The Hawaii Department of Health’s latest annual assisted suicide report shows that the annual number of assisted suicides in Hawaii has almost quadrupled since 2019, and the Department has admitted that undocumented deaths are occurring, prompting calls for Governor Josh Green to commission an urgent independent inquiry. 

The report also reveals Hawaii had the highest proportion of deaths caused by assisted suicide in the seventh full calendar year of the operation of its law among US states where deaths from assisted suicide are reported.

In the report, Hawaii’s Department of Health explicitly admits that not all assisted suicide deaths are being documented. This is a major problem because it means that supposed safeguards in the law to prevent unlawful deaths, such as homicides and other potential issues, may not be followed, and it is much more difficult to monitor whether they are being followed or not.

In a statement published following the release of the report, the Department of Health revealed that “[i]n some instances, the attending provider is not notified whether the qualified patient subsequently died or whether the prescribed medication was ingested”.

The Department added that required follow-up forms may not actually be submitted, or that information required to be included on the forms can be reported as unknown. It said that even in such cases where required follow-up forms are missing, this does not necessarily indicate non-compliance with the law. 

Assisted suicides occurring but not being documented also risk serious crimes, such as this 2024 suspected murder case, going undetected.

Highest proportion in the US at year seven

  • A record 59 people died by assisted suicide in Hawaii in 2025, compared with 38 in 2024 – an increase of 55.3% in a single year. This is the largest annual number recorded since legalisation in 2019.
    • Across the seven years from the beginning of 2019 to the end of 2025, there have been 254 reported assisted suicide deaths in Hawaii.
  • Hawaii had the highest proportion of deaths caused by assisted suicide in the seventh full calendar year of the operation of its law among US states where deaths from assisted suicide are reported.
    • The 59 reported assisted suicide deaths are equivalent to 0.46% of the provisional 12,689 deaths of Hawaii residents in 2025, around one in 215.
    • Compared with 0.33% in California’s seventh full year in 2023 and 0.12% in Oregon’s in 2004. 
  • Hawaii reported 23 assisted suicide deaths per 5,000 deaths in the state in 2025.
    • This is a 53.33% increase from the previous year when there were 15 deaths by assisted suicide per 5000 deaths in Hawaii.

Undocumented deaths, complications and suspected murder

  • In the report, Hawaii’s Department of Health explicitly admits that not all assisted suicide deaths are being documented.
    • This is a major problem because it means that supposed safeguards in the law to prevent unlawful deaths, such as homicides and other potential issues, may not be followed, and this makes it very difficult to monitor whether they are being followed or not.
    • Assisted suicides occurring but not being documented also risk serious crimes, such as this 2024 suspected murder case, going undetected.
    • This also means that the published figures are likely to understate the number of actual assisted suicide deaths.
    • Right To Life is calling on Governor Josh Green to make urgent changes to the operation of the law in Hawaii to ensure all assisted suicide deaths are properly documented.
  • The doctor / advanced practice registered nurse is required to collect information on complications, but these complications are not being reported in the annual statistics
    • The doctor / advanced practice registered nurse is required by law to fill in a form following the patient’s death, which includes collecting data on complications.
    • This means this data is required to be collected, but the Hawaii Department of Health is choosing to not report on this data in the annual reports. This is a problem because it means that there is no visibility on whether these forms are being properly completed and no way for the public to monitor complications.
    • The Department of Health said the lack of publicly available information makes it difficult to discern how frequently complications occur and whether providers are consistently completing the required forms. 
    • There is nothing preventing the publishing of this data as other states, including Oregon and California, do.
    • The Department of Health in Hawaii has reported at least one serious complication in the past. The 2021 report described one complication in which the time to death from ingestion was approximately 12 hours. This indicates there may be other serious complications which are not being reported.
    • Right To Life is calling on Governor Josh Green to ensure that complication data is reported in the annual reports.
  • The report entirely fails to acknowledge the suspected murderof an 88-year-old who allegedly died at the hands of her doctor after he allegedly illegally administered the drugs to her in her home in Honolulu following her receipt of lethal drugs prescribed under Hawaii’s assisted suicide law in October 2024.
    • Investigators alleged that the woman began choking and signalled for the doctor to stop, but he continued administering the medication. The medical examiner classified her death as a homicide.
    • Given the admitted gaps in Hawaii’s monitoring of assisted suicide, questions must be asked about whether any similar incidents have happened and have simply gone undetected.
  • Among the 17 Counseling Providers who conducted mental capacity evaluations during this reporting period, only 3 were psychiatrists.
  • Due to the fact that the death certificate must list the patient’s terminal illness as the cause of death, rather than the assisted suicide drugs, the Department cannot use death certificates as a means to discover how many assisted suicides have taken place.
    • This is significant because Hawaii’s Department of Health admits that not all assisted suicide deaths are documented in its annual report. 
    • The failure to record these deaths accurately means missing assisted suicide deaths cannot reliably be identified through death certificates alone, thereby exacerbating existing gaps in unreported assisted suicide deaths.

Alisdair Hungerford-Morgan, Chief Executive of Right To Life, which opposes assisted suicide and euthanasia and campaigns for greater investment in palliative care, said:

“Governor Josh Green must commission an urgent independent inquiry into Hawaii’s assisted suicide system, including making urgent changes to ensure all deaths and complications are properly documented and reported on, along with investigating whether claimed safeguards in current legislation are protecting vulnerable people in practice.”

“Reported deaths have risen by 293% since the law’s first full year of operation in 2019. The real number is likely higher given that the Department of Health has admitted in the report that not all assisted suicides are being documented.”

“Hawaii also had the highest proportion of deaths caused by assisted suicide in the seventh full calendar year of the operation of its law among US states where deaths from assisted suicide are reported.”

“This makes it more urgent to understand what is driving this and whether people are protected as use grows.”

“The reported case of an 88-year-old woman who allegedly signalled for her doctor to stop as she choked shows why safeguards matter. This case reveals how under the law it is very difficult to verify whether the person self-administers the assisted suicide drugs. This is also a major flaw in safeguards against coercion since the death can take place without independent witnesses. An independent inquiry must identify how fundamental changes to the law’s safeguards can be built into the system to prevent this.”

“An inquiry should establish the full number of deaths, publish the information it holds about complications and examine how suspected unlawful deaths are identified.”

“People nearing the end of their lives deserve protection and the best possible care, not a pathway to suicide”.

Dr Gregory Jackson, Head of Research at Right To Life, said:

“Clear complications like the death that took approximately twelve hours should be a source of concern for supporters and opponents of assisted suicide alike.” 

“Doctors are required by law to collect data on complications during assisted suicide, but for reasons unknown, the Department of Health is choosing not to publish this data. This creates a lack of transparency where serious complications could remain hidden. Other states such as Oregon and California collect and publish such data, and Hawaii should do the same.”

“The significant gaps in publishing of data require urgent correction, especially in light of the horrific suspected murder in 2024. Without effective data collection, there is a real risk that this kind of thing will happen again, or even has already happened, but we simply do not know about it.”

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