Update or Revoke an Advance Directive in England
You Can Change Your ADRT at Any Time — While You Have Capacity
An Advance Decision to Refuse Treatment is not a permanent commitment. Under the Mental Capacity Act 2005, you can update or revoke your ADRT at any point, as long as you have the mental capacity to do so at the time of the change.
This is important for two situations that come up repeatedly: a new medical diagnosis that changes your treatment preferences, and a general change of mind about what you would or would not want refused.
The rules for changing an ADRT are more flexible than most people expect. But the rules for making those changes legally effective — so doctors actually follow the updated version — require careful handling.
Minor Updates vs Substantive Changes
Minor updates — a new address, a change of GP, updated contact details for your attorneys — can be made directly on the original document. Draw a single line through the old information, write the correction above it, initial and date the change, and have your witness initial it as well. Then distribute the updated copy to your GP surgery and anyone else holding a copy.
Substantive changes — adding or removing treatment refusals, changing the clinical circumstances under which your refusals apply, or altering the life-at-risk clause — require a completely new ADRT. Amendments to the substance of treatment refusals on an existing document create legal ambiguity. A fresh document with clear, current wording is safer.
The new ADRT must meet all the original validity requirements: it must be in writing, signed by you, and if it covers life-sustaining treatment, it must include the statutory phrase "even if my life is at risk" and be witnessed.
Updating After a Diagnosis
A new diagnosis — particularly a progressive condition like dementia, motor neurone disease, or certain cancers — is one of the most common reasons to revisit an ADRT. The diagnosis may make your existing refusals more immediately relevant, or it may introduce treatment scenarios you had not previously considered.
If you receive a diagnosis of early-stage dementia, the window for creating or updating an ADRT is still open but narrowing. The legal test is decision-specific capacity: can you understand, retain, and weigh the information about the treatments you are refusing? A dementia diagnosis does not automatically mean you lack capacity, but it does mean capacity should be formally assessed — ideally by your GP or a specialist — and documented at the time you sign the updated ADRT.
Having a medical professional witness your signature and provide a written statement confirming that you had capacity at the time of signing creates a strong evidential safeguard against future challenges.
Practical considerations after a diagnosis:
- Review your existing ADRT against the specific treatment pathways for your condition. A generic refusal of "life-sustaining treatment" may not be specific enough to withstand clinical scrutiny for your particular diagnosis.
- Discuss your revised preferences with your clinical team. They can help you understand which treatments are likely to arise and how to phrase your refusals in medically precise terms.
- If you have a registered Health and Welfare LPA, remember the precedence rule: whichever document was created more recently takes priority. A new ADRT created after an existing LPA overrides the attorney's authority on the specific treatments it covers.
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How to Revoke an ADRT
Revocation is deliberately simple under the Act. You can revoke an ADRT either:
- Verbally — by telling someone (ideally a healthcare professional or your attorneys) that you no longer want the ADRT to apply
- In writing — by marking the original document with "REVOKED," signing and dating it
Written revocation is strongly recommended. A verbal revocation is legally valid, but it creates an evidential problem — in an emergency, a clinical team may find the written ADRT on file and follow it, unaware that you later revoked it verbally.
After revoking, take these steps immediately:
- Retrieve and destroy the original document
- Recall all distributed copies from your GP, hospital, care home, attorneys, and family members
- Notify your GP surgery in writing and ask them to remove the ADRT alert from your electronic patient record
- If you are replacing the old ADRT with a new one, distribute the new version to all the same locations
The Inconsistent-Behaviour Trap
There is one additional way an ADRT can be invalidated that catches people off guard. Under Section 25 of the Mental Capacity Act 2005, if you take actions that are "clearly inconsistent" with the ADRT while you still have capacity, a clinical team can argue the ADRT no longer applies.
The classic example: you create an ADRT refusing blood transfusions on religious grounds, then later accept a blood transfusion during surgery. A treating team could reasonably argue your subsequent behaviour demonstrates the ADRT no longer reflects your wishes.
This does not mean every minor inconsistency invalidates your ADRT. The threshold is actions that are "clearly inconsistent" — not ambiguous lifestyle changes. But it reinforces the value of reviewing your ADRT periodically and confirming in writing that it still reflects your current wishes.
Our England Advance Directive guide includes an ADRT review protocol tied to common trigger events — a new diagnosis, a hospital admission, or an annual health check — along with the exact steps for making changes that are legally airtight.
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