Arkansas Code
Subchapter 2 - Arkansas Rights of the Terminally Ill or Permanently Unconscious Act
§ 20-17-202. Declaration relating to use of life-sustaining treatment

(a)
(1) 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.
(2) A declaration executed under this section before July 1, 2017, is valid if the declaration substantially complies with subdivision (a)(1) of this section.
(3) A declaration executed under this section on and after July 1, 2017, is valid if the declaration document:
(A) Is notarized but does not have two (2) witnesses; or
(B) Satisfies the requirements of the Arkansas Healthcare Decisions Act, § 20-6-101 et seq.

(b) A declaration may be, but need not be, in the following form in the case where the patient has a terminal condition:
(c) A declaration may be, but need not be, in the following form in the case where the patient is permanently unconscious:
(d) A physician or other healthcare provider who is furnished a copy of the declaration shall make it a part of the declarant's medical record.
(e) In the case of a qualified patient, the patient's healthcare 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.
(f) A declaration executed by a qualified individual shall be clear and convincing evidence of his or her wishes, but clear and convincing evidence of an individual's wishes is not limited to the declarations under this section.
(g)
(1) The directives concerning nutrition and hydration contained in subsections (b) and (c) of this section shall apply only to declarations executed on and after July 16, 2003.
(2) All declarations executed before that date shall remain in full force and effect, and the provisions of subsections (b) and (c) of this section pertaining to hydration and nutrition shall not be applied in the interpretation or construction of any such declaration, nor shall they be applied to in any way invalidate any such declaration or to otherwise limit the directives, powers, and authority granted under any such declaration.

“DECLARATION “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 [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 life-sustaining treatment should be withheld or withdrawn]. It is my specific directive that nutrition may be withheld after consultation with my attending physician. It is my specific directive that hydration may be withheld after consultation with my attending physician. It is my specific directive that nutrition may not be withheld. It is my specific directive that hydration may not be withheld. Signed this day of , 20 . Signature Address I am a competent adult who is not named as a healthcare proxy in this document. I witnessed the patient's signature on this form. Witness Address I am a competent adult who is not named as a healthcare proxy in this document. I am not related to the patient by blood, marriage, or adoption and I would not be entitled to any portion of the patient's estate upon his or her death under any existing will or codicil or by operation of law. I witnessed the patient's signature on this form. Witness Address
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“DECLARATION “If I should become permanently unconscious, I direct my attending physician, pursuant to the Arkansas Rights of the Terminally Ill or Permanently Unconscious Act, to [withhold or withdraw life-sustaining treatments that are no longer necessary to my comfort or to alleviate pain] [follow the instructions of whom I appoint as my health care proxy to decide whether life-sustaining treatment should be withheld or withdrawn]. It is my specific directive that nutrition may be withheld after consultation with my attending physician. It is my specific directive that hydration may be withheld after consultation with my attending physician. It is my specific directive that nutrition may not be withheld. It is my specific directive that hydration may not be withheld. Signed this day of , 20 . Signature Address I am a competent adult who is not named as a healthcare proxy in this document. I witnessed the patient's signature on this form. Witness Address I am a competent adult who is not named as a healthcare proxy in this document. I am not related to the patient by blood, marriage, or adoption and I would not be entitled to any portion of the patient's estate upon his or her death under any existing will or codicil or by operation of law. I witnessed the patient's signature on this form. Witness Address
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