER

Advance Health-Care Directive
Effective Date: [EFFECTIVE_DATE]

This Advance Health-Care Directive (“Directive”) is made by [PRINCIPAL_FULL_LEGAL_NAME], residing at [PRINCIPAL_ADDRESS] (“Principal”), pursuant to the Hawaiʻi Uniform Health-Care Decisions Act, Haw. Rev. Stat. chapter 327E (“Act”).

The Principal intends by this Directive to:
a. Designate one or more agents to make health-care decisions on the Principal’s behalf when the Principal lacks capacity; and
b. Provide legally binding instructions concerning future health-care and end-of-life decisions.

2. DEFINITIONS

For purposes of this Directive, capitalized terms have the meanings set forth below and apply uniformly throughout the document. Undefined terms shall be interpreted in accordance with the Act.

“Act” means the Hawaiʻi Uniform Health-Care Decisions Act, Haw. Rev. Stat. ch. 327E.

“Agent” means the individual designated in Section 3.1 (or any Alternate Agent designated in Section 3.2, as the context requires) authorized to make health-care decisions for the Principal under this Directive.

“Capacity” has the meaning assigned in Haw. Rev. Stat. § 327E-2.

“Directive” means this Advance Health-Care Directive, including any attachments, amendments, or duly executed addenda.

“Health-Care Decision” has the meaning assigned in Haw. Rev. Stat. § 327E-2.

“Healthcare Provider” includes any person or entity licensed, certified, or otherwise authorized to administer health care or provide medical treatment.

“Life-Sustaining Treatment” means any medical treatment that uses mechanical or other artificial means to sustain, restore, or supplant a vital function and that, when applied to a patient in a terminal condition, serves only to prolong the dying process.

“Principal” has the meaning set forth in the Document Header.

3. OPERATIVE PROVISIONS

3.1 Appointment of Primary Health-Care Agent

The Principal hereby appoints [PRIMARY_AGENT_FULL_NAME], whose address is [PRIMARY_AGENT_ADDRESS] and phone number is [PRIMARY_AGENT_PHONE], as the Principal’s Primary Health-Care Agent (“Primary Agent”) with full authority to make any and all Health-Care Decisions on the Principal’s behalf when the Principal lacks Capacity, subject to the limitations expressly stated herein.

[// GUIDANCE: Insert qualifiers if limiting the Agent’s authority (e.g., decisions about mental health treatment, life support, etc.).]

3.2 Appointment of Alternate Agents

If the Primary Agent is unavailable, unwilling, or unable to act, the following individuals shall serve successively as Alternate Agents, in the order listed below:
1. [ALTERNATE_AGENT1_FULL_NAME], address [ALTERNATE_AGENT1_ADDRESS], phone [ALTERNATE_AGENT1_PHONE].
2. [ALTERNATE_AGENT2_FULL_NAME], address [ALTERNATE_AGENT2_ADDRESS], phone [ALTERNATE_AGENT2_PHONE].

3.3 General Grant of Authority

Subject to Sections 3.4 and 3.5, the Agent is authorized to:
a. Consult with Healthcare Providers;
b. Consent to, refuse, or withdraw any treatment, including Life-Sustaining Treatment;
c. Employ or discharge Healthcare Providers;
d. Authorize the Principal’s admission to or discharge from health-care facilities;
e. Access all medical records and protected health information (“PHI”); and
f. Take any lawful action necessary to carry out the Principal’s expressed wishes and best interests under the Act.

3.4 Specific Health-Care Instructions

3.4.1 End-of-Life Care
If, in the opinion of two licensed physicians (one of whom is the attending physician), I am in a terminal condition or an irreversible condition and lack Capacity:

☐ I direct that Life-Sustaining Treatment be withheld or withdrawn and that I be permitted to die naturally.
☐ I direct that Life-Sustaining Treatment be provided to prolong my life as long as possible within reasonable medical practice.
☐ Other instructions: [INSERT ADDITIONAL INSTRUCTIONS]

3.4.2 Artificial Nutrition & Hydration
☐ I DO NOT want artificial nutrition and hydration if it is the sole means to sustain me.
☐ I DO want artificial nutrition and hydration unless medically contraindicated.

3.4.3 Pain Management
Regardless of the choices above, I direct that medication or any medical procedure necessary to alleviate pain or provide comfort be administered to me, even if it may hasten my death.

3.4.4 Pregnancy Decision
[// GUIDANCE: State law may restrict refusal of treatment for pregnant patients under certain circumstances. Consider including pregnancy-specific directives if relevant.]

3.5 Anatomical Gifts & Disposition of Remains

3.5.1 Organ & Tissue Donation
☐ I elect to make an anatomical gift under Haw. Rev. Stat. ch. 327.
Designated organs/tissues: [SPECIFY OR “ANY NEEDED”]
Purpose: ☐ Transplant ☐ Therapy ☐ Research ☐ Education

3.5.2 Body Disposition & Funeral Arrangements
I express the following preferences: [BURIAL/CREMATION AND RELATED INSTRUCTIONS].

3.6 HIPAA Authorization

Pursuant to 45 C.F.R. § 164.508(c)(1), I authorize any Healthcare Provider that has provided or will provide care to disclose my PHI to my Agent to facilitate Health-Care Decisions. This authorization is effective immediately and survives my incapacity.

3.7 Effect of Copies; Portability

A photocopy, facsimile, or electronically transmitted copy of this Directive shall have the same legal effect as the original.

4. REPRESENTATIONS & WARRANTIES

4.1 The Principal represents and warrants that:
a. The Principal is at least eighteen (18) years of age and of sound mind.
b. The execution of this Directive is voluntary and free from coercion or undue influence.
c. Any prior directive not expressly revoked herein is either superseded or incorporated as an attachment.

4.2 The Agent(s) represent and warrant, by signing the acknowledgement below, that they:
a. Accept the appointment;
b. Will act in good faith and in accordance with the Principal’s known wishes, or, if unknown, in the Principal’s best interest pursuant to Haw. Rev. Stat. § 327E-8; and
c. Are not disqualified from serving under Section 3.4 of the Act (e.g., not the Principal’s treating physician, nor an employee of a health-care facility in which the Principal resides, unless related to the Principal by blood, marriage, or adoption).

5. COVENANTS & RESTRICTIONS

5.1 Principal’s Covenant to Notify
The Principal covenants to notify the Agent(s) of any amendment or revocation of this Directive forthwith.

5.2 Agent’s Covenant to Consult
Before making any Health-Care Decision, the Agent shall use reasonable efforts to consult with available family members and Healthcare Providers to ascertain and honor the Principal’s wishes.

5.3 Restriction on Delegation
No Agent may delegate authority granted under this Directive to a third party.

6. DEFAULT & REMEDIES

6.1 Conflicting Directives
In case of conflict between this Directive and any other health-care document executed by the Principal, the most recent instrument shall control unless a court of competent jurisdiction orders otherwise.

6.2 Dispute Resolution
Any interested person may petition the appropriate circuit court pursuant to Haw. Rev. Stat. § 327E-14 for guidance, removal of an Agent, or enforcement of this Directive.

6.3 Injunctive Relief
Because monetary damages are inadequate to remedy violations of the Principal’s personal health-care rights, injunctive relief shall be available to enforce this Directive.

6.4 Attorneys’ Fees
A prevailing party in any judicial proceeding to enforce this Directive shall be entitled to reasonable attorneys’ fees and costs.

7. RISK ALLOCATION

7.1 Provider Protection & Indemnification
The Principal and the Principal’s estate shall indemnify and hold harmless any Healthcare Provider who, in good faith reliance on this Directive, acts or refrains from acting, as provided in Haw. Rev. Stat. § 327E-16.

7.2 Limitation of Liability
No Agent shall incur civil or criminal liability for good faith decisions made pursuant to this Directive, consistent with Haw. Rev. Stat. § 327E-16.

8. DISPUTE RESOLUTION

8.1 Governing Law
This Directive and all disputes arising hereunder shall be governed by and construed in accordance with the health-care laws of the State of Hawaiʻi, without regard to conflict-of-law principles.

8.2 Forum Selection
Any court proceeding relating to this Directive shall be brought exclusively in the Circuit Court of the State of Hawaiʻi having jurisdiction over the Principal’s residence at the time of filing.

9. GENERAL PROVISIONS

9.1 Amendment
The Principal may amend this Directive at any time by executing a writing that complies with the Act’s execution requirements.

9.2 Severability
If any provision of this Directive is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

9.3 Entire Agreement
This Directive constitutes the Principal’s entire advance health-care directive under the Act and supersedes any inconsistent prior directives.

9.4 Counterparts & Electronic Signatures
This Directive may be executed in counterparts and by electronic signature, each of which shall be deemed an original.

10. REVOCATION PROCEDURES

10.1 Automatic Revocation
This Directive is automatically revoked upon execution of a subsequent valid advance directive to the extent of any inconsistency.

10.2 Express Revocation by Principal
The Principal may revoke this Directive at any time by:
a. A signed writing;
b. Physical cancellation or destruction of the Directive or directing another to do so in the Principal’s presence; or
c. An oral or other expression of intent to revoke in the presence of a witness eighteen (18) years or older, pursuant to Haw. Rev. Stat. § 327E-13.

10.3 Notification Duty
The Principal should promptly notify the Agent(s) and relevant Healthcare Providers of any revocation.

[// GUIDANCE: Recommend providing new copies to providers after any amendment or revocation to avoid confusion.]

11. EXECUTION BLOCK

11.1 Principal’s Signature

I, [PRINCIPAL_FULL_LEGAL_NAME], the undersigned Principal, understand the contents of this Directive and sign it voluntarily on the Effective Date stated above.

Signature: _____ Date: ______

Printed Name: _____

11.2 Agent Acknowledgement

I, [PRIMARY_AGENT_FULL_NAME], accept the appointment as Primary Agent and agree to act in accordance with this Directive and governing law.

Signature: _____ Date: __
Printed Name: _________

[Add acknowledgment lines for each Alternate Agent if desired.]

11.3 Witness Attestation (Choose Option A OR Option B)

Option A – Two Witnesses (No Notary Required)
We declare that the Principal is personally known to us, appears to be of sound mind, and signed or acknowledged this Directive in our presence. At least one witness is not related to the Principal by blood, marriage, or adoption and is not entitled to any portion of the Principal’s estate.

Witness 1: ____ Date: _
Printed Name: ___
Address: _____

Witness 2: ____ Date: _
Printed Name: ___
Address: _____

Option B – Notarization (One Notary Public; No Witnesses Required)

State of Hawaiʻi )
) ss.
County of ______ )

On this ___ day of ____, 20__, before me, the undersigned Notary Public, personally appeared [PRINCIPAL_FULL_LEGAL_NAME], personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged that they executed the same for the purposes therein contained.

Notary Public: ___
My commission expires: _______

[// GUIDANCE: Provide certified copies to (i) each Agent, (ii) primary care physician, (iii) hospital medical records department, and consider uploading to the Hawaiʻi Advance Health Care Directive Registry if available.]