"Living Will" - Arkansas

An Arkansas Living Will - sometimes confused with an Advance Directive - is a document that allows an individual to clarify their wishes regarding health care and treatment in case of temporary or permanent incapacity.

The form must at the very least address the three following topics:

  • The election of an agent or a healthcare proxy;
  • Life support;
  • Palliative care.

An Arkansas Living Will is defined by § 20-17-201 to § 20-17-218 of the Arkansas Code. The document may be executed by any individual of sound mind and eighteen (18) or more years of age and must be witnessed by two (2) individuals. Not valid if pregnant.

Click on the link below to download a premade template or make your own Living Will using our form builder.

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Arkansas Living Will
I, _______________________________ with a mailing address of ______________
____________________________________________________________________,
being of sound mind, memory, disposition, understanding, and at least eighteen years
of age, do willfully and freely, by this Living Will, direct my family, physician(s),
attorney, and any other individuals who may in the future become responsible for my
health and well-being and any resolutions related thereto, whether partly or fully, to
take the following actions in each of the circumstances described in this Living Will
below.
1. If I develop a condition deemed to be “terminal” with my attending physician
and one other medical professional both agreeing within a reasonable degree of
medical certainty that I cannot be cured, I request the following:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
2. If I fall into a coma with my attending physician and one other medical
professional both agreeing within a reasonable degree of medical certainty that
there is no chance for recovery, I direct the following:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
3. If I develop a persistent vegetative state with my attending physician and one
other medical professional both determining within a reasonable degree of
medical certainty that there is no chance for recovery, I request the following:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Arkansas Living Will
I, _______________________________ with a mailing address of ______________
____________________________________________________________________,
being of sound mind, memory, disposition, understanding, and at least eighteen years
of age, do willfully and freely, by this Living Will, direct my family, physician(s),
attorney, and any other individuals who may in the future become responsible for my
health and well-being and any resolutions related thereto, whether partly or fully, to
take the following actions in each of the circumstances described in this Living Will
below.
1. If I develop a condition deemed to be “terminal” with my attending physician
and one other medical professional both agreeing within a reasonable degree of
medical certainty that I cannot be cured, I request the following:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
2. If I fall into a coma with my attending physician and one other medical
professional both agreeing within a reasonable degree of medical certainty that
there is no chance for recovery, I direct the following:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
3. If I develop a persistent vegetative state with my attending physician and one
other medical professional both determining within a reasonable degree of
medical certainty that there is no chance for recovery, I request the following:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
4. In addition to the directions I have listed on this Living Will, I also want the
following:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Signatures
Principal
By signing this Living Will in front of the witnesses named below, I hereby execute
and subscribe to the statements made in this Living Will both freely and voluntarily,
and wholeheartedly request that my family, physician(s), attorney, and any other
individuals who may in the future become responsible for my health and well-being
and any decisions related thereto, whether partly or fully, all abide by my wishes as
pronounced herein.
_________________________________
Name
_________________________________
Signature
_________________________________
Date of signing
Witnesses
This Living Will was signed by _________________________________ in the
presence of the following two witnesses, who by their signatures below, confirm that
_________________________________ was, at the time this document was signed,
at least eighteen years of age, of sound mind, memory, disposition, understanding, not
under any improper influence and able to understand the weight of this decision. The
undersigned have subscribed this document in the presence of each other and
_________________________________ and at their request.
First Witness: ​ _ ________________________________ ​ w ith a mailing address of
____________________________________________________________________.
_________________________________
Signature
_________________________________
Date of signing
Second Witness: ​ _ ________________________________ ​ w ith a mailing address of
____________________________________________________________________.
_________________________________
Signature
_________________________________
Date of signing
Notary Acknowledgement
STATE OF ARKANSAS
COUNTY OF _________________________________
I, _________________________________, a Notary Public of said County, do certify
that _________________________________, as Principal, and __________________
________________ and _________________________________, as witnesses,
whose names are signed to the writing above bearing date on the _______ day of
______________, ______, have this day acknowledged the same before me.
Given under my hand this _______ day of ______________, ______.
My commission expires: ___________________________________
______________________________________
Signature of Notary Public
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What Is an Arkansas Living Will?

A Living Will is a document used if a patient is for any reason unable to express their decisions and desires related to end-of-life medical care. The will comes into effect when a person is incapacitated to the point where they are no longer able to actively take part in making the decisions for their own life or unable to direct their physician to do so.

An individual has the right to print a will with the objective to give it to the medical personnel in order to inform them about the type of care they wish to have or wish to avoid in situations of terminal illnesses or incapacitation.

How to Make a Living Will in Arkansas?

A basic will of this variety can be completed without a lawyer or an attorney. Generally, all Living Wills in Arkansas include the following sections:

  1. A designation of health care proxy - a third party tasked with making any and all healthcare-related decisions on the patient's behalf.
  2. General provisions - the general wishes concerning healthcare, custody and medical treatment.
  3. Life-sustaining medical treatment - provisions regarding life-support, tube feeding, surgeries, antibiotics or medication.
  4. Comfort and pain relief - the patient may choose any treatment even if it results in hastening the death or a temporary addiction.
  5. The agent's obligations - the agent must take the patient's personal values to the extent known to them into consideration.
  6. End of life decisions - including the provisions regarding the withholding or withdrawal of treatment.
  7. The patient's statement and signature - the patient must certify that they are fully aware and completely understand the contents of the document.
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