Hawaii POLST Form vs. Advance Healthcare Directive: Which Do You Need?
An Advance Healthcare Directive names your agent for medical choices, while a Hawaii POLST form provides binding, immediate medical orders for emergency responders. Most adults need a Directive, but a POLST is specifically for those facing serious illnesses.
Understanding the Legal and Medical Intent
Planning for medical emergencies is critical, especially as we age. In Hawaii, two main documents help ensure your healthcare wishes are honored: the Advance Healthcare Directive (AHCD) and the Provider Orders for Life-Sustaining Treatment (POLST). Many people confuse the two, but they serve entirely different purposes. An AHCD is a legal document that outlines your general wishes and names someone to speak for you. A POLST is an actionable medical order that dictates exactly what treatments paramedics can and cannot perform on the spot. Understanding the difference can save families from heartbreak and confusion. If you need help drafting these documents, you can find a qualified estate planning attorney in our US Lawyer Directory.
Step-by-Step Process: When to Use Each Document
Whether you are perfectly healthy or managing a serious illness in Honolulu or Hilo, you need to know how these tools work in the real world.
Step 1: What is an Advance Healthcare Directive?
Under Haw. Rev. Stat. § 327E-3, an Advance Healthcare Directive allows you to appoint a healthcare power of attorney (your agent) to make medical decisions if you become incapacitated. It also lets you leave general instructions about artificial nutrition, hydration, and life support. Every adult over the age of 18 can execute an Advance Healthcare Directive using the statutory sample form established under Haw. Rev. Stat. § 327E-16. It guides your family and doctors regarding your long-term care goals.
Step 2: Chronically Ill Elders and the POLST
While an AHCD is for the future, a POLST is for the present. Governed by Haw. Rev. Stat. § 327K-2, the POLST is printed on brightly colored lime-green paper so it stands out. It is specifically designed for chronically ill elders, frail patients, or anyone whose doctor would not be surprised if they passed away within the next year. It translates your general wishes from the AHCD into specific medical orders, such as 'Do Not Resuscitate' (DNR) or 'Comfort Measures Only'.
Step 3: Emergency Responders (EMS) Protocols During a 911 Call
During a medical crisis at home, you might call 911. When paramedics from Emergency Medical Services, Honolulu arrive, their default legal protocol is to attempt to revive the patient using CPR and intubation. They do not have the time to read a ten-page Advance Healthcare Directive or call your lawyer. However, if they see a signed, lime-green Form POLST, Hawaii, Department of Health, Provider Orders for Life-Sustaining Treatment on your refrigerator, they are legally required to follow those specific medical orders immediately, even if it means allowing a natural death.
Step 4: The Requirement for Physician Signatures
You can fill out and sign an Advance Healthcare Directive yourself, as long as it is witnessed or notarized. A POLST is entirely different. Because it is a medical order, a POLST is not valid unless it is signed by a licensed physician, an advanced practice registered nurse (APRN), or a physician assistant (PA) operating in Hawaii. You must have a serious conversation with your healthcare provider to ensure the orders reflect your current medical reality.
Step 5: How Both Documents Work Together in a Hospital Setting
If you are transported to a facility like The Queen's Medical Center, Honolulu, the emergency room doctors will first look at your POLST to manage your immediate, critical care. Once you are stabilized or admitted to the ward, the hospital staff will consult your Advance Healthcare Directive. They will reach out to your appointed healthcare agent to make ongoing decisions about surgeries, long-term treatments, or transitioning to hospice care.
How Much Does it Cost in Hawaii?
Preparing for your healthcare future does not have to be prohibitively expensive.
| Document Type | Estimated Cost in Hawaii |
|---|---|
| Advance Healthcare Directive (DIY/Standard Form) | Free to $50 (Notary fees) |
| Advance Healthcare Directive (Attorney Drafted) | $300 to $800 |
| POLST Form | Free (Usually covered during a standard doctor visit) |
How Long Does the Process Take?
Drafting an Advance Healthcare Directive with an attorney generally takes one to two weeks to finalize and notarize. Completing a POLST form takes only as long as a routine appointment with your primary care doctor. Once signed, both documents take effect immediately upon completion, though the AHCD's power of attorney provisions usually only trigger when a doctor declares you lack the capacity to make your own decisions.
Does a POLST replace my Advance Healthcare Directive?
No. A POLST only covers immediate emergency medical interventions. It does not appoint an agent to make decisions for you if you become incapacitated. You should generally have both documents if you are seriously ill.
Can my healthcare agent override my POLST?
Under Hawaii law, your designated healthcare agent generally has the authority to void or modify your POLST if they determine that your medical condition has changed in a way that makes the original order contrary to your best interests or previous instructions.
Where should I keep my POLST form?
You should keep the original, brightly colored POLST form in an incredibly obvious place, such as pinned to your refrigerator or taped to the back of your bedroom door, so emergency responders can find it instantly.
Is a POLST from the mainland valid in Hawaii?
Hawaii law generally recognizes valid out-of-state medical orders, but emergency responders are trained to look for the specific Hawaii state POLST. If you move to Hawaii, it is highly recommended to fill out the local Hawaii form with a local doctor.
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