A Living Will is a legal document that allows individuals in Arkansas to express their wishes regarding medical treatment in the event they become unable to communicate their preferences. This important form provides clarity to loved ones and healthcare providers, ensuring that your values and desires are honored during critical times. If you're ready to take this important step, fill out the form by clicking the button below.
In the realm of healthcare decisions, the Arkansas Living Will form plays a vital role in ensuring that an individual's wishes are respected when it comes to end-of-life care. This legal document allows a person to outline their preferences regarding medical treatment in situations where they may no longer be able to communicate their desires. It addresses critical decisions, such as the use of life-sustaining treatments, resuscitation efforts, and palliative care. By clearly stating one’s intentions, the form helps alleviate the burden on family members and healthcare providers during emotionally charged moments. Additionally, the Arkansas Living Will must be signed in the presence of witnesses or a notary to ensure its validity. Understanding the nuances of this form empowers individuals to take control of their healthcare choices, fostering peace of mind for both themselves and their loved ones.
Arkansas Living Will
This Living Will is designed in accordance with the Arkansas Rights of the Terminally Ill or Permanently Unconscious Act, allowing individuals to direct their medical care in the event they can no longer communicate their wishes. This document serves as a declaration of one's desires regarding life-sustaining treatment, nutrition, and hydration when faced with a terminal condition or permanent unconsciousness.
Personal Information
I, _________________ (full legal name), residing at ______________________________________ (address), being of sound mind, hereby declare this document as my Living Will.
Date of Birth: _______________
Social Security Number: ____________
Declaration
I understand that this declaration will only be effective when I am unable to communicate my desires myself due to my medical condition. In such circumstances, I direct the following:
I desire to ___ (initial one) receive/decline life-sustaining treatments that could extend my life for a limited duration without a reasonable chance of recovery or improvement of my condition.
I desire to ___ (initial one) receive/decline artificial nutrition and hydration if I can no longer eat or drink by mouth and my doctors determine that my condition is terminal or I am permanently unconscious.
__________________________________________________________________________
Agent for Health Care Decisions
In the event that I am unable to make my wishes known, I designate the following person as my health care agent:
Name: ______________________________________________
Relationship to me: __________________________________
Address: ____________________________________________
Phone: _______________________ Email: _____________________________
This person will have the authority to make health care decisions for me, including the decision to withhold or withdraw life-sustaining treatment.
Alternate Agent
If my primary agent is unable, unwilling, or unavailable to act on my behalf, I designate the following person as my alternate agent:
Signatures
This Living Will shall be effective only when I am unable to communicate my wishes regarding my medical treatment. This declaration reflects my firm and settled commitment to refuse life-sustaining treatment under the circumstances described above.
Signed this ____ day of ____________, 20__.
____________________________________ (Signature)
State of Arkansas County of _________________
Subscribed and sworn before me this ____ day of ____________, 20__.
____________________________________ (Signature of Notary Public)
My Commission Expires: ______________
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