A Nebraska living will — called a Declaration under the state’s Rights of the Terminally Ill Act — is a written document telling your doctors whether to continue or stop life-sustaining treatment if you develop a terminal condition or enter a persistent vegetative state and can no longer speak for yourself.1Nebraska Legislature. Nebraska Code 20-401 – Act, How Cited To make one that will actually be followed, you need to be an adult of sound mind, sign the document in front of either two qualified witnesses or a notary, and get a copy into your physician’s hands.
Who Can Sign One
You must be an adult of sound mind.2Nebraska Legislature. Nebraska Revised Statutes 20-404 – Declaration Relating to Use of Life-Sustaining Treatment One detail worth pausing on: Nebraska’s age of majority is 19, not 18.3Nebraska Legislature. Nebraska Revised Statute 43-2101 – Persons Under Nineteen Years of Age Declared Minors The statute uses “adult” without a separate definition, so the general rule governs. You can sign at any time — there’s no requirement to wait for a diagnosis or an admission to a hospital.
What the Declaration Actually Controls
A Nebraska living will applies in two situations and no others. The first is a terminal condition: an incurable, irreversible condition that your attending physician believes will cause death within a relatively short time absent life-sustaining treatment. The second is a persistent vegetative state, meaning total and irreversible loss of consciousness and the ability to interact with your environment, with no reasonable hope of improvement.4Nebraska Legislature. Nebraska Revised Statute 20-403 – Terms, Defined
Life-sustaining treatment under the Act is any medical procedure that would only prolong the dying process or keep you in a persistent vegetative state. The Declaration directs your physician to withhold or withdraw that treatment while explicitly preserving comfort care and pain relief. You are not refusing all medical care, only interventions that have no purpose beyond postponing death when recovery is impossible.
One important limit: if you are pregnant, life-sustaining treatment cannot be withheld or withdrawn under your Declaration if doing so would prevent the unborn child from developing to the point of live birth.5Nebraska Legislature. Nebraska Revised Statute 20-408 – Life-Sustaining Treatment, When Not Withheld or Withdrawn A Declaration will not control other medical decisions — surgery after an accident, treatment during a temporary incapacity — because those situations don’t involve a terminal diagnosis or PVS. For those gaps you need a healthcare power of attorney, discussed below.
Filling Out the Form
Nebraska includes a sample Declaration in the statute itself, and the Department of Health and Human Services publishes a printable version.6Nebraska Department of Health and Human Services. Nebraska Living Will Declaration You are not required to use that specific form. The statute says a Declaration “may, but need not” follow the sample language.2Nebraska Legislature. Nebraska Revised Statutes 20-404 – Declaration Relating to Use of Life-Sustaining Treatment
The statutory form is short and general. It directs your physician to stop life-sustaining treatment that is not necessary for comfort or pain relief, but it does not include checkboxes for specific interventions like CPR, mechanical ventilation, or artificial nutrition. Because the form is a floor rather than a ceiling, you can add detail: that you want pain medication even if it hastens death, for example, or that you accept hydration but not a ventilator. Talking through these choices with a physician before signing helps you understand what each intervention actually involves, and specific language reduces the chance of confusion during a crisis.
If you plan to be an organ donor, note it in your Declaration. Organ retrieval can require brief continuation of life-sustaining treatment after brain death, and a line consenting to short-term treatment for donation purposes keeps your two sets of wishes from colliding.
Signing: Witnesses or a Notary
You must sign the Declaration — or have someone else sign at your direction — in front of either two adult witnesses or a notary public.2Nebraska Legislature. Nebraska Revised Statutes 20-404 – Declaration Relating to Use of Life-Sustaining Treatment One or the other satisfies the statute. You don’t need both.
If you choose witnesses, Nebraska restricts who can serve. No more than one witness can be an administrator or employee of a healthcare provider currently caring for you, and no witness can be an employee of your life or health insurance provider. These restrictions exist to prevent conflicts of interest. They do not apply if you use a notary instead.
A notary is often the simpler path. The notary verifies your identity with a government-issued ID and applies the official seal. Standard Nebraska notary fees are modest, typically under $15 per signature. Either method produces an equally valid document.
When the Declaration Starts Controlling Your Care
Signing a Declaration doesn’t change anything about your care that day. It becomes operative only when four conditions are met at the same time:7Nebraska Legislature. Nebraska Revised Statutes 20-405 – When Declaration Operative
- Your attending physician has received the Declaration.
- Your physician has determined you have a terminal condition or are in a persistent vegetative state.
- Your physician has determined you can no longer make your own treatment decisions.
- Your physician has notified a reasonably available member of your immediate family, or your guardian, of both the diagnosis and the intent to follow the Declaration.
The first condition is the one you control. If no one on your medical team has a copy when a crisis hits, the document can’t do its job.
Getting It to the Right People
Distribution is what makes the Declaration legally functional. Give a copy directly to your primary care physician and to the hospital or system where you usually receive treatment. Any physician who receives a copy is required to make it part of your medical record.
Keep the original somewhere secure but accessible — a fireproof safe or a clearly labeled folder a family member can find quickly. Hand copies to close relatives and to anyone you have named as a healthcare agent under a separate power of attorney. A wallet card listing the location of your original and the people who hold copies adds an extra layer during emergencies. Digital storage services can serve as backup, but they do not substitute for physically giving your doctor a copy.
Changing Your Mind
You can revoke your Declaration at any time, in any manner, regardless of your mental or physical condition at that moment.8Nebraska Legislature. Nebraska Revised Statutes 20-406 – Revocation of Declaration Nebraska intentionally sets a low bar. You can destroy the document, write a new statement, or simply tell your doctor or another provider that you are revoking it. The revocation takes effect as soon as it reaches your attending physician or provider, who must then record the revocation in your medical record.
If you revoke verbally during a hospital stay, make sure someone present can confirm the communication to the medical team. After revoking, you can execute a new Declaration whenever you want.
If a Doctor Won’t Follow It
A physician who receives your Declaration must put it in your medical record, and must promptly tell you if they are unwilling to honor it. Once the Declaration is operative, a provider who won’t follow it has to arrange a transfer to one who will.7Nebraska Legislature. Nebraska Revised Statutes 20-405 – When Declaration Operative A provider who willfully fails to transfer you commits a Class I misdemeanor under the statute.9Nebraska Legislature. Nebraska Revised Statute 20-411 – Penalties
Separately, the Act gives you or your next of kin a civil cause of action for any unjustifiable violation of your written instructions, with remedies available in both law and equity.10Nebraska Legislature. Nebraska Revised Statute 20-402 – Statement of Policy The combination of criminal and civil enforcement means a provider cannot simply ignore the document.
Pair It With a Healthcare Power of Attorney
A Declaration tells your medical team what you want. A healthcare power of attorney names a specific person — your agent — to make decisions for you when you cannot.11Nebraska Legislature. Nebraska Revised Statute 30-3408 – Power of Attorney for Health Care Nebraska authorizes healthcare powers of attorney under a separate statute, and the two documents work best together.
The Declaration covers only terminal conditions and persistent vegetative states. A healthcare power of attorney can give your agent authority over any medical situation where you lack capacity. If you have only a Declaration and something happens that doesn’t qualify as terminal or PVS, no one has legal authority to speak for you. That gap is exactly what the power of attorney fills. Most Nebraska estate planning attorneys recommend executing both documents at the same time.
If You Live or Travel in More Than One State
No federal law requires states to honor each other’s advance directives. Many do, but coverage is uneven and the formalities vary. If you split time between states, the safer approach is to execute a separate advance directive that complies with the law of each state where you spend significant time. At a minimum, having both two qualified witnesses and a notary on your Nebraska Declaration — even though Nebraska treats them as alternatives — gives the document the best chance of being accepted elsewhere.