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Arkansas Living Will Form | Declaration

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The Arkansas living will, also referred to as an ‘Advance Directive‘, is a document that will provide an avenue for one to provide an explanation in writing, while they are still able to make their own decisions with a sound mind, as to how they would like to have their medical treatment conducted when they are at an end of life scenario and are no longer able to make decisions regarding their healthcare on a daily basis and on their own. This document will provide information with regard to the desires of the Principal and their chosen medical directives only. This form may be revoked at any time as long as the Principal still has the mental capacity to do so.

Laws§ 20-17-202

Signing Requirements (§ 20-17-202)- Two (2) Witnesses or a Notary Public.

Medical Power of Attorney – Use for creating an attorney-in-fact that can oversee and make healthcare decisions in the chance you are not able to on your own.

How to Write

Step 1 – Name of Declarant (Principal) – At the top of the document, enter the full legal name of the Principal

Step 2 – Life-Sustaining Treatments – The Principal must carefully read or have read to them, the next two paragraphs on the document and respond by checking any of the various selections with regard to what they would wish to have withheld or completely withdrawn, in the event that there will be no opportunity for recovery:

  • The life-sustaining treatments which may be withheld or withdrawn are:
  • Cardiopulmonary Resuscitation
  • Mechanical Breathing
  • Major Surgery
  • Kidney Dialysis
  • Chemotherapy
  • Minor Surgery (unless necessary for my comfort or to alleviate pain)
  • Invasive Diagnostic Tests
  • Antibiotics
  • Blood Products
  • Other Medications not Necessary for Alleviation of Pain
  • Add other medical directives (if any) in the lines provided (if more writing space is required, enter the continuing information on an added sheet and attach to the document)

Step 3 – Artificial Nutrition and Hydration – The state of Arkansas requires that any Principal preparing a living will make known, separately, if they would wish to have artificial nutrition and/or hydration withdrawn in order to accelerate the natural process of death. The Principal must read or have read to them, each of the options and initial the lines preceding each statement. If they choose to remain on life-sustaining fluids and nutrition simply place “N/A” on the lines as follows:

  • I understand that Arkansas law requires me to make my wishes regarding artificial nutrition and hydration known separately from the above directions. Therefore, by initializing the appropriate line(s) below, I specifically:
  • DIRECT that artificial nutrition may be withheld or withdrawn after consultation with my attending physician
  • OR
  • DIRECT that artificial hydration may be withheld or withdrawn after consultation with my attending physician
  • Date the Principal’s Signature in dd/mm/yyyy format
  • The Principal must then provide a signature (or have someone they trust and of their choosing, sign in their stead)

Step 4 –  Witness Signatures and Information – Although there is no notarization necessary for this form (unless otherwise instructed by the Principal), there must be two trusted witnesses who are willing to state that the living will be completed by the Principal while he or she was of sound mind to do so. The witnesses must carefully read the statement and then provide:

Witness 1 – 

  • Witness’ Signature
  • Physical Address
  • City, State, Zip Code

Witness 2 –

  • Witness’ Signature
  • Physical Address
  • City, State, Zip Code

Make copies for all signatories

Give the original to the Principal