Default Health-Care Surrogate Priority in Nebraska

At a glance

Requirements one by one

When the default route opens

The Health Care Surrogacy Act defines an adult as 19 or older and also covers an emancipated minor (§ 30-603(1), (13)). A surrogate may act when the primary health care provider determines the individual incapable and no agent or guardian has been appointed (§ 30-604(1)). The determination must be written, with the cause and nature documented in the medical record; a physician designated as surrogate cannot make that determination (§ 30-606). A later decision ordinarily requires the provider to confirm in writing that incapability continues (§ 30-611).

Care or setting covered

The act covers decisions about physical or mental health care, including providers, facilities, services, procedures, medications, and nutrition (§ 30-603(7)–(11)). It does not confine the initial surrogate route to one kind of facility. A transfer to another health care facility ends the existing surrogate's authority under § 30-604(6)(d), so authority must be assessed again there.

Family and other eligible people

An individual may designate a natural person as surrogate by personally informing the primary provider (§ 30-604(2)(a)). Without a designation, agent, or guardian, the family classes run in this order: spouse unless legally separated or divorce, annulment, or separation proceedings are pending; adult or emancipated child; parent; then adult or emancipated sibling (§ 30-604(2)(b)). A higher-priority person may decline by telling the provider, who records it. A person who has shown special care and concern, knows the individual's values, and is reasonably available is also eligible under subsection (2); subsection (3) does not assign that person a numbered family rank (§ 30-604(2)(c), (3)).

Decision within one class

If multiple people in one class agree, each claiming authority must sign and date a writing attesting to agreement for the medical record. If they disagree, they must confer to seek consensus; the provider may convene a meeting and ask other providers or an ethics committee to help. If timely consensus fails, the disagreeing claimants are disqualified and the provider may consult other people in that class or lower-priority classes (§ 30-604(5)). The operative test is timely consensus among those claiming authority.

Who is available and eligible

“Reasonably available” means reachable without undue effort and willing and able to act in time for the person's care (§ 30-603(21)). The provider may disqualify an otherwise eligible person on documented or otherwise clear and convincing evidence of abuse or failure to act for the patient's interests and must record that evidence (§ 30-604(2)(d)). The individual can disqualify a candidate through a signed, dated writing or by personally telling the provider and a qualified witness. The provider may require a declaration under penalty of perjury establishing claimed authority (§ 30-604(7)–(8)). An unrelated owner, operator, or employee of a treating or specified state institution cannot serve (§ 30-605).

Decisions limited or excluded

The surrogate consults medical personnel and follows the person's instructions and known wishes; if these cannot reasonably be ascertained, the surrogate uses best interests with regard to known religious and moral beliefs (§ 30-610(1)). Section 30-609(1) excludes acts the person could not authorize and certain decisions involving a known pregnancy. Withholding or withdrawing a life-sustaining procedure or artificial nutrition or hydration requires the specific terminal-condition or persistent-vegetative-state, disproportionate-treatment, and explicit-grant findings in § 30-610(2), with the person's intent established by clear and convincing evidence. Comfort care and usual oral nutrition and hydration cannot be withheld or withdrawn by the surrogate (§ 30-610(3)).

No surrogate or disputed authority

If no other eligible person is reasonably available after a consensus failure, the primary provider may take or decline action consistent with the act, the person's known values and beliefs, and best interests (§ 30-604(5)(v)). A dispute about incapability can go to county court with a guardian ad litem and the statutory hearing schedule (§ 30-608). The county court may also determine whether surrogate authority continues or whether proposed acts match the person's wishes or interests; § 30-613 identifies who may petition (§ 30-612).

What trips people up

A provider's determination that the person is incapable of one health care decision does not establish incapability for other purposes (§ 30-604(1)). The person’s own objection to an incapability finding or surrogate decision prevails unless a county court determines incapability (§ 30-609(5)).

Common questions

Can one adult child outvote another?

The act calls for a signed common decision if they agree. If they disagree, they and the provider seek consensus. If timely consensus fails, the disagreeing children lose authority for that decision and the provider may ask others in that class or a lower class (§ 30-604(5)).

Does a prior directive lose effect when a surrogate is chosen?

No. Surrogate authority does not supersede another advance health care directive (§ 30-604(9)).

Statutes and sources

• Neb. Rev. Stat. §§ 30-603–606, 30-608–613 — Health Care Surrogacy Act definitions, priority, disqualification, capacity, decision limits, and court review: https://nebraskalegislature.gov/laws/display_html.php?begin_section=30-601&end_section=30-619 (accessed 2026-10-08). The statute entries above link each current section.