Arkansas: Living Will and Advance Health-Care Instruction Requirements

Arkansas recognizes two related ways for an adult to state treatment wishes. The
Arkansas Healthcare Decisions Act allows a broad individual instruction that
may be oral or written. The Arkansas Rights of the Terminally Ill or Permanently
Unconscious Act supplies the narrower formal declaration for life-sustaining
treatment in a terminal condition or permanent unconsciousness. §§ 20-17-201
and 20-17-215 define that declaration statute's terms and title.

Requirements one by one

A broad instruction may be oral, but the formal declaration is written

Under § 20-6-103(a), an adult may give an oral or written individual
instruction and may make it effective only if a stated condition arises. That
route is broader than the declaration statute's optional forms.

For the formal declaration, § 20-17-202(a) requires a person of sound mind
who is at least 18. The declarant signs, or another person signs at the
declarant's direction. The optional forms cover terminal condition and permanent
unconsciousness separately and include a signature date and address.

Post-2017 declarations use a notary or the qualified-witness route

A declaration made on or after July 1, 2017 may be notarized without two
witnesses or satisfy the Arkansas Healthcare Decisions Act (§ 20-17-202(a)(3)).
Under § 20-6-103(c), the witnessed route uses two competent adult witnesses,
neither of whom is the agent. At least one must be unrelated by blood, marriage,
or adoption and not entitled to inherit from the declarant, and a witnessed
directive carries an attestation clause. The optional declaration forms use the
same two-witness structure and refer to the appointed person as a health-care
proxy.

Two physicians make the declaration operative

Under § 20-17-203, the declaration becomes operative after it is communicated
to the attending physician and the attending physician plus another physician
determine either that the declarant has a terminal condition and can no longer
decide about life-sustaining treatment, or that the declarant is permanently
unconscious. § 20-17-205 then requires the attending physician to record the
condition finding and the declaration's terms in the medical record.

The two alternatives are not identical. Terminal condition requires the extra
inability-to-decide finding. Permanent unconsciousness is itself the alternative
operative condition stated in § 20-17-203.

Nutrition, hydration, and comfort are separate choices

The § 20-17-202 forms allow a direct withholding-or-withdrawal instruction or
a direction to follow a named proxy's decision. They also list separate choices
for whether nutrition may be withheld and whether hydration may be withheld.
Signing a direction about other life-sustaining treatment does not silently
answer either feeding question.

Under § 20-17-204(a), a patient's request for nutrition or hydration must be
honored, but artificial means that require inserting apparatus into the body
need not be used unless the patient specifically requests artificial means.
§ 20-17-206(b) preserves treatment, including nutrition and hydration, for
comfort, care, or pain alleviation.

What trips people up

• Pregnancy suspends the formal declaration under the statute's own test.
  Under § 20-17-206(c), a known pregnant qualified patient's declaration is
  not given effect while it remains possible that continued life-sustaining
  treatment could allow the fetus to develop to live birth. The form cannot
  replace that statutory rule with a different election.
• The declaration's revocation rule does not require capacity. § 20-17-204
  allows revocation anytime and in any manner regardless of mental or physical
  condition. It becomes effective when the declarant or a witness communicates
  it to the attending physician or another provider, who must add it to the
  medical record.
• A provider may use the Act's refusal-and-transfer process. § 20-17-207
  imports the Arkansas Healthcare Decisions Act's compliance rules. Under
  § 20-6-109, conscience, a timely communicated institutional conscience
  policy, or medically inappropriate care may support refusal; the provider or
  institution must give prompt notice, continue care during the transfer effort,
  and make reasonable transfer efforts unless assistance is refused.

Common questions

Does an Arkansas declaration need both witnesses and a notary?
No. For a declaration made since July 1, 2017, notarization without two witnesses
is one route. A Healthcare Decisions Act-compliant two-witness execution is the
other (§ 20-17-202(a)(3)).

Can I state treatment wishes orally?
Yes, as a broader individual instruction under § 20-6-103(a). The narrower
terminal-condition or permanent-unconsciousness declaration under § 20-17-202
is a written document with its own execution rules.

Can I change my declaration after losing capacity?
The formal declaration statute says it may be revoked at any time and in any
manner without regard to mental or physical condition. The revocation takes
effect when it is communicated to the attending physician or another provider
by the declarant or a witness (§ 20-17-204).

Will Arkansas recognize a declaration signed elsewhere?
Yes. § 20-17-212 recognizes a declaration executed in another state if it
complied with that state's law or Arkansas law. The broader advance-directive
recognition rule appears in § 20-6-103(h).

Statutes and sources

• Ark. Code §§ 20-17-201 and 20-17-215 — key definitions and the Act's
  title. Official Act 713 of 1987 (accessed 2026-07-31).
• Ark. Code § 20-17-201(2) — declaration is a writing and an advance
  directive under the Healthcare Decisions Act. Official Act 974 of 2017
  (accessed 2026-07-31).
• Ark. Code § 20-6-103(a), (c) and (h) — oral or written individual
  instruction; notary-or-witness execution; foreign-directive recognition.
  Official Act 974 of 2017 (accessed 2026-07-31).
• Ark. Code § 20-17-202 — declarant, signature, post-2017 validity routes,
  optional forms, medical-record placement, and evidentiary effect. Official
  Act 974 of 2017 (accessed 2026-07-31).
• Ark. Code §§ 20-17-203 and 20-17-205 — operative medical findings and
  record notation. Official Act 1536 of 1999 (accessed 2026-07-31).
• Ark. Code § 20-17-204 — revocation and patient requests for nutrition or
  hydration. Official Acts 713 of 1987 and 1322 of 2003 (accessed 2026-07-31).
• Ark. Code § 20-17-206 — comfort care and pregnancy. Official Acts 713 of
  1987 and 1322 of 2003 (accessed 2026-07-31).
• Ark. Code §§ 20-17-207 and 20-6-109 — compliance, refusal, continuing
  care, and transfer. Official Acts 974 of 2017 and 1264 of 2013 (accessed
  2026-07-31).
• Ark. Code §§ 20-17-208, 20-17-210 and 20-17-212 — immunity, limits, and
  out-of-state declarations. Official Act 713 of 1987 (accessed 2026-07-31).