How to Update or Revoke an Advance Directive in Wales

You Can Change or Cancel an ADRT at Any Time

Under the Mental Capacity Act 2005, you can update, amend, or revoke your Advance Decision to Refuse Treatment at any point — as long as you have mental capacity when you do it. There is no cooling-off period, no fee, and no formal application process. The freedom to change your mind is absolute.

This matters because medical circumstances change, treatments evolve, and your views at 50 may differ significantly from your views at 70. An ADRT should be a living reflection of your current wishes, not a document frozen in time.

How to Revoke an ADRT Entirely

Revocation can be done in writing, verbally, or even by conduct. If you tell your GP "I no longer want my ADRT to apply," that verbal statement is legally sufficient. If you do something clearly inconsistent with the ADRT — like consenting to a treatment you previously refused — that conduct may also constitute revocation.

However, verbal and conduct-based revocations create evidential problems. If you revoke verbally and then lose capacity, how does the hospital know? Your family says you changed your mind; the scanned ADRT on the Welsh Clinical Portal says otherwise. The clinical team faces a legal conflict.

The reliable approach:

1. Write a brief revocation statement — "I, [name], hereby revoke the Advance Decision to Refuse Treatment dated [date]. This revocation is made on [today's date]." Sign and date it.
2. Deliver the revocation to your GP surgery and ask them to update your Welsh Clinical Portal record — removing or archiving the old ADRT.
3. Destroy or mark the old copies — in the Green Bottle, with family members, with your LPA attorney. Write "REVOKED" across each copy if you can't physically collect them all.
4. Notify your LPA attorney (if you have one) that the ADRT no longer applies.

How to Update Specific Refusals

If you want to change some refusals but keep others — say you've been diagnosed with a heart condition and now want to refuse dialysis in addition to CPR and ventilation — the cleanest approach is to draft an entirely new ADRT.

Amending an existing document with handwritten additions or strikethroughs is technically permissible, but it raises questions about when the changes were made, whether you had capacity at that point, and whether the amendments were witnessed (if they affect life-sustaining treatment). A clinician confronted with a heavily amended ADRT under time pressure may conclude it's ambiguous and default to treatment.

A fresh ADRT with a new date, new signatures, and new witness details eliminates all ambiguity. The new document supersedes the old one automatically — the most recent valid ADRT takes precedence.

After a Diagnosis: What to Change and When

A new diagnosis — cancer, motor neurone disease, heart failure, early dementia — is the most common trigger for reviewing an ADRT. The diagnosis may change your perspective on specific treatments, or it may make your existing refusals more urgent and specific.

Key considerations:

• Terminal diagnosis: you may want to add refusals for treatments that would only extend the dying process (IV antibiotics, dialysis, artificial feeding) while keeping those that manage symptoms (pain relief, anti-nausea medication).
• Dementia diagnosis: the window for updating your ADRT may be limited. Early-stage dementia usually preserves capacity, but capacity can fluctuate and decline unpredictably. Update sooner rather than later, and include a capacity assessment from your GP to preempt any future challenge.
• Cardiac condition: your views on CPR may shift. CPR success rates vary dramatically depending on the underlying condition — discuss the realistic outcomes with your cardiologist before updating your refusal clause.

After any update, take the new ADRT to your GP surgery for rescanning to the Welsh Clinical Portal, replace the copy in your Green Bottle, and distribute new copies to family and your LPA attorney.

The Review Cycle That Keeps Your ADRT Credible

Even if nothing has changed, a periodic review strengthens your ADRT's clinical credibility. The All Wales ADRT form includes a review section — a log where you sign and date each review to confirm the document still reflects your current wishes.

NHS Wales guidance recommends reviewing every two years or after any significant health event. A recent review signature tells a clinician: "This person was alive, had capacity, and actively confirmed these wishes on this date." An ADRT from eight years ago with no review evidence invites questions — not legal ones (the ADRT remains valid regardless), but clinical ones about whether the person's views may have evolved.

Review doesn't require re-witnessing or GP involvement. Read the document, confirm it still reflects your wishes, sign and date the review section. If it doesn't reflect your wishes anymore, draft a new ADRT.

Our Wales ADRT planning guide includes a two-year review checklist, a revocation template, and a document distribution log for tracking who holds copies and when they were last updated.

Get the complete planning kit and keep your treatment wishes current as your circumstances change.

See more Wales guides →