Advance Health Directive 10-Year Rule in Western Australia

Your AHD Doesn't Expire — But It Can Lose Its Teeth

There's a persistent misunderstanding that an Advance Health Directive (AHD) in Western Australia has a fixed expiry date. It doesn't. Under the Guardianship and Administration Act 1990, a properly executed AHD remains legally valid indefinitely, unless the maker revokes it while they still have capacity.

But there's a significant qualifier that most people miss. WA law gives treating clinicians the authority to "read down" an AHD — essentially to reduce its binding force — if the directive is old enough that circumstances may have changed since it was written. The benchmark used in clinical practice is approximately 10 years, though the legislation doesn't prescribe a hard cutoff.

This reading-down power means an AHD you signed in your fifties might not be followed the way you intended when you're in your seventies — not because the document is invalid, but because a clinician decides the treatment decisions you recorded no longer reflect what a reasonable person in your situation would want.

What "Reading Down" Actually Means

Reading down doesn't mean the AHD is thrown out. It means a clinician weighs the directive's authority against several factors:

• The age of the document: An AHD signed two years ago carries more weight than one signed fifteen years ago
• The maker's age at signing vs their current age: A directive written at 55 about treatments in old age carries different weight than one written at 80
• Changes in medical technology: If the AHD refuses a treatment that has since become significantly safer or more effective, a clinician may question whether the maker would have refused it today
• Changes in the maker's circumstances: A new diagnosis, a changed family situation, or a move into residential care could all suggest the maker's values have shifted

In practice, reading down most commonly arises when an AHD refuses life-sustaining treatment and the treating team believes the refusal was based on outdated clinical information. For example, an AHD written in 2015 that refuses "cardiac intervention" may not have contemplated the minimally invasive procedures available in 2026. A clinician could argue that the maker's intent was to refuse the invasive surgery that was standard in 2015, not the lower-risk procedure available today.

The Practical Risk

The reading-down provision creates genuine uncertainty for families. When your family presents your AHD to a hospital, the clinical team assesses whether to follow it. If they decide to read it down, they'll instead consult the next person on the statutory hierarchy of treatment decision-makers — your enduring guardian (if you have one), then your family.

This means:

• Your treatment preferences might not be followed if the AHD is seen as outdated
• Your enduring guardian or family may be asked to make decisions you'd already made for yourself
• The clinical team has significant discretion in how aggressively they apply the reading-down test

How to Protect Your AHD From Being Read Down

Review and Re-execute Regularly

The WA Department of Health recommends reviewing your AHD every two to five years. But reviewing isn't enough to replace the document — if you need a current AHD, revoke the old one and execute a new one with fresh signatures and witnessing.

A simple annotation or addendum on the original form doesn't have the same effect. The witnessing and signing requirements under the Act apply to the whole document, not individual amendments.

The process is straightforward:

1. Revoke your existing AHD
2. Complete a new AHD form with your current treatment preferences
3. Have it witnessed by two independent adults, at least one authorised under the Oaths, Affidavits and Statutory Declarations Act 2005
4. Upload the new AHD to My Health Record and provide fresh copies to your GP and family

Update After Any Significant Health Event

Beyond the regular review cycle, specific triggers should prompt an immediate update:

• A new diagnosis: Particularly conditions that affect cognitive function, mobility, or life expectancy
• A major procedure or hospitalisation: Your treatment preferences may shift after experiencing the healthcare system firsthand
• Changes in available treatments: If a treatment you refused has become significantly safer, consider whether your refusal still reflects your values
• Changes in your personal circumstances: Divorce, estrangement, the death of your appointed enduring guardian, or a move into aged care

Write Time-Aware Treatment Decisions

One strategy for reducing vulnerability to reading down is to write your AHD's treatment decisions in a way that anticipates future medical advances. Instead of refusing specific treatments by name, frame your refusals around outcomes and conditions:

Weaker (more vulnerable to reading down): "I refuse mechanical ventilation."

Stronger (harder to read down): "I refuse any form of assisted ventilation if I have an irreversible condition where there is no reasonable medical prospect of recovering the capacity to breathe independently and communicate."

The second version ties the refusal to a clinical condition rather than a specific technology. If a new, less invasive ventilation method is developed, the clinician must still assess whether the underlying condition meets the criteria — rather than arguing that the maker would have accepted the new technology.

Keep a Capacity Trail

If you're updating an AHD years after the original, document your continued capacity. A GP note confirming capacity at the time of the new signing makes it harder for clinicians to later argue that your updated directive was itself compromised by cognitive decline.

The Relationship Between Reading Down and Revocation

Reading down and revocation are different mechanisms. Revocation is your deliberate act of cancelling an AHD — you can do this at any time while you have capacity. Reading down is something a clinician does when they believe the AHD's treatment decisions no longer reliably reflect the maker's wishes.

You can't prevent clinicians from exercising their reading-down judgment. But you can make that judgment harder to justify by keeping your AHD current, specific, and well-documented.

If you want to understand the full revocation process — including the witnessing and notification steps — our post on how to revoke an advance health directive in WA covers it in detail.

What About Goals of Patient Care?

In hospital settings, the Goals of Patient Care (GoPC) process creates a parallel layer of clinical decision-making. Even if your AHD is current and specific, the admitting team will still initiate a GoPC discussion to establish a clinical ceiling of care for that particular admission.

A current AHD actually makes the GoPC process smoother — the clinical team can reference your documented preferences and align the GoPC form accordingly. An outdated AHD, on the other hand, can create tension between what the form says, what the family wants, and what the clinical team believes is appropriate. Reading down the AHD forces the GoPC discussion onto the family instead, adding stress to an already difficult situation.

Taking Action

The Western Australia Advance Directive & Living Will Kit includes a Review and Revocation Checklist that walks you through the update cycle: when to review, how to revoke an old AHD, and how to execute a replacement with fresh signatures and witnessing. It also includes the treatment decision worksheets that help you frame your preferences in outcome-based language — the format most resistant to clinical reading-down.

If your AHD is approaching or past the 10-year mark, an update isn't optional. It's the difference between your wishes being followed and your family being asked to guess.

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