Hawaii Advance Directive

A Hawaii advance directive is one chapter with two halves. Chapter 327E of the Hawaii Revised Statutes calls itself the Uniform Health-Care Decisions Act (Modified) at HRS 327E-1, and the word modified is there for a reason, so read Hawaii's own text before trusting any uniform-act summary. The individual instruction says what care you want. The power of attorney for health care names an agent to decide for you. HRS 327E-2 defines an advance health-care directive as either one.

Every section quoted on this page was read at the Hawaii State Legislature's statute pages on September 24, 2026, and each is cited where it appears. Use this page as a plain-language map of chapter 327E and its neighbors, then have a Hawaii attorney draft or review what you sign. It is general information about Hawaii law rather than advice about your situation.

One fact shapes the rest. Hawaii has no ranked family ladder. When nobody was named, HRS 327E-5 asks your family and close friends to agree among themselves on one decision maker, and sends them to court for a guardianship if they cannot. Naming an agent in writing is how you keep that conversation from happening at a bedside.

The Documents at a Glance

Chapter 327E has no separate living will document. Living will content goes into the individual instruction, and Part 2 of the statutory form in HRS 327E-16 is where you write it down.

Who Can Sign

HRS 327E-3(a) and (b) let an adult or an emancipated minor give an instruction and sign a power of attorney for health care. Hawaii's age of majority is eighteen under HRS 577-1. HRS 327E-2 defines an emancipated minor as a person under eighteen who is totally self-supporting, so a self-supporting seventeen-year-old can name a health care agent in Hawaii.

HRS 327E-11(b) presumes every individual has capacity to make a health-care decision, to give or revoke a directive, and to designate or disqualify a surrogate. Nobody has to prove you were competent when you signed.

Signing the Power of Attorney: Four Requirements and a Choice

HRS 327E-3(b) requires the power to be:

1. In writing.
2. Dated with the date of its execution.
3. Signed by the principal.
4. Witnessed by one of two methods.

The two methods are listed in the same subsection. Under HRS 327E-3(b)(1), at least two individuals sign, each of whom witnessed either your signing or your acknowledgment of your signature. Under HRS 327E-3(b)(2), you acknowledge the document before a notary public "at any place within this State." You pick one. A notarized Hawaii power needs no witnesses, and a witnessed one needs no notary.

Watch the notary phrase. A notary in another state does not satisfy HRS 327E-3(b)(2). A document signed outside Hawaii can still be valid under HRS 327E-3(j) if it complied with the law of the state where you signed it, which the out-of-state section below covers.

Who cannot witness

HRS 327E-3(c) bars three people from witnessing:

• A health-care provider.
• An employee of a health-care provider or facility.
• The agent you are naming.

HRS 327E-3(d) then adds a balance rule. At least one of the two witnesses must be neither related to you by blood, marriage or adoption, nor entitled to any part of your estate under a will existing when you sign or by operation of law. The second witness may be a relative or an heir.

The statutory form in HRS 327E-16 asks each witness to sign a declaration under penalty of false swearing under HRS 710-1062. It asks the witnesses to confirm that you are personally known to them, that you appear to be of sound mind and free of duress, fraud or undue influence, and that they are not your agent or a health-care worker. Only the first witness block also declares the witness is unrelated and not an heir, which is how the form puts the balance rule on paper.

Who cannot be your agent

Unless related to you by blood, marriage or adoption, an agent may not be an owner, operator or employee of the health-care institution where you are receiving care, under HRS 327E-3(b). A cousin who works at the hospital can serve. A stranger who works there cannot.

When the Agent's Authority Starts

Under HRS 327E-3(e), the agent's authority becomes effective only when a determination is made that you lack capacity, and it stops when you recover, unless the document says otherwise. HRS 327E-3(f) assigns that determination to the primary physician, again unless your written directive names someone else or sets another test.

The statutory form offers a checkbox for immediate authority. Item 3 of Part 1 in HRS 327E-16 says the agent's authority takes effect immediately if you mark the box. Leave it blank and the agent waits for the physician's finding.

Here is how the agent must decide. HRS 327E-3(g) directs the agent to follow your individual instructions and other known wishes, and otherwise to decide in your best interest, considering your personal values. HRS 327E-2 lists seven factors for best interest, from pain and prognosis to your religious beliefs. Under HRS 327E-3(h), an agent's decision needs no court approval.

Hawaii Has No Default Family Ranking

HRS 327E-5 lets a surrogate decide once the primary physician determines the patient lacks capacity and no agent or guardian has been appointed, or none is reasonably available. Nothing in the section ranks a spouse above a child or a child above a parent.

The process runs in three steps:

1. The physician finds people. HRS 327E-5(b) directs the primary physician or a designee to make reasonable efforts to notify the patient and to locate as many interested persons as practicable.
2. The physician tells them. Under HRS 327E-5(c), the interested persons learn the patient lacks capacity and that a surrogate should be selected.
3. They choose by consensus. HRS 327E-5(d) asks them to make reasonable efforts to agree. The person selected should be someone with a close relationship who is most likely to be currently informed of the patient's wishes.

HRS 327E-2 defines the interested persons as the spouse, unless legally separated or estranged; a reciprocal beneficiary; any adult child; either parent; an adult sibling or adult grandchild; and any adult who has exhibited special care and concern for the patient and is familiar with the patient's personal values. A reciprocal beneficiary sits on that list by name, and so does a close friend.

When they cannot agree, or one of them objects to the choice or a decision, HRS 327E-5(d) lets any of them start guardianship proceedings under chapter 551 or chapter 560. Only interested persons who took part in the discussion may file. The provider also gets proof: HRS 327E-5(j) requires the supervising provider to obtain a written declaration, under penalty of false swearing, stating facts that establish the surrogate's claimed authority.

You can skip the consensus meeting

HRS 327E-5(a) lets you designate or disqualify any individual as surrogate by personally informing your supervising health-care provider. No form, no witness. It is the fastest way to keep a particular relative out of the decision.

A chosen surrogate has more authority than an unchosen one

A surrogate you designated may make any decision you could have made, under HRS 327E-5(f). A surrogate you never designated has three limits under HRS 327E-5(g):

• Artificial nutrition and hydration may be withheld or withdrawn only when the primary physician and a second independent physician certify in the medical record that it is merely prolonging the act of dying and that the patient is highly unlikely to have any neurological response in the future.
• A decision about life-sustaining procedures may not rest, in whole or in part, on a preexisting long-term disability or on the patient's economic status.
• The surrogate must tell the patient, to the extent possible, about the proposed procedure and that someone else is deciding.

HRS 327E-5(i) also lets a surrogate act as a Medicaid authorized representative for applications and redeterminations with the Department of Human Services, a power that ends when an agent or guardian becomes available or the patient dies.

A Guardian Outranks Your Agent

HRS 327E-6(b) provides that, absent a court order to the contrary, a health-care decision of a guardian appointed under chapter 560 takes precedence over that of an agent. HRS 327E-6(a) softens it: the guardian must comply with your individual instructions and may not revoke your pre-incapacity directive unless a court expressly authorizes it.

Two practical moves follow. First, write your instructions down, because a guardian is bound by them. Second, use HRS 327E-3(i), which lets a written directive nominate a guardian, so the person a court appoints is the person you already chose as agent. The statutory form does this for you in item 5 of Part 1. Read how a guardian affects your directive before you decide whether that default suits you.

The Mental Health Directive Has Its Own Rules

Chapter 327G creates a separate advance mental health care directive. HRS 327G-3(a) lets a competent adult or emancipated minor state preferences or instructions about mental health treatment, including consent or refusal, and says the document may be combined with a chapter 327E directive.

Its signing rule is stricter than chapter 327E's. HRS 327G-3(e) requires a writing that is dated and signed, then either two competent adult witnesses who attest you are known to them, signed in their presence and appear of sound mind, or acknowledgment before a notary public within this State. HRS 327G-3(f) bars as witnesses:

• A health care provider, a supervising provider, or an employee or relative of either.
• An owner, operator or employee of the facility where you are a patient or resident.
• Anyone related to you by blood, marriage or adoption.
• The agent or alternate agents.

So the relative who can serve as your second witness under HRS 327E-3(d) cannot witness a mental health directive at all. Sign the two documents with two unrelated witnesses if you sign them together.

Three more differences are worth knowing:

• It starts on delivery. HRS 327G-3(h) makes the directive effective when delivered to a provider or institution, and it stays effective until revoked.
• Two professionals find incapacity. HRS 327G-7(d) requires the supervising provider who is a physician and one other physician or licensed psychologist to examine you before your agent's authority is invoked.
• Your agent outranks a guardian. HRS 327G-9(b) gives the mental health agent's decision precedence over a guardian's absent a court order, the reverse of the chapter 327E rule.

HRS 327G-8 lists the only two situations where treatment may run contrary to your directive: a conflicting court order under part 3 of article V of chapter 560, or an emergency in which you pose an imminent threat to yourself or others. Separately, HRS 327E-13(e) bars a chapter 327E agent or surrogate from consenting to admission to a psychiatric facility unless your written directive expressly allows it.

POLST and Comfort Care Only Are Medical Orders

A POLST is not an advance directive. HRS 327K-1 says so, and defines the form as one signed by the patient, or if incapacitated by the patient's agent, guardian or surrogate, together with the patient's provider. The provider must be a physician, physician assistant or advanced practice registered nurse. HRS 327K-2(b) requires the physician or provider to explain the difference between the form and an advance directive. Under HRS 327K-2(c), emergency medical services personnel and emergency physicians must follow a properly signed form, unless it asks for medically ineffective care. The patient or representative may revoke it at any time in any manner under HRS 327K-2(d).

HRS 321-23.6 separately directs the Department of Health to adopt rules for a "comfort care only" document, signed by the patient or the patient's guardian, agent or surrogate and by two other adults who personally know the patient. It tells emergency responders not to restart the heart and to give comfort care only. The statute lets the patient or representative revoke it verbally, even during the emergency.

We have not read the Department of Health's current POLST form or its comfort care only form, because the department's website refused our research requests. Ask your physician for the current versions rather than relying on a downloaded copy.

Revoking or Replacing a Directive

HRS 327E-4 splits revocation in two:

• Revoking an agent takes a signed writing or personally informing the supervising health-care provider, under HRS 327E-4(a).
• Revoking anything else in the directive can happen at any time and in any manner that communicates intent, under HRS 327E-4(b).

A decree of annulment, divorce, dissolution or legal separation revokes the designation of a spouse as agent unless the decree or the document says otherwise, under HRS 327E-4(d). A later directive that conflicts with an earlier one revokes the earlier one to the extent of the conflict, under HRS 327E-4(e). Anyone told of a revocation must pass it on to the supervising provider and the facility under HRS 327E-4(c).

What Providers Must Do

HRS 327E-7 sets the provider's side:

• Record the directive, and request and keep a copy if it is written, under HRS 327E-7(b).
• Comply with your instruction and with decisions of your authorized decision maker, under HRS 327E-7(d).
• Decline only for reasons of conscience, under an institution policy communicated in time, or where the care would be medically ineffective, under HRS 327E-7(e) and (f).
• When declining, tell you, keep caring for you, and help transfer you to a willing provider, under HRS 327E-7(g).
• Never require or prohibit a directive as a condition of care, under HRS 327E-7(h).

HRS 327E-12 gives a copy the same effect as the original, so hand out signed copies freely. The statutory form tells you to give one to your physician, other providers, any facility treating you and each agent.

Chapter 327E puts money behind these duties. Under HRS 327E-10(a), a provider or institution that intentionally violates the chapter owes $500 or actual damages, whichever is greater, plus reasonable attorney's fees. Under HRS 327E-10(b), anyone who intentionally forges, conceals or destroys a directive or a revocation without consent, or coerces someone into signing or revoking one, owes $2,500 or actual damages, whichever is greater, plus fees.

Documents From Another State

HRS 327E-3(j) treats a directive as valid if it complies with chapter 327E or was executed in compliance with the laws of the state where it was executed. A new Hawaii resident does not have to re-sign to be covered. Re-signing on Hawaii's form is still worth considering, because a Hawaii provider reads a Hawaii form faster and the statutory form carries Hawaii's guardian nomination and witness declarations.

Where Disputes Go

HRS 327E-14 lets the patient, an agent, guardian or surrogate, or a provider or institution petition any court of competent jurisdiction to enjoin or direct a health-care decision. The proceeding runs under part 3 of article V of chapter 560, the guardianship part of Hawaii's probate code. HRS 327E-14 names no particular court, and under HRS 560:5-106 family court and circuit court share jurisdiction over adult guardianship matters. A health-care decision by an agent, surrogate or guardian otherwise takes effect without court approval under HRS 327E-3(h), 327E-5(h) and 327E-6(c).

Where This Sits in a Hawaii Plan

Most Hawaii adults need two documents here: the advance health-care directive under chapter 327E, which the statutory form in HRS 327E-16 combines into one packet with an agent, instructions, an optional organ donation part and a primary physician part, and the financial power of attorney, which is a separate chapter with its own signing rule. Add a chapter 327G directive if psychiatric care is a concern.

Next steps:

1. Pick an agent and two alternates, and talk to each of them.
2. Fill in the statutory form or have a lawyer draft one, and nominate your agent as guardian.
3. Sign with one unrelated non-heir witness and one other qualified witness, or before a notary in Hawaii.
4. Give copies to your physician, your agents and any facility treating you.

For wills, trusts and the rest of the document set, start with the other planning documents.

Frequently Asked Questions

Does a Hawaii advance directive have to be notarized?

No, a notary is one of two routes, and only for the power of attorney for health care. HRS 327E-3(b) requires that power to be in writing, dated and signed by the principal, and then either signed by at least two witnesses or acknowledged before a notary public at any place within this State. The individual instruction half of a directive needs neither, because HRS 327E-3(a) lets you give an instruction orally or in writing.

Who can witness a Hawaii health care power of attorney?

Most adults, with three exclusions and one balance rule. HRS 327E-3(c) bars a health-care provider, an employee of a health-care provider or facility, and the agent. HRS 327E-3(d) then requires at least one of the two witnesses to be neither related to you by blood, marriage or adoption nor entitled to any part of your estate under your will or by operation of law. So your adult child can be one witness, provided the other witness is an unrelated person who inherits nothing from you.

Who makes medical decisions in Hawaii if I never signed anything?

A surrogate chosen by consensus, with no ranked list. HRS 327E-5(d) directs the interested persons to make reasonable efforts to agree on who among them should decide, and says the person selected should be the one with a close relationship who is most likely to know your current wishes. HRS 327E-2 defines interested persons as your spouse unless legally separated or estranged, a reciprocal beneficiary, any adult child, either parent, an adult sibling or adult grandchild, and any adult who has shown special care and concern and knows your personal values. If they cannot agree, any of them who took part in the discussion may start a guardianship case.

Can I name a surrogate in Hawaii without signing a form?

Yes. HRS 327E-5(a) lets a patient designate or disqualify any individual as surrogate by personally informing the supervising health-care provider. A surrogate you designated that way may make any health-care decision you could have made, under HRS 327E-5(f), without the extra feeding-tube limit that applies to a surrogate you never chose.

Does a court-appointed guardian override my health care agent in Hawaii?

Yes, for ordinary health care, unless a court orders otherwise. HRS 327E-6(b) says a health-care decision of a guardian appointed under chapter 560 takes precedence over that of an agent absent a court order to the contrary. Mental health care runs the other way: HRS 327G-9(b) says the mental health care decision of an agent named in an advance mental health care directive takes precedence over that of a guardian.

Is a POLST the same as an advance directive in Hawaii?

No. HRS 327K-1 says in so many words that a provider orders for life-sustaining treatment form is not an advance health-care directive. It is a medical order signed by the patient, or by the patient's agent, guardian or surrogate, together with the patient's provider, meaning a physician, physician assistant or advanced practice registered nurse. HRS 327K-2(c) requires emergency medical services personnel and other providers to follow a properly signed form.

Is an advance directive signed in another state valid in Hawaii?

Yes, if it was valid where you signed it. HRS 327E-3(j) treats an advance health-care directive as valid for purposes of chapter 327E if it complies with the chapter or was executed in compliance with the laws of the state where it was executed. That same subsection is also why the notary rule matters less for a document signed elsewhere, since the phrase at any place within this State only limits the Hawaii notary route.

Related Guides

• Hawaii estate planning covers the will, trust and other documents that sit beside this one.
• Hawaii power of attorney covers the financial document, which runs under a separate chapter.
• Hawaii guardianship planning covers what a court does when no agent was named or the family cannot agree.
• Hawaii probate guide covers what opens after a death, once every document on this page has stopped working.

Sources:

• Title: HRS 327E-1, Short title. Publisher: Hawaii State Legislature. Publication Date: L 1999, c 169, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0327E/HRS_0327E-0001.htm
• Title: HRS 327E-2, Definitions. Publisher: Hawaii State Legislature. Publication Date: Last amended L 2018, c 125, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0327E/HRS_0327E-0002.htm
• Title: HRS 327E-3, Advance health-care directives. Publisher: Hawaii State Legislature. Publication Date: Last amended L 2004, c 161, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0327E/HRS_0327E-0003.htm
• Title: HRS 327E-4, Revocation of advance health-care directive. Publisher: Hawaii State Legislature. Publication Date: L 1999, c 169, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0327E/HRS_0327E-0004.htm
• Title: HRS 327E-5, Health-care decisions; surrogates. Publisher: Hawaii State Legislature. Publication Date: Last amended L 2018, c 125, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0327E/HRS_0327E-0005.htm
• Title: HRS 327E-6, Decisions by guardian. Publisher: Hawaii State Legislature. Publication Date: Last amended L 2004, c 161, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0327E/HRS_0327E-0006.htm
• Title: HRS 327E-7, Obligations of health-care provider. Publisher: Hawaii State Legislature. Publication Date: L 1999, c 169, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0327E/HRS_0327E-0007.htm
• Title: HRS 327E-10, Statutory damages. Publisher: Hawaii State Legislature. Publication Date: L 1999, c 169, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0327E/HRS_0327E-0010.htm
• Title: HRS 327E-11, Capacity. Publisher: Hawaii State Legislature. Publication Date: L 1999, c 169, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0327E/HRS_0327E-0011.htm
• Title: HRS 327E-12, Effect of copy. Publisher: Hawaii State Legislature. Publication Date: L 1999, c 169, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0327E/HRS_0327E-0012.htm
• Title: HRS 327E-13, Effect of this chapter. Publisher: Hawaii State Legislature. Publication Date: Last amended L 2018, c 2, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0327E/HRS_0327E-0013.htm
• Title: HRS 327E-14, Judicial relief. Publisher: Hawaii State Legislature. Publication Date: L 1999, c 169, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0327E/HRS_0327E-0014.htm
• Title: HRS 327E-16, Optional form. Publisher: Hawaii State Legislature. Publication Date: Last amended L 2004, c 161, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0327E/HRS_0327E-0016.htm
• Title: HRS 327G-3, Advance mental health care directive; designation of agent. Publisher: Hawaii State Legislature. Publication Date: Last amended L 2005, c 22, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0327G/HRS_0327G-0003.htm
• Title: HRS 327G-7, Presumption of capacity; determination of lack of capacity; recovery of capacity. Publisher: Hawaii State Legislature. Publication Date: L 2004, c 224, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0327G/HRS_0327G-0007.htm
• Title: HRS 327G-8, Limitations on applicability of advance mental health care directive. Publisher: Hawaii State Legislature. Publication Date: L 2004, c 224, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0327G/HRS_0327G-0008.htm
• Title: HRS 327G-9, Decisions by guardian. Publisher: Hawaii State Legislature. Publication Date: Last amended L 2005, c 22, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0327G/HRS_0327G-0009.htm
• Title: HRS 327K-1, Definitions. Publisher: Hawaii State Legislature. Publication Date: Last amended L 2024, c 98, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0327K/HRS_0327K-0001.htm
• Title: HRS 327K-2, Provider orders for life-sustaining treatment form; execution; explanation; compliance; revocation. Publisher: Hawaii State Legislature. Publication Date: Last amended L 2014, c 154, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0327K/HRS_0327K-0002.htm
• Title: HRS 321-23.6, Rapid identification documents. Publisher: Hawaii State Legislature. Publication Date: Last amended L 2006, c 46, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0321/HRS_0321-0023_0006.htm
• Title: HRS 577-1, Age of majority. Publisher: Hawaii State Legislature. Publication Date: Last amended L 1975, c 77, accessed 2026-09-24. URL: https://data.capitol.hawaii.gov/hrscurrent/Vol12_Ch0501-0588/HRS0577/HRS_0577-0001.htm

It is not legal advice.