Information and Instructions
Arkansas Living Will
This package contains (1) Information and Instruction for Arkansas Living Will; (2) Arkansas
This Arkansas Living Will is based on Title 20 Chapter 17 Subchapter 2 Section 20 -17-201 et.
Seq. of the Arkansas Codes. For your convenience, we have included useful excerpts from the
Arkansas Statutes relating to Living Wills.
20-17-202. Declaration relating to use of life-sustaining treatment.
(a) An individual of sound mind and eighteen (18) or more years of age may execute at any
time a declaration governing the withholding or withdrawal of life-sustaining treatment. The
declaration must be signed by the declarant, or another at the declarant's direction, and
witnessed by two (2) individuals.
(b) A declaration may, but need not, be in the following form in the case where the patient
has a terminal condition. (see form below)
(d) A physician or other health care provider who is furnished a copy of the declaration shall
make it a part of the declarant's medical record and, if unwilling to comply with the
declaration, promptly so advise the declarant.
(e) In the case of a qualified patient, the patient's health care proxy, in consultation with the
attending physician, shall have the authority to make treatment decisions for the patient
including the withholding or withdrawal of life-sustaining procedures.
20-17-203. When declaration operative.
A declaration becomes operative when (i) it is communicated to the attending physician and
(ii) the declarant is determined by the attending physician and another physician in
consultation either to be in a terminal condition and no longer able to make decisions
regarding administration of life-sustaining treatment or to be permanently unconscious. When
the declaration becomes operative, the attending physician and other health care providers
shall act in accordance with its provisions or comply with the transfer provisions of § 20-17-
20-17-204. Revocation of declaration.
(a)(1) A declaration may be revoked at any time and in any manner by the declarant without
regard to the declarant's mental or physical condition. A revocation is effective upon
Information & Instructions – Page 2
communication to the attending physician or other health care provider by the declarant or a
witness to the revocation.
(2)(A) The wishes of a patient who requests nutrition, hydration, or both, shall be honored.
(B) Unless the use of artificial means is specifically requested, a patient's request for
nutrition or hydration, or both, shall not be honored by use of artificial means if doing so
would require the insertion of any apparatus into the patient's body.
(b) The attending physician or other health care provider shall make the revocation a part of
the declarant's medical record.
[_] These forms are provided “as is” and no implied or express warranties have been made or are
provided as to their suitability for any specific purpose or as to their legal effect or completeness.
[_]These forms are not intended and are not a substitute for legal and/or tax advice. Laws vary
from time to time and from state to state. These forms should only be a starting point for you and
should not be used or signed without consulting an attorney first to make sure it fits your
particular situation. Advice from a local attorney is always recommended when dealing with
estate planning matters. Any possible tax consequences arising out of this document should be
discussed with a tax professional.
If I should have an incurable or irreversible condition that will cause my death within a relatively
short time, and I am no longer able to make decisions regarding my medical treatment, I direct
my attending physician, pursuant to the Arkansas Rights of the Terminally Ill or Permanently
Unconscious Act, to (select and initial one):
______________ withhold or withdraw treatment that only prolongs the process of dying
and is not necessary to my comfort or to alleviate pain
______________ follow the instructions of ___________________________________,
whom I appoint as my Health Care Proxy to decide whether li