Structure
The Nebraska Living Will form serves as a vital document for individuals wishing to express their healthcare preferences in advance, particularly in situations where they may be unable to communicate their wishes due to illness or injury. This form allows individuals to specify their desires regarding medical treatment, including life-sustaining measures, in a clear and legally recognized manner. It typically covers critical aspects such as the types of medical interventions one wishes to accept or refuse, ensuring that personal values and beliefs are honored during medical emergencies. Additionally, the form can provide guidance to family members and healthcare providers, alleviating the burden of decision-making during challenging times. By completing a Living Will, individuals take an important step in planning for their future healthcare needs while promoting peace of mind for themselves and their loved ones.
Document Preview Example
Nebraska Living Will
This Living Will is designed to reflect the wishes of the undersigned regarding healthcare decisions in the event of incapacitation or terminal illness. It is in compliance with the Nebraska Right to Make Decisions Regarding Resuscitation and Life-Sustaining Procedures Act.
Part 1: Information of the Declarant
Name: ____________________________________________
Date of Birth: ____________________________________
Address: _________________________________________
City/State/Zip: ___________________________________
Phone: __________________________________________
Part 2: Declaration
In the presence of the undersigned witnesses, I, _________________________, declare that:
- If, in the judgement of my attending physician, I am suffering from a terminal condition or am in a persistent vegetative state that is irreversible, I direct that life-sustaining treatment be withheld or withdrawn when the burdens of treatment outweigh the expected benefits. I want my doctors to focus on providing care that relieves pain and suffering.
- I designate the following individual as my healthcare representative to make healthcare decisions for me, including decisions about withholding or withdrawing life-sustaining treatment, if I am unable to make those decisions myself:
Name: ____________________________________________
Relationship: ______________________________________
Phone: ___________________________________________ - If my primary healthcare representative is unwilling, unable, or unavailable to act on my behalf, I designate the following individual as an alternate:
Name: ____________________________________________
Relationship: ______________________________________
Phone: ___________________________________________
Part 3: Organ Donation (Optional)
I express the following wishes regarding organ and tissue donation:
- I wish to donate any needed organs or tissues.
- I wish to donate the following organs or tissues: _______________________________.
- I do not wish to donate any organs or tissues.
Part 4: Signature and Date
This document becomes effective only upon my incapacity to participate in healthcare decisions. By signing below, I affirm this Living Will reflects my wishes.
Signature: _______________________________ Date: __________________
Part 5: Witness Declaration
This Living Will was signed in my presence. The Declarant, to the best of my knowledge, appears to be of sound mind and not under duress, fraud, or undue influence.
Name: ____________________________________________
Signature: __________________________ Date: __________________
Address: _________________________________________
Part 6: Second Witness Declaration (Optional in Nebraska)
This section complies with optional legal frameworks within Nebraska and provides additional validation of this Living Will.
Name: ____________________________________________
Signature: __________________________ Date: __________________
Address: _________________________________________
Document Features
| Fact Name | Details |
|---|---|
| Purpose | The Nebraska Living Will form allows individuals to express their wishes regarding medical treatment in the event they become incapacitated. |
| Governing Law | The form is governed by the Nebraska Revised Statutes, specifically Chapter 20, sections 20-401 to 20-411. |
| Eligibility | Any adult who is of sound mind can create a Living Will in Nebraska. |
| Witness Requirement | Two witnesses must sign the Living Will, affirming that the individual is of sound mind and not under duress. |
| Revocation | The individual can revoke the Living Will at any time, either verbally or in writing. |
| Durable Power of Attorney | A Living Will can be accompanied by a Durable Power of Attorney for Health Care, allowing someone to make medical decisions on behalf of the individual. |
| Storage | It is advisable to keep the Living Will in an accessible location and provide copies to family members and healthcare providers. |
| Limitations | The Living Will only addresses end-of-life decisions and does not cover other medical treatment preferences. |
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