Nebraska: Living Will and Advance Health-Care Instruction Requirements

Nebraska's Rights of the Terminally Ill Act, §§ 20-401 and 20-403,
creates a standalone written declaration. It is separate from the health-care
power of attorney in §§ 30-3401–3432 and does not appoint an agent.

Requirements one by one

Nebraska uses age 19 and a narrow witness screen

An adult of sound mind may execute the declaration at any time. For this Act,
adult means age 19 or older, or a person who is or has been married
(§ 20-403(1)). The declarant signs or directs another person to sign.

Under § 20-404(1), two adult witnesses or a notary verifies the declaration.
No more than one witness may be an administrator or employee of a provider
caring for the declarant, and an employee of the declarant's life or health
insurer cannot witness. Those witness restrictions do not apply to the notary.
Unlike Nebraska's health-care-POA chapter, this declaration section states no
relative, heir, or medical-financial-responsibility witness bar.

Four events make the declaration operative

Under § 20-405, the declaration operates only after it reaches the attending
physician; that physician determines terminal condition or persistent vegetative
state; the physician also determines the declarant cannot decide about
life-sustaining treatment; and the physician notifies a reasonably available
immediate-family member or guardian of the diagnosis and intended invocation.

The Act uses one attending-physician determination. § 20-407 requires the
physician, after personal examination, to record the diagnosis, determination,
and declaration terms in writing in the medical record.

Comfort nutrition and hydration remains

The optional § 20-404 form directs withholding or withdrawal of
life-sustaining treatment that is not needed for comfort or pain relief. The
Act's definition includes procedures that only prolong dying or maintain the
qualified patient in a persistent vegetative state.

Nebraska does not print a separate artificial-nutrition-or-hydration election in
this form. § 20-408(2) instead preserves treatment, including nutrition and
hydration, for comfort care or pain alleviation.

If a provider gives effect to the declaration without knowledge of revocation or
acts consistently with reasonable medical standards, § 20-410 supplies the
Act's stated immunity.

What trips people up

• Family or guardian notice is part of the trigger. The attending physician
  must notify a reasonably available immediate-family member or guardian of the
  diagnosis and intent to invoke the declaration before it operates
  (§ 20-405).
• Pregnancy uses a probable-live-birth test. Under § 20-408(3),
  life-sustaining treatment may not be withheld or withdrawn under the
  declaration while continued treatment probably would allow the fetus to
  develop to live birth.
• Revocation needs no capacity or form. § 20-406 permits revocation
  anytime and in any manner regardless of mental or physical condition. It is
  effective when the declarant or a witness communicates it to the attending
  physician or another provider, who records it.

Common questions

Do I need both witnesses and a notary?
No. § 20-404(1) permits either two adult witnesses or a notary public.

Does the declaration cover persistent vegetative state?
Yes. It operates for either terminal condition or persistent vegetative state,
with the separate inability and family-notice findings in § 20-405.

Can I make a separate feeding-tube choice in the statutory form?
The statutory form does not print a separate artificial-feeding election.
§ 20-408(2) preserves nutrition and hydration when provided for comfort or
pain relief.

Will Nebraska recognize a declaration signed elsewhere?
Yes. A declaration compliant with the law of the other state or Nebraska is
valid under § 20-414.

Statutes and sources

• Neb. Rev. Stat. §§ 20-401 and 20-403 — Act title and definitions. Nebraska
  Legislature (accessed 2026-07-31).
• Neb. Rev. Stat. § 20-404 — execution, optional form, and medical-record
  handling. Same official source (accessed 2026-07-31).
• Neb. Rev. Stat. §§ 20-405 and 20-407 — operative trigger and written
  record. Same source (accessed 2026-07-31).
• Neb. Rev. Stat. § 20-406 — revocation. Same source (accessed 2026-07-31).
• Neb. Rev. Stat. § 20-408 — capable-patient decisions, comfort care, and
  pregnancy. Same source (accessed 2026-07-31).
• Neb. Rev. Stat. §§ 20-409 and 20-410 — transfer and immunity. Same source
  (accessed 2026-07-31).
• Neb. Rev. Stat. § 20-412 — reasonable-standards and assisted-suicide
  boundaries. Same source (accessed 2026-07-31).
• Neb. Rev. Stat. § 20-414 — out-of-state declarations. Same source
  (accessed 2026-07-31).