Free Arkansas Living Will Template
Arkansas Living Will
This Living Will is made on [Date] by [Your Name], residing at [Your Company Address]. This document outlines my wishes regarding my medical treatment and care. I execute this Living Will while I am of sound mind and not under duress, fraud, or undue influence.
I. Declaration
In the event I am incapacitated and unable to express my wishes directly, I wish my family members and medical providers to adhere to the guidelines stipulated in this document. I intend to remove all burdens by making my medical preferences known in advance.
II. Appointment of Health Care Agent
To ensure that my intentions and medical care preferences are honored, I appoint the following individual as my Health Care Agent:
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Name: [Agent's Full Name]
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Relationship: [Relationship to You]
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Address: [Agent's Address]
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Phone Number: [Your Company Number]
My Health Care Agent shall have the power to make all healthcare decisions on my behalf, including decisions about withdrawing or withholding life-sustaining treatment, when I am unable to make these decisions for myself.
III. General Instructions for Health Care
My health care should be administered according to the following preferences:
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Comfort and Dignity: I prioritize maintaining my comfort and dignity throughout all aspects of my care. It is essential to me that healthcare providers take steps to ensure my physical comfort and emotional well-being.
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Pain Management: I request that healthcare providers prioritize effective pain management to alleviate any discomfort or suffering that I may experience. Prompt and comprehensive pain relief is important to me.
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Life-Sustaining Treatments: I specify that life-sustaining treatments, such as mechanical ventilation, artificial nutrition, and hydration, should only be administered if they are likely to improve my quality of life or alleviate pain and suffering. If these treatments would only prolong the dying process without offering significant benefits, I do not wish for them to be used.
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End-of-Life Care: If my condition becomes terminal and death is imminent, I request a transition to end-of-life care focused on maximizing comfort and ensuring a peaceful passing. I desire hospice care and palliative measures to manage symptoms and provide emotional support to both myself and my loved ones. I also value the involvement of my family members in decisions about my care.
IV. Specific Wishes
Should there come a time when I am incapacitated in a hospital or dwelling, the following are my specific wishes:
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Resuscitation Preferences: In the event of cardiac or respiratory failure, I prefer the following resuscitation preferences: [CPR Do Not Resuscitate/Allow Natural Death]. I request that my healthcare providers honor these preferences by state laws and regulations.
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Treatment Preferences: I request that all medical treatments and interventions be administered to improve my quality of life and alleviate suffering. Additionally, I prefer conservative measures to be attempted before invasive procedures, whenever possible.
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Health Care Agent: I designate my Health Care Agent, as appointed in this Living Will, to communicate with healthcare providers on my behalf and make decisions about my care if I am unable to do so. I request that my healthcare providers respect and honor the decisions made by my Health Care Agent according to my wishes outlined in this document.
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Organ and Tissue Donation: In the event of my death, I [wish/do not wish] to donate any of my organs, tissues, or eyes for organ transplantation, therapy, research, or education.
VI. Signature and Witnesses
I sign this Living Will on [Date] in the presence of the following witnesses, who also sign in my presence.
Declarant
[Your Name]
Witness 1
Name: [Witness 1 Name]
Address: [Witness 1 Address]
Witness 2
Name: [Witness 2 Name]
Address: [Witness 2 Address]
VII. Notary Acknowledgment
County of [County Name], State of Arkansas
On this [Date], before me, [Notary's Name], a notary public in and for the said state, personally appeared [Your Name], known to me to be the person described in and who executed the foregoing instrument, and acknowledged that he/she executed the same as his/her free act and deed.
Witness my hand and official seal.
Notary Public: [Notary's Name]
My Commission Expires: [Expiration Date]
