(a) A patient may designate or disqualify any individual to act as a surrogate by personally informing the supervising health-care provider. In the absence of such a designation, or if the designee is not reasonably available, a surrogate may be appointed to make a health-care decision for the patient.
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Terms Used In Hawaii Revised Statutes 327E-5

  • Agent: means an individual designated in a power of attorney for health care to make a health-care decision for the individual granting the power. See Hawaii Revised Statutes 327E-2
  • Best interest: means that the benefits to the individual resulting from a treatment outweigh the burdens to the individual resulting from that treatment and shall include:

    (1) The effect of the treatment on the physical, emotional, and cognitive functions of the patient;

    (2) The degree of physical pain or discomfort caused to the individual by the treatment or the withholding or withdrawal of the treatment;

    (3) The degree to which the individual's medical condition, the treatment, or the withholding or withdrawal of treatment, results in a severe and continuing impairment;

    (4) The effect of the treatment on the life expectancy of the patient;

    (5) The prognosis of the patient for recovery, with and without the treatment;

    (6) The risks, side effects, and benefits of the treatment or the withholding of treatment; and

    (7) The religious beliefs and basic values of the individual receiving treatment, to the extent that these may assist the surrogate decision-maker in determining benefits and burdens. See Hawaii Revised Statutes 327E-2

  • Capacity: means an individual's ability to understand the significant benefits, risks, and alternatives to proposed health care and to make and communicate a health-care decision. See Hawaii Revised Statutes 327E-2
  • Emancipated minor: means a person under eighteen years of age who is totally self-supporting. See Hawaii Revised Statutes 327E-2
  • Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
  • Guardian: means a judicially appointed guardian having authority to make a health-care decision for an individual. See Hawaii Revised Statutes 327E-2
  • Health-care decision: means a decision made by an individual or the individual's agent, guardian, or surrogate, regarding the individual's health care. See Hawaii Revised Statutes 327E-2
  • Health-care provider: means an individual licensed, certified, or otherwise authorized or permitted by law to provide health care in the ordinary course of business or practice of a profession. See Hawaii Revised Statutes 327E-2
  • Interested persons: means the patient's spouse, unless legally separated or estranged, a reciprocal beneficiary, any adult child, either parent of the patient, an adult sibling or adult grandchild of the patient, or any adult who has exhibited special care and concern for the patient and who is familiar with the patient's personal values. See Hawaii Revised Statutes 327E-2
  • Person: means an individual, corporation, business trust, estate, trust, partnership, association, joint venture, government, governmental subdivision, agency, or instrumentality, or any other legal or commercial entity. See Hawaii Revised Statutes 327E-2
  • Physician: means an individual authorized to practice medicine or osteopathy under chapter 453. See Hawaii Revised Statutes 327E-2
  • Primary physician: means a physician designated by an individual or the individual's agent, guardian, or surrogate, to have primary responsibility for the individual's health care or, in the absence of a designation or if the designated physician is not reasonably available, a physician who undertakes the responsibility. See Hawaii Revised Statutes 327E-2
  • Reasonably available: means able to be contacted with a level of diligence appropriate to the seriousness and urgency of a patient's health care needs, and willing and able to act in a timely manner considering the urgency of the patient's health care needs. See Hawaii Revised Statutes 327E-2
  • State: means a state of the United States, the District of Columbia, the Commonwealth of Puerto Rico, or a territory or insular possession subject to the jurisdiction of the United States. See Hawaii Revised Statutes 327E-2
  • Supervising health-care provider: means the primary physician or the physician's designee, or the health-care provider or the provider's designee who has undertaken primary responsibility for an individual's health care. See Hawaii Revised Statutes 327E-2
  • Surrogate: means an individual, other than a patient's agent or guardian, authorized under this chapter to make a health-care decision or to act as a medicaid authorized representative for the patient. See Hawaii Revised Statutes 327E-2
(b) A surrogate may make a health-care decision for a patient who is an adult or emancipated minor if the patient has been determined by the primary physician to lack capacity and no agent or guardian has been appointed or the agent or guardian is not reasonably available. Upon a determination that a patient lacks decisional capacity to provide informed consent to or refusal of medical treatment, the primary physician or the physician’s designee shall make reasonable efforts to notify the patient of the patient’s lack of capacity. The primary physician, or the physician’s designee, shall make reasonable efforts to locate as many interested persons as practicable, and the primary physician may rely on such individuals to notify other family members or interested persons.
(c) Upon locating interested persons, the primary physician, or the physician’s designee, shall inform such persons of the patient’s lack of decisional capacity and that a surrogate decision-maker should be selected for the patient.
(d) Interested persons shall make reasonable efforts to reach a consensus as to who among them shall make health-care decisions on behalf of the patient. The person selected to act as the patient’s surrogate should be the person who has a close relationship with the patient and who is the most likely to be currently informed of the patient’s wishes regarding health-care decisions. If any of the interested persons disagrees with the selection or the decision of the surrogate, or, if after reasonable efforts the interested persons are unable to reach a consensus as to who should act as the surrogate decision-maker, then any of the interested persons may seek guardianship of the patient by initiating guardianship proceedings pursuant to chapter 551 or chapter 560, as applicable. Only interested persons involved in the discussions to choose a surrogate may initiate such proceedings with regard to the patient.
(e) If any interested person, the guardian, or primary physician believes the patient has regained decisional capacity, the primary physician shall reexamine the patient and determine whether or not the patient has regained decisional capacity and shall enter a decision and the basis for such decision into the patient’s medical record and shall notify the patient, the surrogate decision-maker, and the person who initiated the redetermination of decisional capacity.
(f) A surrogate who has been designated by the patient may make health-care decisions for the patient that the patient could make on the patient’s own behalf.
(g) A surrogate who has not been designated by the patient may make all health-care decisions for the patient that the patient could make on the patient’s own behalf, except that artificial nutrition and hydration may be withheld or withdrawn for a patient upon a decision of the surrogate only when the primary physician and a second independent physician certify in the patient’s medical records that the provision or continuation of artificial nutrition or hydration is merely prolonging the act of dying and the patient is highly unlikely to have any neurological response in the future.

The surrogate who has not been designated by the patient shall make health-care decisions for the patient based on the wishes of the patient, or, if the wishes of the patient are unknown or unclear, on the patient’s best interest.

The decision of a surrogate who has not been designated by the patient regarding whether life-sustaining procedures should be provided, withheld, or withdrawn shall not be based, in whole or in part, on either a patient’s preexisting, long-term mental or physical disability, or a patient’s economic status. A surrogate who has not been designated by the patient shall inform the patient, to the extent possible, of the proposed procedure and the fact that someone else is authorized to make a decision regarding that procedure.

(h) A health-care decision made by a surrogate for a patient is effective without judicial approval.
(i) A surrogate may act as a medicaid authorized representative, pursuant to federal and state medicaid laws relating to authorized representatives, on the patient’s behalf for the purposes of medicaid, including but not limited to assisting with, submitting, and executing a medicaid application, redetermination of eligibility, and other on-going medicaid-related communications with the department of human services. For the purposes of medicaid, the surrogate may access medicaid records of the patient on whose behalf the surrogate was designated to act. For a surrogate to be able to act under this subsection, the surrogate shall agree to be legally bound by the federal and state authorities related to authorized representatives, including but not limited to maintaining the confidentiality of any information provided by the department of human services, in compliance with all state and federal confidentiality laws. The surrogate’s status as an authorized representative for the purposes of medicaid shall terminate when revoked by a patient who no longer lacks decisional capacity, upon appointment or availability of an agent or guardian of the person, or upon the patient’s death.
(j) A supervising health-care provider shall require a surrogate to provide a written declaration under the penalty of false swearing stating facts and circumstances reasonably sufficient to establish the claimed authority.

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