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Arkansas Living Will Form (Advance Directive) |
The Arkansas declaration of living will form, or ‘Advance Directive’, is created in accordance with § 20-6-103(c), § 20-17-202, and requires at least two witnesses or a notary. The form declares that the principal may legally choose the medical treatment they will receive if they ever become incapacitated to such a severity that they can not make the decisions at that time. This document goes so far as to cover situations where a patients life may be ended for example after incurring severe brain damage.
How to Write
DECLARATION OF LIVING WILL
1) Enter name of principle.
2)
Section One. Life-Sustaining Treatments
Check box relating to relevant treatments NOT to be administered.
- Cardiac/pulmonary resuscitation.
- Assisted mechanical breathing.
- Major surgery.
- Minor surgery (unless necessary for my comfort or to alleviate pain).
- Chemotherapy.
- Kidney dialysis.
- Invasive diagnostic tests.
- Antibiotics.
- Blood products.
- Medications NOT necessary for alleviation of pain.
Other Medical Directives
- Enter details for any other medical treatments the principal may require.
Section 2. Artificial Nutrition and Hydration
The principal must initial the relevant boxes
- If artificial nutrition may be withheld/withdrawn
- If artificial hydration may be withheld/withdrawn
i) The principal must sign and date within the blank fields.
ii) Two witnesses must sign and enter their full address in the blank fields.
