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Nebraska Advance Directive
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Nebraska Advance Directive

Nebraska spreads advance directives across four separate acts, sets two different minimum ages, and names a decision maker for anyone who signed nothing.

By Settled Editorial

A Nebraska advance directive is four documents spread across four acts. The power of attorney for health care names an agent. The declaration under the Rights of the Terminally Ill Act writes down instructions about life-sustaining treatment. The Health Care Surrogacy Act supplies a decision maker when you named nobody. The Advance Mental Health Care Directives Act covers psychiatric treatment and outranks the others on that subject.

Every section quoted on this page was read at the Nebraska Legislature's own statute pages on September 10, 2026, and each one is cited where it appears. Read this as a plain-language map of those four acts, then have a Nebraska attorney draft or review what you sign. This is general information about Nebraska law rather than advice about your situation.

One fact shapes everything else on this page. A Nebraskan who signed nothing still has a statutory decision maker. Neb. Rev. Stat. 30-604 hands authority to a spouse, then an adult child, then a parent, then an adult sibling, with no court order and no guardianship. Nebraska wrote that ladder into statute in 2018, by Laws 2018, LB104. What it charges for the convenience is control, because the ladder runs in a fixed order and signing your own document is the only way to change it.

Four Acts, and a Fifth Route With Nothing to Sign

InstrumentStatuteSigning ruleWhat switches it on
Power of attorney for health careNeb. Rev. Stat. 30-3401 to 30-3432Two adults 18 or older, or acknowledgment before a notaryA written determination that the principal is incapable
Declaration, the Nebraska living willNeb. Rev. Stat. 20-401 to 20-416Two adults 19 or older, or a notary acting as witnessThe four conditions of Neb. Rev. Stat. 20-405, including notice to family
Advance mental health care directiveNeb. Rev. Stat. 30-4401 to 30-4415Two disinterested adults, or signing before a notaryLoss of capacity, unless the directive sets its own standard
Surrogate under the Health Care Surrogacy ActNeb. Rev. Stat. 30-601 to 30-619Nothing to signA provider finds the individual incapable and no agent or guardian exists
Individual instructionNeb. Rev. Stat. 30-603(14)Nothing to signWhenever a surrogate knows what you wanted

Nebraska defines the umbrella phrase in its own code, which saves an argument later. Neb. Rev. Stat. 30-603(2) says an advance health care directive means an individual instruction under the Health Care Surrogacy Act, a declaration executed in accordance with the Rights of the Terminally Ill Act, or a power of attorney for health care. Three of the four instruments sit inside that one definition.

The acts arrived in three waves. The living will and the health care agent both landed in 1992, by Laws 1992, LB 671 and Laws 1992, LB 696. The Health Care Surrogacy Act followed twenty-six years later by Laws 2018, LB104. The mental health directive is the newest, by Laws 2020, LB247. Nebraska never merged them, and no section of any of the four acts names a uniform act, so a single combined advance directive downloaded off a form site will not match the structure Nebraska's code expects.

Nebraska Names Someone Even If You Sign Nothing

A surrogate may act once two conditions are met together. Neb. Rev. Stat. 30-604(1) asks that the individual has been determined incapable by the primary health care provider, and that no agent and no guardian has been appointed. A determination of incapability for a health care decision is not a finding of incapacity for anything else.

The order in Neb. Rev. Stat. 30-604(2)(b) is short:

  1. The individual's spouse, unless legally separated or unless proceedings are pending for divorce, annulment or legal separation.
  2. A child of the individual who is an adult or an emancipated minor.
  3. A parent of the individual.
  4. A brother or sister of the individual who is an adult or an emancipated minor.

The ladder stops at siblings. No grandparent class, no adult grandchild class, no next-of-kin catch-all. Every candidate must also be reasonably available at the moment the decision is due, which Neb. Rev. Stat. 30-603(21) defines as readily able to be contacted without undue effort and willing and able to act in a timely manner considering how urgent the care is.

One subsection sits outside that list and deserves quoting rather than paraphrasing. Neb. Rev. Stat. 30-604(3) provides that a person who has exhibited special care and concern for the individual, who is familiar with the individual's personal values, and who is reasonably available to act as a surrogate is eligible to act as a surrogate under subsection (2) of this section. The sentence gives that person no rank inside the four classes and does not say it creates a fifth one. A close friend is eligible in Nebraska. Where the friend stands against a sibling is a question the statute leaves open.

You can also skip the ladder without a lawyer. Neb. Rev. Stat. 30-604(2)(a) lets you designate a natural person as surrogate by personally informing the primary health care provider. No writing, no witness, no notary. A designation made that way displaces the four default classes, because those classes apply only where an individual has not designated a surrogate. The mirror-image power sits in the same section: Neb. Rev. Stat. 30-604(7)(a) lets you disqualify someone, family included, by a signed and dated writing or by telling the provider in front of a qualifying witness. The practical check on an oral designation is Neb. Rev. Stat. 30-604(8), which lets a provider demand a written declaration under penalty of perjury from anyone claiming the role.

Two more sections keep the surrogate honest. A provider may disqualify an otherwise eligible person on documented or otherwise clear and convincing evidence of an abusive relationship, or of another basis for finding the person is not acting in the individual's best interests, and that evidence goes in the medical record under Neb. Rev. Stat. 30-604(2)(d). Under Neb. Rev. Stat. 30-605, an owner, operator or employee of the facility where the individual lives or is being treated may not serve unless related by blood, marriage or adoption.

Nebraska also answers the family argument in the statute rather than leaving it to a hospital policy. Where several members of one class hold authority, Neb. Rev. Stat. 30-604(5)(a) lets them all act so long as they agree and attest to the agreement in a writing signed and dated by every one of them. Where they disagree, Neb. Rev. Stat. 30-604(5)(b) runs an escalation: the claimants confer, the provider seeks consensus and may convene a meeting, an ethics committee may be brought in, and if consensus still cannot be reached in time, every claimant in that class is deemed disqualified and the provider moves down. If nobody is reasonably available at all, subdivision (5)(b)(v) lets the provider take or decline to take the actions it determines appropriate, in line with the individual's values and beliefs where known.

Surrogate authority is temporary by design. Under Neb. Rev. Stat. 30-604(6) it ends when a guardian is appointed, when the provider finds the individual capable again, when a higher-priority person becomes reasonably available, on transfer to another facility, or on death.

Two Minimum Ages, and the Gap Is One Year

Nebraska's general age of majority is nineteen. Neb. Rev. Stat. 43-2101(1) says so, and marriage ends minority early. Two of the three signed instruments follow that number and one does not.

  • Living will: nineteen. Neb. Rev. Stat. 20-403(1) defines an adult as any person nineteen or older or who is or has been married.
  • Mental health directive: nineteen. Neb. Rev. Stat. 30-4404(4) defines a principal as an individual nineteen years of age or older with capacity.
  • Health care power of attorney: eighteen. Neb. Rev. Stat. 30-3402(1) defines an adult for that act as any person who is eighteen years of age or older or is not a minor.

So an eighteen-year-old Nebraskan can appoint a health care agent and cannot sign a declaration. For a family sending a freshman to Lincoln or Omaha, the agent document is the one the statute already lets an eighteen-year-old sign.

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Signing the Health Care Agent Document: Five Requirements

Neb. Rev. Stat. 30-3404 reads as an and-list of five items with a choice buried in the last one. The power of attorney for health care shall:

  1. Be in writing.
  2. Identify the principal, the attorney in fact and the successor attorney in fact, if any.
  3. Specifically authorize the attorney in fact to make health care decisions on the principal's behalf if the principal is incapable.
  4. Show the date of its execution.
  5. Be witnessed and signed by at least two adults, each of whom witnesses either the signing and dating by the principal or the principal's acknowledgment of the signature and date, or be signed and acknowledged by the principal before a notary public who is not the attorney in fact or successor attorney in fact.

Item four is a hard statutory element. An undated Nebraska health care power of attorney does not comply, and no amount of witnessing fixes it. Item five gives two routes rather than one: a notarized document with no witness signatures complies, and so does a witnessed document no notary ever saw. Read the witness route closely too, because each witness may witness an acknowledgment rather than the signing itself, so the document can be signed first and witnessed later.

Who may not witness it, under Neb. Rev. Stat. 30-3405(1)(a): the principal's spouse, parent, child, grandchild, sibling, presumptive heir, known devisee, attending physician, mental health treatment team member, romantic or dating partner, or attorney in fact, and any employee of a life or health insurance provider for the principal. Subdivision (1)(b) then allows no more than one witness to be an administrator or employee of a health care provider caring for or treating the principal. The romantic partner bar and the treatment team bar arrived with Laws 2020, LB247, section 17, so a Nebraska form printed before 2020 will not list them.

Each witness also signs a written declaration in substantially the form printed at Neb. Rev. Stat. 30-3408, which has the witness state that the principal is personally known to them, signed or acknowledged the signature in their presence, appears of sound mind and free of duress or undue influence, and that neither witness nor the attending physician is the attorney in fact.

Four people are barred from serving as agent under Neb. Rev. Stat. 30-3406: the attending physician or a member of the principal's mental health treatment team; an employee of either, where unrelated to the principal by blood, marriage or adoption; an owner, operator or employee of a health care provider where the principal is a patient or resident, on the same relation test; and anyone unrelated to the principal who already serves as attorney in fact for ten or more principals.

Signing the Living Will: Two Adults or One Notary

Neb. Rev. Stat. 20-404(1) states the whole rule in three sentences. An adult of sound mind may execute a declaration governing the withholding or withdrawal of life-sustaining treatment. The declaration must be signed by the declarant or another person at the declarant's direction, and witnessed by two adults or a notary public. No more than one witness may be an administrator or employee of a health care provider caring for or treating the declarant, and no witness may be an employee of a life or health insurance provider for the declarant.

Three differences from the agent document catch Nebraskans out.

The notary here acts as a witness. The statute writes "witnessed by two adults or a notary public", and the final sentence of the subsection exempts a notary public from the restrictions on who may witness. The health care power of attorney runs the opposite structure, where the notary takes an acknowledgment of the principal's signature.

Somebody else may sign it for you. Neb. Rev. Stat. 20-404(1) allows signature by another person at the declarant's direction. The health care power of attorney has no such provision.

Nothing in the statute requires a date. The optional form at Neb. Rev. Stat. 20-404(2) prints a date line, and dating a document you may rely on twenty years later is obviously sensible, but the operative sentence asks only for signature and witnessing. That is the reverse of the agent document, where the date is requirement four.

The witness bar is also shorter here, and copying the other list across is a mistake. The Rights of the Terminally Ill Act does not disqualify a spouse, a relative, an heir or a devisee from witnessing a declaration. Only the two health-provider and insurance restrictions apply.

The statutory declaration form at Neb. Rev. Stat. 20-404(2) runs one paragraph, and the act says a declaration may, but need not, use it. Compliance is measured against subsection (1), not against the form.

The Mental Health Directive Has the Strictest Signing Rule

Neb. Rev. Stat. 30-4405(1) asks for five things. The directive shall be in writing; be dated and signed by the principal, or by another individual acting at the principal's direction where the principal is physically unable to sign, and never by the attorney in fact; state whether the principal wants to be able to revoke it at any time or whether it stays irrevocable during periods of incapacity; state that the principal is aware of its nature and signs freely and voluntarily; and either be signed in the presence of a notary public who is not the attorney in fact, or be witnessed in writing by at least two disinterested adults.

Failing to say whether it is revocable does not sink it. Under the same subsection, a directive that does not say is revocable at any time.

Two rules make this the tightest of the three regimes. Both witnesses must be disinterested, where the health care power of attorney allows one facility employee. The bars at Neb. Rev. Stat. 30-4405(4) rule out the attending physician or a mental health treatment team member, the principal's spouse, parent, child, grandchild, sibling, presumptive heir or known devisee, a romantic or dating partner, the attorney in fact or anyone designated to make mental health decisions, and the owner, operator, employee or a relative of an owner or operator of a treatment facility where the principal is receiving care.

And remote witnessing is off the table for this document. Neb. Rev. Stat. 30-4405(5)(a) makes each witness attest that the witness was present when the principal signed. The witness also attests that the principal did not appear incapacitated or under undue influence or duress, and that the principal presented identification or was personally known to the witness.

Whether an online notarization satisfies any of the three notary routes is an open question in Nebraska, and this page will not guess at it. The Online Notary Public Act authorizes an online notary to take acknowledgments, jurats, verifications or proofs, and oaths or affirmations under Neb. Rev. Stat. 64-408, and Neb. Rev. Stat. 64-402 defines the technology for a signer who is not in the physical presence of the notary. No section read here says whether that reaches Neb. Rev. Stat. 30-3404(5), Neb. Rev. Stat. 20-404(1) or Neb. Rev. Stat. 30-4405(1)(e)(i). The living will is the hardest case of the three, because there the notary acts as a witness and Neb. Rev. Stat. 64-408 lists no witnessing function. Ask a Nebraska attorney before signing any of the three at a webcam.

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Nothing Happens Until a Doctor Writes It Down

Signing a Nebraska health care power of attorney does nothing on its own. Neb. Rev. Stat. 30-3411 starts the agent's authority only on a determination that the principal is incapable, made under Neb. Rev. Stat. 30-3412. That determination must be made in writing by the attending physician and any physician consulted about it, must document the cause and nature of the incapacity, and goes into the medical record. A physician who has been named as the principal's attorney in fact may not make it.

Read the wording rather than the folklore. Nebraska asks for the attending physician plus any physician consulted, so one attending physician suffices where nobody else was consulted. A principal who wants the two-doctor rule writes it in, and the statutory form at Neb. Rev. Stat. 30-3408(1) carries a line for exactly that.

Incapable means the inability to understand and appreciate the nature and consequences of health care decisions, including their benefits, risks and alternatives, or the inability to communicate an informed health care decision in any manner. That is Neb. Rev. Stat. 30-3402(7).

Notice goes out under Neb. Rev. Stat. 30-3413 to the principal where there is any sign of ability to understand it, to the attorney in fact and to the health care provider. The agent then notifies the most proximate next of kin under Neb. Rev. Stat. 30-3414. Before acting on any later decision, the attending physician confirms in writing, in the medical record, that the principal is still incapable, and Neb. Rev. Stat. 30-3419(2) shuts the authority off again if the principal recovers.

The living will runs on a different switch, and its fourth condition is the one nobody expects. Neb. Rev. Stat. 20-405 makes a declaration operative only when all four of these have happened: it is communicated to the attending physician; the attending physician determines the declarant is in a terminal condition or in a persistent vegetative state; the attending physician determines the declarant is unable to make decisions about life-sustaining treatment; and the attending physician has notified a reasonably available member of the declarant's immediate family or guardian of the diagnosis and of the intent to invoke the declaration. That is a notice condition on operativeness. The relative gets told, and gets no veto.

The surrogate track mirrors the agent track. Neb. Rev. Stat. 30-606 requires a written incapability determination by the primary health care provider and any physician consulted, with the surrogate's identity recorded alongside it, and bars a physician who has been designated surrogate from making the call. Neb. Rev. Stat. 30-611 requires written confirmation before each later decision.

What the Living Will Actually Reaches

Two conditions, and the second one is easy to miss. A declaration reaches a terminal condition and a persistent vegetative state, so a Nebraskan who is not dying can still be covered. Neb. Rev. Stat. 20-403(6) defines the persistent vegetative state as a total and irreversible loss of consciousness and capacity for cognitive interaction with the environment, with no reasonable hope of improvement.

What may be withheld is narrow. Neb. Rev. Stat. 20-403(5) defines life-sustaining treatment as a medical procedure or intervention that, administered to a qualified patient, will serve only to prolong the process of dying or maintain the patient in a persistent vegetative state. Neb. Rev. Stat. 20-408(2) then preserves treatment, nutrition and hydration included, given for comfort care or to alleviate pain. Comfort measures never sit inside the choice.

Terminal condition is defined three times in Nebraska, differently, and quoting the wrong one is a factual error.

ActSectionThe test
Rights of the Terminally Ill ActNeb. Rev. Stat. 20-403(11)Death within a relatively short time, in the attending physician's opinion, without life-sustaining treatment
Power of attorney for health careNeb. Rev. Stat. 30-3402(14)Death regardless of continued treatment, with no time limit stated
Health Care Surrogacy ActNeb. Rev. Stat. 30-603(24)Death within six months regardless of continued treatment

The same patient can be terminal under one Nebraska act and not under another. Anyone drafting or reading a Nebraska document should name the act as well as the condition.

While you can still speak, you decide. Neb. Rev. Stat. 20-408(1) lets a qualified patient make decisions about life-sustaining treatment for as long as the patient is able to do so, and the paper waits.

Life Support and Feeding Tubes Need Their Own Sentence

Nebraska splits nutrition and hydration in two, and the split turns on one definition. The usual and typical provision of nutrition and hydration means delivery of food and fluids orally, including by cup, eating utensil, bottle or drinking straw. That wording appears at Neb. Rev. Stat. 30-3402(15) and again word for word at Neb. Rev. Stat. 30-603(25).

Oral feeding is then walled off at every level. It is carved out of the definition of a health care decision at Neb. Rev. Stat. 30-3402(5). An attorney in fact has no authority to withhold or withdraw consent to it under Neb. Rev. Stat. 30-3418(3), and a surrogate has none under Neb. Rev. Stat. 30-610(3). Signing a power of attorney does not waive the right to it under Neb. Rev. Stat. 30-3426, and the existence of a surrogate does not waive it under Neb. Rev. Stat. 30-615. No Nebraska document reaches it.

Artificially administered nutrition and hydration is the separate question, and it travels with life-sustaining procedures. For an agent, Neb. Rev. Stat. 30-3418(2) removes the authority to consent to withholding or withdrawing either one unless both of these hold: the principal is suffering from a terminal condition or is in a persistent vegetative state, and the document explicitly grants the authority or the principal's intent is established by clear and convincing evidence.

For a surrogate the test is longer. Neb. Rev. Stat. 30-610(2) asks for a terminal condition or persistent vegetative state, plus a finding that the procedure or care would be an extraordinary or disproportionate means of treatment, plus an explicit grant of authority by the individual, plus clear and convincing evidence of intent. Every element has to be present at once, which is why a Nebraskan with strong views about a ventilator or a feeding tube should write them into a signed document rather than rely on a surrogate to carry them.

A related definition keeps comfort care out of reach. Neb. Rev. Stat. 30-3402(8) says a life-sustaining procedure does not include routine care necessary to maintain patient comfort or the usual and typical provision of nutrition and hydration.

Pregnancy Suspends One Document and Narrows Two Others

Nebraska carries three pregnancy provisions in three acts, worded differently. Quoting one for another gets the law wrong.

  • Living will, Neb. Rev. Stat. 20-408(3). Life-sustaining treatment may not be withheld or withdrawn under a declaration from an individual known to the attending physician to be pregnant, so long as it is probable that the fetus will develop to the point of live birth with continued application of life-sustaining treatment.
  • Health care agent, Neb. Rev. Stat. 30-3417(1)(b). The attorney in fact has no authority to make any decision, when the principal is known to be pregnant, that will result in the death of the unborn child where it is probable the unborn child will develop to the point of live birth with continued health care.
  • Surrogate, Neb. Rev. Stat. 30-609(1)(b). The same wording, applied to the surrogate.

The living-will version suspends the document. The other two remove authority over a class of decisions and leave the rest of the document standing. All three turn on the probability of live birth rather than being absolute, and none of them names a gestational threshold.

The Mental Health Directive Can Bind Your Future Self

This act inverts the logic of the other three, on purpose. The legislative findings at Neb. Rev. Stat. 30-4402 record that an acute mental health episode can produce a refusal of care the same person would not make with unimpaired judgment.

So Nebraska lets a principal write a directive that is irrevocable during periods of incapacity under Neb. Rev. Stat. 30-4405(3), stated in the document itself. That is what makes the self-binding arrangement at Neb. Rev. Stat. 30-4408 work: advance consent that survives a later, illness-driven refusal takes two things together, an irrevocable directive and express consent to the specific treatment, whether inpatient admission or psychotropic medication. Neb. Rev. Stat. 30-4410(2) applies the same paired condition to an attorney in fact acting over an incapacitated principal's objection, and to electroconvulsive therapy.

The binding stops at capacity. Neb. Rev. Stat. 30-4411(1) says that despite activation, an advance mental health care directive, an irrevocable one included, shall not prevail over contemporaneous preferences expressed by a principal who has capacity.

Three other features have no analogue elsewhere in Nebraska law. The directive sets its own trigger if the principal wants: Neb. Rev. Stat. 30-4409(1) activates it on loss of capacity unless the principal designates otherwise, and subsection (2) lets the principal describe different circumstances. Consent to retention in a treatment facility runs to a maximum of twenty-one days on the face of the statutory form at Neb. Rev. Stat. 30-4415(1). And a principal may not consent to psychosurgery under Neb. Rev. Stat. 30-4406(2), though a clause attempting it does not void the rest of the directive.

Neb. Rev. Stat. 30-4406(1) lists what the directive can address: consent to or refusal of inpatient treatment, psychotropic medication and electroconvulsive therapy, named facilities, physicians and medications, emergency interventions including seclusion and restraint, trauma-informed care, people barred from visiting, and a HIPAA release authorization form naming who may receive information while the directive is activated.

Because the mental health directive may live inside a power of attorney for health care under Neb. Rev. Stat. 30-3408(5), a Nebraskan can carry one document and still get the priority rule below.

Which Document Wins

Nebraska states most of its hierarchy expressly, which spares families the argument. The ordinary chain of authority for health care runs: you, while capable; then the attorney in fact under a power of attorney for health care; then a court-appointed guardian; then a surrogate.

  • A power of attorney for health care supersedes any conflicting preexisting directive, and supersedes guardianship or conservatorship proceedings to the extent they involve the right to make health care decisions, unless the document says otherwise (Neb. Rev. Stat. 30-3420(5)).
  • A surrogate acts only where no agent and no guardian has been appointed (Neb. Rev. Stat. 30-604(1)), and a surrogate's authority never supersedes any other advance health care directive (Neb. Rev. Stat. 30-604(9)).
  • Guardianship law says the same thing from its own side. Neb. Rev. Stat. 30-2628(c) provides that nothing in that section alters the decisionmaking authority of an attorney in fact under a power of attorney for health care, and Neb. Rev. Stat. 30-2628(a)(3) makes a guardian consider and carry out the intent the ward expressed before incompetency.
  • The one override runs the other way. Where a power of attorney for health care and an advance mental health care directive conflict, the mental health directive controls on mental health instructions and preferences (Neb. Rev. Stat. 30-4411(2)), and it binds the attorney in fact (Neb. Rev. Stat. 30-4406(1)).
  • Your own objection outranks everyone until a judge says otherwise. Neb. Rev. Stat. 30-3417(5) and Neb. Rev. Stat. 30-609(5) both provide that where the person objects to the incapacity determination or to a decision made for them, that objection prevails unless a county court determines the person is incapable of making health care decisions.

Nebraska has no last-document-wins rule across instrument types. Neb. Rev. Stat. 30-3420(4) revokes a previously executed power of attorney for health care only, and Neb. Rev. Stat. 30-3420(5)(a) supersedes a conflicting preexisting directive, which runs one direction. A later living will does not override an earlier agent document, and a later agent document does not revoke an earlier living will. Two consequences follow: a stale Nebraska living will can still speak on the day it matters, and the mental health directive should be treated as the controlling document for psychiatric instructions no matter how broadly the health care power of attorney was drafted.

Writing separate wishes or limits also leaves the appointment intact. Under Neb. Rev. Stat. 30-3420(2), creating written wishes, instructions about health care or limits on the agent's authority does not revoke the power of attorney for health care unless the writing expressly says so.

No DNR Form, No POLST, No Registry

Three absences, and each was checked against the code rather than assumed. All four acts were read section by section, and the Legislature's own keyword search of the statutes was run against a term already known to be present and a term already known to be absent before either result below was believed.

  • No do not resuscitate statute of any kind. Nebraska has no out-of-hospital DNR form, no DNR order section, and no bracelet or medallion program. Searching the statutes for the word resuscitate returns three sections, and not one of them creates a directive a Nebraskan can sign.
  • No POLST or MOLST statute. No Nebraska act creates portable physician orders for life-sustaining treatment, and no agency is told to design such a form.
  • No advance directive registry. No act creates a filing with a court, the Secretary of State or the Department of Health and Human Services, and none directs an agency to keep a register.

What fills the first gap is the definition of a health care decision. Neb. Rev. Stat. 30-603(8)(b)(ii) puts approval or disapproval of orders not to resuscitate inside that definition, so an agent under Neb. Rev. Stat. 30-3417, a guardian under Neb. Rev. Stat. 30-2628(a)(3) or a surrogate under Neb. Rev. Stat. 30-609 can approve or disapprove one as ordinary care. The Legislature has assumed the same elsewhere: Neb. Rev. Stat. 83-4,157(6)(n) tells the Department of Correctional Services medical director to write protocols for do not resuscitate orders initiated under the Rights of the Terminally Ill Act, even though that act never uses the word.

What fills the registry gap is the medical record. A declaration furnished to a provider becomes part of the declarant's record under Neb. Rev. Stat. 20-404(3). A power of attorney for health care becomes part of the record once its existence is known under Neb. Rev. Stat. 30-3409. Incapability determinations, revocations and disqualifications are recorded the same way. A Nebraska document nobody hands to the treating provider is invisible, because there is no central place to look one up. Neb. Rev. Stat. 30-3417(6) sharpens the point: no provider is required to accept decisions from an attorney in fact until it has received a signed original or a photostatic copy of one.

One limit is worth stating plainly. These are absences from the Nebraska Revised Statutes. A protocol created by state regulation rather than by statute would sit outside them, so a Nebraskan who wants paramedics to honor a decision at home should ask the local emergency medical service what it accepts rather than rely on a form.

Revoking Any of Them

The living will is the easiest document in Nebraska to revoke, by a wide margin. Neb. Rev. Stat. 20-406(1) lets a declarant revoke at any time and in any manner without regard to mental or physical condition, and the revocation takes effect on communication to the attending physician or other provider, by the declarant or by a witness to the revocation. The provider then makes it part of the medical record.

Read the capacity clause twice, because it runs backwards from the execution rule. Signing a declaration takes an adult of sound mind. Revoking one takes nothing at all, so a declarant who could no longer make a declaration can still cancel the one already signed.

The health care power of attorney asks slightly more. Neb. Rev. Stat. 30-3420(1) lets a principal who is competent revoke the document, or a single decision the agent made, in any manner by which the principal can communicate the intent. It takes effect on communication to the attending physician, to the provider, or to the agent, and the last two must promptly tell the attending physician. Executing a valid new one revokes the old one under subsection (4), unless the new document says otherwise. A county court can revoke it under Neb. Rev. Stat. 30-3421(1) where the agent made or proposed a decision authorizing an illegal act, or failed or cannot perform the duty owed to the principal and the principal now lacks capacity to revoke.

The agent can also step out. Under Neb. Rev. Stat. 30-3407, an agent withdraws by notice to the principal while the principal is not incapable, and by notice to the health care provider once the principal is. The document ends when the principal dies, when it is revoked, or when the agent and every successor have withdrawn (Neb. Rev. Stat. 30-3410).

The mental health directive follows its own path. A principal may revoke even while incapacitated unless the directive was made irrevocable, and revocation runs by a written statement or by a later directive; where the later directive does not revoke the earlier one in full, only inconsistent provisions drop out (Neb. Rev. Stat. 30-4407(2) and (3)). Consenting to different treatment while you have capacity waives the inconsistent provision rather than cancelling the document (subsection (4)). A directive lasts until it expires by its own terms or is revoked, whichever comes first, and the statutory form invites the principal to write in an expiration date.

Good faith protects the people who acted before they heard. Neb. Rev. Stat. 30-3420(7) provides that an action taken in good faith and without actual knowledge of a revocation binds the principal and the principal's heirs, devisees and personal representatives, and Neb. Rev. Stat. 30-604(7)(b) gives a surrogate the same protection against an unknown disqualification.

Divorce Cuts the Spouse Out on the Decree

Nebraska states the rule rather than leaving it to inference, and the two acts answer it at different moments.

Under Neb. Rev. Stat. 30-3420(6), a decree of divorce or legal separation may specify whether the choice of the principal's spouse as attorney in fact is revoked or stays effective. Where the decree says nothing, the choice of the spouse is deemed revoked upon entry of the decree. Two points a Nebraskan needs. The default runs toward revocation, so keeping an ex-spouse in the role takes a decree that says so. And the trigger is entry of the decree, so a spouse named as agent keeps authority throughout a pending divorce.

The Health Care Surrogacy Act answers earlier. Under Neb. Rev. Stat. 30-604(2)(b)(i) the spouse class is unavailable where the couple is legally separated, or where proceedings for divorce, annulment or legal separation are merely pending. Filing is enough there.

The Nebraska power of attorney works on a third clock again, because the financial document is governed by a separate act with its own termination rules.

When a Provider Will Not Follow It

All three acts that create decision makers pair a conscience route with a duty to move the patient, and two of the three back that duty with a crime.

Under the Rights of the Terminally Ill Act, an attending physician or provider unwilling to comply must take all reasonable steps, as promptly as practicable, to transfer care of the declarant to someone willing (Neb. Rev. Stat. 20-409). Willful failure is a Class I misdemeanor under Neb. Rev. Stat. 20-411(1). Neb. Rev. Stat. 20-404(3) adds an earlier duty: a provider furnished a copy of a declaration who is unwilling to comply shall promptly say so.

Under the health care power of attorney act, an organization may refuse a decision that conflicts with a formally adopted policy expressly based on religious beliefs or sincerely held ethical or moral convictions central to its operating principles, where it has told the principal or the agent about the policy if that was reasonably possible. An individual provider may refuse on personal religious, moral or ethical grounds and must promptly tell the agent and the organization, which must then help arrange a transfer (Neb. Rev. Stat. 30-3428). Willfully preventing a transfer is a Class I misdemeanor under Neb. Rev. Stat. 30-3432(3). The Health Care Surrogacy Act repeats the structure at Neb. Rev. Stat. 30-617, with the same penalty at Neb. Rev. Stat. 30-619(3).

None of this asks a clinician to abandon judgment. Neb. Rev. Stat. 30-3427 and Neb. Rev. Stat. 30-616 both have the provider exercise the same independent medical judgment it would exercise in following a patient's own decision.

Nobody may make you sign, and nobody may make you refuse. Neb. Rev. Stat. 20-412(3) bars conditioning insurance or health care services on executing a declaration, and Neb. Rev. Stat. 20-411(5) makes doing it a Class I misdemeanor. Neb. Rev. Stat. 30-3429(1) and (2) do the same for the health care power of attorney and go further, barring an insurer or health plan from refusing, discontinuing, limiting or repricing coverage, or invoking a suicide exclusion, because someone executed one or declined to.

Two more sections stop an inference before it starts. An attempted suicide is not to be construed as any indication of a person's wishes about health care (Neb. Rev. Stat. 30-3431 and Neb. Rev. Stat. 30-618). And the fact that someone appointed nobody, or gave no instructions, creates no presumption about their wishes (Neb. Rev. Stat. 30-3430, with the matching rule for declarations at Neb. Rev. Stat. 20-412(4)).

Tampering Is a Felony When It Hastens a Death

The grading turns on effect. Under Neb. Rev. Stat. 30-3432(1), willfully signing or altering a power of attorney for health care without authority, or altering, forging, concealing or destroying one, or willfully concealing or destroying a revocation, is a Class II felony where it is done with the intent and effect of causing life-sustaining procedures or artificially administered nutrition or hydration to be withheld or withdrawn in a way that hastens the principal's death. Neb. Rev. Stat. 30-619(1) makes it a Class II felony to conceal or destroy evidence of a surrogate's disqualification with the same intent and effect.

Take the hastened death out and the grade drops. Altering, forging, concealing or destroying a power of attorney for health care or its revocation without the principal's authorization is a Class I misdemeanor under Neb. Rev. Stat. 30-3432(2), and doing the same to evidence of a directive, a guardian appointment, an agent appointment or a surrogate disqualification is one under Neb. Rev. Stat. 30-619(2). Willfully preventing a transfer is a Class I misdemeanor of its own again, under Neb. Rev. Stat. 30-3432(3) and Neb. Rev. Stat. 30-619(3).

The Rights of the Terminally Ill Act writes six Class I misdemeanors, one in each of Neb. Rev. Stat. 20-411(1) through (6): willfully failing to transfer a patient; willfully failing to record a determination or the terms of a declaration; concealing, cancelling, defacing or obliterating another person's declaration, or forging a revocation of it; falsifying or forging another person's declaration, or withholding personal knowledge of a revocation; requiring or prohibiting a declaration as a condition of insurance or care; and coercing or fraudulently inducing someone to sign one. Subsection (7) adds no seventh offense. It preserves whatever sanction other law already supplies.

There is also a civil door. Neb. Rev. Stat. 20-402(1) makes an unjustifiable violation of a patient's direction a cause of action maintainable by the patient or the patient's next of kin.

Providers who act in good faith are protected in all four acts, and three of the four say outright that the shield stops at negligence. Neb. Rev. Stat. 30-3423(2) for the agent and Neb. Rev. Stat. 30-614(2) for the surrogate each keep liability alive for a negligent act or omission in the medical diagnosis, treatment or care of the patient, and Neb. Rev. Stat. 30-4414(3) does the same for the mental health directive in wider terms, reaching the attorney in fact as well as the health care professional. The Rights of the Terminally Ill Act carries no such sentence: Neb. Rev. Stat. 20-410 shields a provider who gives effect to a declaration without knowing of a revocation, and shields action taken in accord with reasonable medical standards, and it says nothing either way about negligence. Providers may also assume a document is what it looks like until told otherwise, under Neb. Rev. Stat. 30-3425 and Neb. Rev. Stat. 20-413.

Older Documents and Documents From Another State

Both older-document rules run in the reader's favor, and the standards differ. An instrument executed anywhere before July 15, 1992 that substantially complies with Neb. Rev. Stat. 20-404(1) is effective under the Rights of the Terminally Ill Act (Neb. Rev. Stat. 20-415). A power of attorney for health care executed before January 1, 1993 is effective where it fully complies with Neb. Rev. Stat. 30-3404 (Neb. Rev. Stat. 30-3408(3)).

For out-of-state paperwork, two of the three instruments are recognized. Neb. Rev. Stat. 20-414 accepts a declaration executed in another state in compliance with the law of that state or of Nebraska. Neb. Rev. Stat. 30-3408(4) accepts a power of attorney for health care executed in another state and valid there, according to its terms, and Neb. Rev. Stat. 30-603(18) folds a designation under a similar law of another state into the surrogacy act's own definition. The Advance Mental Health Care Directives Act carries no recognition provision at all, so someone moving to Nebraska with psychiatric instructions should sign a Nebraska directive.

Organ donation sits in a fifth act again. The health care power of attorney ends at death under Neb. Rev. Stat. 30-3410, so the authority to make an anatomical gift comes from the Revised Uniform Anatomical Gift Act instead. Neb. Rev. Stat. 71-4832(a)(1) puts an agent of the decedent first in the ten-class priority, ahead of the spouse, adult children, parents and adult siblings. Where a directive's refusal of measures collides with the measures needed to keep an organ suitable, Neb. Rev. Stat. 71-4843(b) has the physician and the donor confer, then the agent or a surrogate, and if the conflict is not resolved expeditiously the direction of the declaration or directive controls.

Where Disputes Go: the County Court

Advance-directive disputes in Nebraska go to the county court of the county where the person resides or is located, rather than to the district court. That holds for a fight over incapacity under Neb. Rev. Stat. 30-3415 and Neb. Rev. Stat. 30-608, and for a petition about the instrument or the decision maker under Neb. Rev. Stat. 30-3421(2) and Neb. Rev. Stat. 30-612(2).

The incapacity track moves fast, and both acts set the same clock. The court appoints a guardian ad litem, holds a hearing within seven days of receiving the petition, and issues its determination within seven days of the hearing.

Standing is broad. Neb. Rev. Stat. 30-3422 and Neb. Rev. Stat. 30-613 both let the person, the agent or surrogate, a spouse, parent, sibling or adult child, a close adult friend, a guardian, the attending or primary health care provider or another provider, or any other interested party bring the petition.

Where a court does appoint a guardian, Nebraska prefers the smallest order that works. Neb. Rev. Stat. 30-2620(a) requires a limited guardianship unless clear and convincing evidence shows a full one is necessary, and the appointment priority at Neb. Rev. Stat. 30-2627(b) starts with the person the incapacitated person most recently nominated in a power of attorney, ahead of the spouse. That is one more reason to sign a document that names someone. Nebraska guardianship covers that court lane in full.

Where This Sits in a Nebraska Plan

Three documents cover most Nebraskans: a power of attorney for health care naming an agent, a declaration writing down what you want at the end, and a financial power of attorney under a separate act. Anyone with a psychiatric history should look hard at the fourth. Signing the health care agent document is the single change that moves the most, because it lifts a person of your choosing above the statutory ladder and above a guardianship.

Two habits are worth building in. Give a signed copy to the treating provider, since there is no registry to fall back on. And date every document, because the agent form fails without a date and a declaration is easier to trust with one.

For the rest of the document set, start with Nebraska estate planning basics. For what happens after a death rather than before one, start with the Nebraska probate guide.

Frequently Asked Questions

Does Nebraska have one advance directive form?

No. Nebraska runs health care planning through four separate acts. The power of attorney for health care at Neb. Rev. Stat. 30-3401 through 30-3432 names an agent. The declaration at Neb. Rev. Stat. 20-401 through 20-416 writes instructions about life-sustaining treatment. The Health Care Surrogacy Act at Neb. Rev. Stat. 30-601 through 30-619 supplies a decision maker when nobody was named. The Advance Mental Health Care Directives Act at Neb. Rev. Stat. 30-4401 through 30-4415 covers psychiatric treatment. Each act carries its own signing rule, its own trigger and its own definition of a terminal condition, so a Nebraskan who wants both instructions and a named agent signs at least two documents.

Who makes medical decisions in Nebraska if I never signed anything?

A statutory surrogate, with no court order. Neb. Rev. Stat. 30-604(1) lets a surrogate act once the primary health care provider determines the individual is incapable and no agent or guardian has been appointed. The default order in Neb. Rev. Stat. 30-604(2)(b) is spouse, then a child who is an adult or emancipated minor, then a parent, then a brother or sister who is an adult or emancipated minor. The ladder stops at siblings, with no grandparent, grandchild or next-of-kin class. Neb. Rev. Stat. 30-604(3) separately makes a person who has exhibited special care and concern for the individual, who knows the individual's personal values, and who is reasonably available eligible to serve, without giving that person a numbered rank.

Does a Nebraska health care power of attorney have to be notarized?

No, a notary is one of two routes. Neb. Rev. Stat. 30-3404(5) asks for the document to be witnessed and signed by at least two adults, each witnessing either the signing and dating by the principal or the principal's acknowledgment of the signature and date, or to be signed and acknowledged by the principal before a notary public who is not the attorney in fact or successor. That word or does real work: a notarized Nebraska document carrying no witness signatures complies, and so does a witnessed one no notary saw. Requirement (4) of the same section is the one people miss, because an undated document fails the statute outright.

Can an 18-year-old sign a Nebraska living will?

No, and the reason is that Nebraska carries two minimum ages. The general age of majority is nineteen under Neb. Rev. Stat. 43-2101(1). The Rights of the Terminally Ill Act follows it, because Neb. Rev. Stat. 20-403(1) defines an adult as a person nineteen or older or who is or has been married. The Advance Mental Health Care Directives Act follows it too at Neb. Rev. Stat. 30-4404(4). The power of attorney for health care reaches lower: Neb. Rev. Stat. 30-3402(1) defines an adult for that act as any person eighteen or older or who is not a minor. So an eighteen-year-old Nebraskan may appoint a health care agent and may not sign a declaration or a mental health directive.

Does a Nebraska advance directive cover mental health treatment?

Only a mental health directive does the whole job. The Advance Mental Health Care Directives Act, enacted by Laws 2020, LB247, creates a stand-alone instrument that can consent to or refuse inpatient treatment, psychotropic medication and electroconvulsive therapy under Neb. Rev. Stat. 30-4406(1). Two rules give it priority. Neb. Rev. Stat. 30-4411(2) makes the mental health directive control over a conflicting power of attorney for health care on any mental health instruction or preference, and Neb. Rev. Stat. 30-4406(1) makes it binding on the attorney in fact. A principal may not consent to psychosurgery at all under Neb. Rev. Stat. 30-4406(2).

Can a Nebraska agent stop a feeding tube?

Only on a conjunctive test, and never for food and fluids given by mouth. Neb. Rev. Stat. 30-3418(2) withholds that authority from an attorney in fact unless the principal is suffering from a terminal condition or is in a persistent vegetative state, and the document explicitly grants the authority or the principal's intent is established by clear and convincing evidence. Neb. Rev. Stat. 30-610(2) sets a longer version of the same test for a surrogate, adding that the care must be an extraordinary or disproportionate means of treatment. Oral feeding is walled off entirely: Neb. Rev. Stat. 30-3402(15) defines the usual and typical provision of nutrition and hydration as delivery of food and fluids orally, and Neb. Rev. Stat. 30-3418(3) and Neb. Rev. Stat. 30-610(3) leave nobody with authority to refuse it.

Does Nebraska have a DNR form or an advance directive registry?

No to both, as a matter of statute. No Nebraska section creates an out-of-hospital do not resuscitate form, a DNR order statute, a bracelet program or a POLST form, and no section creates a registry. An order not to resuscitate is treated as an ordinary health care decision instead, because Neb. Rev. Stat. 30-603(8)(b)(ii) puts orders not to resuscitate inside the statutory definition of a health care decision, so an agent, guardian or surrogate can approve or disapprove one. In place of a registry, Nebraska puts the paperwork in the medical record under Neb. Rev. Stat. 30-3409 and Neb. Rev. Stat. 20-404(3), which means a document nobody hands to the treating provider is invisible.

Is an advance directive from another state valid in Nebraska?

Two of the three are covered. Neb. Rev. Stat. 20-414 treats a declaration executed in another state in compliance with the law of that state or of Nebraska as valid for purposes of the Rights of the Terminally Ill Act. Neb. Rev. Stat. 30-3408(4) provides that a power of attorney for health care executed in another state and valid under the laws of that state is valid according to its terms. The Advance Mental Health Care Directives Act contains no recognition provision at all, so a mental health directive signed elsewhere has no Nebraska section behind it. New residents who care about psychiatric instructions should sign fresh Nebraska paperwork.

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Information current as of September 10, 2026

Settled Estate is not a law firm, and this content is for informational purposes only and does not constitute legal advice. Probate laws and procedures in Nebraska can change. Consult with a qualified attorney for advice specific to your situation. Full disclaimer.

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