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


1) Enter name of principle.


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  • If artificial nutrition may be withheld/withdrawn
  • If artificial hydration may be withheld/withdrawn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.