How to Update or Revoke an Advance Directive in the ACT

Why Your Advance Care Documents Need Reviewing

A Health Direction you signed five years ago might not reflect what you want today. A new cancer diagnosis, a move into residential aged care, or even a change of mind about resuscitation can all make your existing documents dangerously out of date — and in the ACT, a valid Health Direction remains binding on clinicians until it is replaced or revoked in a way recognised by the Act.

The ACT does not use a single "advance directive" instrument. Your end-of-life planning sits across three documents — the statutory Health Direction under the Medical Treatment (Health Directions) Act 2006, the non-binding Statement of Choices, and the Enduring Power of Attorney (EPoA) under the Powers of Attorney Act 2006. Each has its own update and revocation rules.

Updating a Health Direction

You cannot simply cross out lines or add handwritten notes to an existing Health Direction. Annotations on a previously executed document can invalidate the attempted amendment and can cause the document to be rejected, leaving clinicians unable to rely on your recorded wishes.

Instead, you execute a new Health Direction on the current Form AF2017-46. A new Health Direction replaces the older one to the extent of inconsistency. So if your original direction refused artificial ventilation but your new one removes that refusal, the new document controls.

The execution requirements remain the same each time: you must sign in the presence of two adult witnesses who also sign in each other's presence. There is no professional qualification requirement for Health Direction witnesses (unlike EPoA witnesses), and the Act does not impose the EPoA's attorney-witness exclusion.

Updating a Statement of Choices

The Statement of Choices is simpler. Because it is non-binding — it guides clinical staff rather than legally compelling them — you can complete a new Statement of Choices form from the ACT Advance Care Planning Booklet at any time, with no formal witnessing protocol. The practical step most people miss is uploading the updated version to the MyDHR patient portal (or emailing it to the Canberra Health Services CPF scanning registry) and notifying your GP and any specialists who hold copies of the old version.

Updating an EPoA

If you want to change who acts as your substitute decision-maker — perhaps the person you originally appointed has moved interstate, become ill themselves, or you have lost trust in them — you need to execute an entirely new EPoA on Form AF2017-45.

The new EPoA's witnessing rules are stricter than those for a Health Direction. You need two adult witnesses present simultaneously, and Witness 1 must be someone authorised to witness statutory declarations — typically a solicitor, Justice of the Peace, or court registrar. The appointed attorney must also formally accept the role in writing.

A critical sequencing rule applies here: under section 19 of the Medical Treatment (Health Directions) Act 2006, if the documents are consistent, the attorney must comply with the Health Direction. If they are inconsistent, the attorney must comply with the EPoA when the Health Direction was made first, and with the Health Direction when the Health Direction was made after the EPoA. If you want a later Health Direction to control an inconsistent treatment decision, execute the EPoA first, then the Health Direction.

How to Formally Revoke Without Replacing

If you want to cancel an EPoA without putting a new one in place, sign a formal revocation instrument, witnessed following the EPoA's execution rules. A Health Direction can be revoked by a clear oral or written statement to a health professional; it does not use the EPoA's witnessing protocol.

For an EPoA, if you registered the original with Access Canberra Land Titles (required for any real property transactions), you must also register the revocation with Land Titles to maintain legal clarity. If you deposited the original with the Public Trustee and Guardian's Will and EPoA Register, notify them of the revocation as well.

For a Health Direction, notify every person and institution that holds a copy that it has been revoked or changed — your GP, specialists, Canberra Health Services, and any aged care facility. Remove or replace the document on MyDHR and My Health Record.

Updating After a New Diagnosis

A new diagnosis — particularly dementia, motor neurone disease, or a terminal cancer — is the most common trigger for updating advance care documents. The critical issue is timing: you must have decision-making capacity at the moment you sign the updated documents. Once capacity is lost, you cannot execute a valid replacement.

If capacity is fluctuating (common in early-stage dementia), a medical practitioner can provide a written cognitive assessment confirming capacity at the time of signing. This assessment is not legally required, but it is strong evidence against any future challenge to the document's validity.

After a diagnosis, consider whether your original Health Direction's treatment refusals still align with your wishes. Some people originally refused CPR but, after a treatable cancer diagnosis, want to reverse that refusal during active treatment. Others want to add refusals they had not previously considered — such as artificial nutrition or mechanical ventilation.

Keep Your Records Current

After any update or revocation, work through this distribution list:

• For a Health Direction or Statement of Choices, upload to MyDHR or email to the Canberra Health Services CPF scanning registry
• Provide copies to your GP and treating specialists
• Notify any aged care facility that holds copies
• If your EPoA is registered with Access Canberra Land Titles, register the change
• If your EPoA is deposited with the PTG, notify them
• Inform your appointed attorneys and family members

The ACT Advance Care Planning Booklet recommends reviewing your documents annually, or whenever your health status changes significantly. An out-of-date document is worse than no document at all — it can legally compel clinicians to follow instructions you no longer want.

If you want a structured system for tracking which documents exist, where they are stored, and when they were last reviewed, the ACT Advance Directive & Living Will Kit includes a document execution tracker and storage log designed for exactly this process.

See more Australian Capital Territory guides →