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ADVANCE HEALTH-CARE DIRECTIVE
You have the right to revoke this advance health-care directive or replace this form at any time.
If I revoke my agent's authority or if my agent is not willing, able, or reasonably available to make a health-care decision for me, I designate as my first alternate agent:
First Alternate
| Agent Name: |
| Address: |
| , |
| Phone: | Home: Work: |
If I revoke the authority of my agent and first alternate agent or if neither is willing, able, or reasonably available to make a health-care decision for me, I designate as my second alternate agent:
Second Alternate
| Agent Name: |
| Address: |
| , |
| Phone: | Home: Work: |
INCLUDING NOT INCLUDING If I mark this box [ ], my agent's authority to make health-care decisions for me takes effect immediately.If I mark this box [ X ], my agent's authority to make health-care decisions for me takes effect immediately. If that agent is not willing, able, or reasonably able to act as guardian, I nominate the alternate agents whom I have named, in the order designated.
. PRIMARY PHYSICIAN: I designate the following physician as my primary physician:
| Name: |
| Address: |
| , |
| Phone: | Home: Phone: |
If the physician I have designated above is not willing, able, or reasonably available to act as my primary physician, I designate the following physician as my primary physician:
| Name: |
| Address: |
| , |
| Phone: | Home: Phone: |
PART 2 - INSTRUCTIONS FOR HEALTH CAREPART 1 - INSTRUCTIONS FOR HEALTH CARE
[X ] CHOICE NOT TO PROLONG LIFE. I do not want my life to be prolonged if I have an incurable and irreversible condition that will result in my death within a relatively short time.
[X ] CHOICE TO PROLONG LIFE. I want my life to be prolonged as long as possible within the limits of generally accepted health-care standards.
If I mark this box [ ], artificial nutrition and hydration must be provided regardless of my condition and regardless of the choice I have made in the section above.If I mark this box [X], artificial nutrition and hydration must be provided regardless of my condition and regardless of the choice I have made in the section above.If I mark this box [ ], I direct that treatment to alleviate pain or discomfort should be provided to me even if it hastens my death.If I mark this box [X], I direct that treatment to alleviate pain or discomfort should be provided to me even if it hastens my death.However, if at any point it is determined that it is not possible that the fetus could develop to the point of live birth with continued application of death-prolonging procedures, it is my preference that this document be given effect at that point. If life-sustaining procedures will be physically harmful or unreasonably painful to me in a manner that cannot be alleviated by medication, I request that my desire for personal physical comfort be given consideration in determining whether this document shall be effective if I am pregnant.
A. EFFECT OF COPY. A copy of this form has the same effect as the original.
B. HOLD HARMLESS. All persons or entities who in good faith endeavor to carry out the terms and provisions of this document shall not be liable to me, my estate, my heirs or assigns for any damages or claims arising because of their action or inaction based on this document, and my estate shall defend and indemnify them.
C. SEVERABILITY. If any provision of this document is held to be invalid, such invalidity shall not affect the other provisions which can be given effect without the invalid provision, and to this end the directions in this document are severable.
D. STATEMENT OF INTENTIONS. It is my intent that this document be legally binding and effective. If the law does not recognize this document as legally binding and effective, it is my intent that this document be taken as a formal statement of my desire concerning the method by which any health care decisions should be made on my behalf during any period in which I am unable to make such decisions.
| Signature: | ________________________________________ |
| Name: |
| Address: |
| County |
| Name: |
| Address: |
| , |
| Name: | ________________________________ |
| Address: | ________________________________ |
| ________________________________ |
| ________________________________ |
| Name: |
| Address: |
| , |
| Name: | ________________________________ |
| Address: | ________________________________ |
| ________________________________ |
| ________________________________ |
| _____ | You must indicate your wishes regarding artificial nutrition and hydration. |
| _____ | (your Agent) |
| * | You should discuss the document and your wishes with any person you want to designate as an Agent before doing so to assure they agree to act on your behalf. |
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It's very easy to record your medical wishes using a free Hawaii Living Will template from Rocket Lawyer:
This solution is often much less time-consuming than meeting and hiring your average provider. If necessary, you may prepare a Living Will on behalf of an elderly parent, spouse, or another relative and then help them sign it when ready. Keep in mind that for this document to be considered legally valid, the principal must be mentally competent when they sign. In the event that the principal has already been declared legally incompetent, a court-appointed conservatorship may be necessary. When facing this scenario, it would be best for you to speak with an attorney .
Everyone over 18 years old ought to have a Living Will. Although it may be tough to think about, there will likely come a day when you aren't able to make your own medical decisions. Here are some typical circumstances where it may be helpful to make or update your Living Will:
Regardless of whether this Hawaii Living Will has been prepared as part of a long-term plan or created as a result of a change in your health, notarization and/or witnesses often help to protect your document if a third party disputes its validity. In Hawaii, please keep in mind that Advance Directives are not valid if the principal is pregnant.
Making a Living Will is usually easy to do, but you or your agent may still need advice. Getting a legal professional to comment on your Hawaii Living Will could be fairly time-intensive. A more cost-effective alternative would be to go through the Rocket Lawyer attorney network. As a Premium member, you can get your document reviewed or send any questions. As always, Rocket Lawyer will be by your side.
The fees associated with finding and hiring a legal provider to produce a Living Will could total anywhere between $200 and $1,000, depending on where you are located. Rocket Lawyer isn't a run-of-the-mill Living Will template provider. With us, anyone under a Rocket Lawyer Premium membership can take advantage of up to 40% in savings when hiring an attorney from our Rocket Lawyer attorney network.
Alongside your Hawaii Living Will form, there's a set of instructions on what to do next. With a membership, you will be able to make edits, print it out, or sign it. Finally, take care to ensure that your agent(s), care providers, and other impacted parties get their copy of the fully executed document.
The specific rules and restrictions governing Living Wills are different in each state; however, in Hawaii, your Living Will must be signed by two witnesses or notarized. Witnesses must not be your healthcare provider or an employee of your healthcare provider's facility. At least one of the witnesses should be someone who is not your relative, spouse, adoptee, heir, or any other beneficiary. As a general principle, your witnesses must not be under the age of 18, and no witness should simultaneously be designated as your healthcare agent.
