Hawaii Advance Health Care Directive: Living Will and Healthcare Surrogate Guide

If your parent gets rushed to the ER and can't speak for themselves, who makes the medical decisions? Without a legally valid Advance Health Care Directive (AHCD), that question gets answered by Hawaii's default surrogate hierarchy — which may not put the right person in charge.

An AHCD is the document that names a healthcare surrogate and records your parent's end-of-life care instructions. It's different from a Power of Attorney (which handles finances) and different from a POLST (which is a physician's order for emergency treatment). Understanding what each document does — and making sure your parent has all three — is the foundation of a safe care transition.

What an AHCD Covers

A Hawaii AHCD does two things:

1. Designates a healthcare surrogate — the person authorized to make medical decisions when your parent can no longer communicate their own wishes
2. Records care instructions — preferences about life-sustaining treatment, artificial nutrition, mechanical ventilation, and organ donation

The AHCD takes effect when a physician determines that your parent lacks the capacity to make healthcare decisions. Until that point, your parent retains full decision-making authority regardless of what the directive says.

How It Differs from a Living Will

In many states, a "living will" and an AHCD are separate documents. In Hawaii, the AHCD combines both functions — it serves as the living will (instructions about end-of-life care) and the healthcare proxy (naming a decision-maker). You don't need separate documents.

How It Differs from a POLST

A POLST (Provider Orders for Life-Sustaining Treatment) is an actionable medical order signed by a physician or APRN. It translates your parent's preferences into immediate protocols that EMTs and hospital staff follow in an emergency — printed on bright pink paper so it's instantly recognizable.

An AHCD records wishes. A POLST creates medical orders. Your parent should have both.

The AHCD guides overall decision-making and names the surrogate. The POLST tells emergency responders exactly what to do right now — CPR or not, intubation or not, transport to hospital or comfort measures only. If your parent is in advanced decline or entering a care facility, a POLST is essential.

Requirements for a Valid Hawaii AHCD

Hawaii law provides a statutory form, but you're not required to use it. Any document that meets these requirements is valid:

• The principal must have mental capacity at the time of signing
• The document must be signed by the principal (or by another person at the principal's direction, in their presence)
• Two witnesses must sign, or the signature must be notarized
• Witnesses cannot be: the healthcare provider, an employee of the healthcare provider, or the designated surrogate

While Hawaii doesn't require notarization, getting the AHCD notarized avoids disputes later. Healthcare providers are more likely to honor a notarized directive without delay.

Choosing the Healthcare Surrogate

This is the most consequential decision in the document. The surrogate will be making life-and-death calls during a medical crisis, potentially over objections from other family members. Choose someone who:

• Knows your parent's actual wishes — not what the family assumes they want, but what they've explicitly said
• Can handle high-pressure medical conversations with physicians
• Is geographically accessible — if your parent is on Oahu and the surrogate is on the mainland, response time during an emergency is a real concern
• Will follow your parent's wishes even when those wishes are difficult (especially around withdrawing life support)

Name an alternate surrogate in the document in case the primary is unavailable.

Common Mistakes

Waiting too long. Once your parent loses cognitive capacity, they can no longer legally execute an AHCD. At that point, your only option is a court-appointed guardianship — which is expensive, public, and slow.

Not distributing copies. The AHCD needs to be on file with your parent's primary care physician, in their medical records at any hospital where they might be treated, and with the healthcare surrogate. A directive locked in a safe deposit box is useless during a 2 AM emergency.

Confusing AHCD with financial POA. A healthcare surrogate cannot access bank accounts or manage property. That requires a separate financial Power of Attorney under HRS Chapter 551E.

Getting It Done

The Hawaii Care Decision Guide includes a complete legal authority chapter that walks through AHCD, financial POA, and POLST — what each document does, how they interact, and what happens if your parent's capacity is already declining. The forms directory lists the exact state resources and filing requirements.

See more Hawaii guides →