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Advance Directives


Advance Directive–Five Wishes
Many things in life are out of our hands, but by using the Good Samaritan endorsed Five Wishes advance directive, you can control how you wish to be treated if you become seriously ill. Five Wishes is an easy-to-complete form that makes your personal, emotional and spiritual needs as well as your medical wishes known by checking a box, circling a direction or writing a few sentences. It lets you appoint the person you choose to make your healthcare decisions if you are unable (power of attorney for healthcare) and once signed, is valid under the law in Nebraska.

You are not required to have an advance directive, but Five Wishes or other types of advance directives containing a living will and power of attorney for healthcare, are helpful if questions arise about the kind of medical treatment that you do or do not want and who you want to make those decisions if you are unable. As long as you can make personal decisions on your own behalf, your healthcare providers will rely on you, not your advance directive. You can cancel your advance directive at any time by destroying your original copy and contacting those with copies.

If you choose to complete an advance directive, make sure that someone, such as a family member, knows where it is located.

You might also consider the following:

            • If you have a power of attorney for healthcare, give a copy or the original to your “agent”  or “representative.”

            • Tell your healthcare provider that you have an advance directive and ask the provider to make it part of your medical record.

            • Keep a second copy of your advance directive in a safe place where it can be found easily, if it is needed.

            • In your purse or wallet, keep a small card that states you have an advance directive, where it is located and who your “agent”
              or “representative” is, if you have named one.

            • If you move, make sure your advance directive is valid in that state.

Good Samaritan Hospital offers an informational video about our Five Wishes advance directive on TV channel 77 in all patient rooms. You can receive a Five Wishes booklet or the Nebraska Department of Social Services written description of Nebraska’s law concerning advance directives by contacting Good Samaritan Care Management by dialing 7408 on any hospital phone. If you have additional questions about your legal rights, you should seek the professional advice of an attorney.

Good Samaritan Hospital reserves the right not to comply with directives given by a patient or their named decision maker if those directives conflict with the moral position of the Catholic Church or hospital policy. If Good Samaritan Hospital is unable to comply with your directives, we will make every effort to assist with your transfer to a different facility. Five Wishes does comply with the moral position of the Catholic Church and hospital policy.