Updating or Revoking an Advance Care Directive in South Australia

You Can't Edit an Existing ACD — You Replace It

This surprises most people: under the Advance Care Directives Act 2013, you cannot amend, annotate, or partially modify an existing Advance Care Directive. If you want to change anything — a treatment instruction, an SDM appointment, a value statement — you must execute an entirely new ACD from scratch.

The moment a valid new ACD is executed, it automatically revokes all prior directives. You don't need to file a separate revocation. You don't need to return the old document. The new one simply replaces everything that came before.

This total-replacement approach is deliberate. It prevents the confusion of having a base document with amendments scattered across multiple pages or dates — something that would create real problems during a medical crisis when a clinical team needs to know your current wishes quickly and clearly.

When Should You Update?

SA Health recommends reviewing your ACD at least every two years, but several life events should trigger an immediate update:

• A major health diagnosis — a cancer diagnosis, progressive neurological condition, heart failure, or any condition that changes your treatment landscape
• A change in SDMs — your first preferred SDM has died, become estranged, moved overseas, or told you they no longer want the responsibility
• A change in personal circumstances — marriage, divorce, entering aged care, moving to a new state
• A change in the law — the 2024 amendments to the Act changed witness categories, digital copy rules, and the suicide override provision. An ACD written in 2014 is still legally valid, but it doesn't reflect current provisions.
• A change in your values — what mattered to you at 60 may not reflect your priorities at 75

An older ACD remains legally valid indefinitely — there's no expiry date. But outdated instructions can be worse than no instructions at all. If your ACD refuses chemotherapy but you've since been diagnosed with a highly treatable cancer, your binding refusal could prevent treatment you'd now want.

How to Replace Your ACD

The process for executing a new ACD is identical to creating one for the first time:

1. Get the current form — download the post-March 2024 version from SA Health's website
2. Draft your updated instructions — revise treatment refusals, value statements, and preferences to reflect your current wishes
3. Appoint or reappoint SDMs — even if your SDMs haven't changed, each one must sign the acceptance section on the new form
4. Complete the witnessed signing — the same strict signing order applies: SDMs first, then you sign before an authorised witness
5. Distribute the new version — give certified copies to every SDM, your GP, your hospital, and aged care facility. Upload to My Health Record, replacing the old version.

Step 5 is critical. If your GP still has a copy of your 2018 ACD on file and doesn't know you executed a new one in 2026, the medical team might act on outdated instructions during an emergency. You need to actively retrieve and destroy old copies.

How to Cancel Without Replacing

If you want to cancel your ACD entirely — not replace it with a new one, but simply revoke it and have no directive at all — there's a separate statutory process.

You must complete the official "Cancelling my Advance Care Directive" form, available from SA Health's website. You sign it in the presence of an authorised witness, who must certify that you have capacity and understand the consequences of having no ACD in place.

After cancellation:

• Retrieve and destroy all certified copies of the cancelled ACD
• Notify every SDM in writing that their appointment has ended
• Contact your GP, hospital, and aged care facility to remove the document from their records
• Delete the digital copy from My Health Record

Without an ACD, medical decisions will default to the "Person Responsible" hierarchy under the Consent to Medical Treatment and Palliative Care Act 1995. Make sure you understand what that means before cancelling — the statutory hierarchy might not align with who you'd actually want making decisions.

What If You've Lost Capacity?

If you've lost decision-making capacity, you cannot execute a new ACD or cancel an existing one yourself. The document stands as-is unless SACAT intervenes.

A family member, SDM, healthcare provider, or the Office of the Public Advocate can apply to SACAT to vary or revoke the ACD. SACAT will only cancel or modify the directive if it's satisfied that:

• The cancellation or modification reflects the genuine current wishes of the person, or
• The directive is no longer appropriate in the circumstances

This is a formal tribunal process. It requires medical evidence, may involve a hearing, and the outcome is binding. It's the safety valve for situations where an ACD no longer serves the person's interests — but it's not a quick or simple path.

The Pre-2014 Documents

If you executed a Medical Power of Attorney, Enduring Power of Guardianship, or Anticipatory Direction before 1 July 2014, these legacy documents remain legally valid. They weren't automatically revoked by the introduction of the ACD system.

However, if you now execute a new ACD, it will automatically revoke all prior legacy documents. You can't have both. The transition is one-way: once you move to the modern ACD framework, the old instruments are permanently cancelled.

For most people with pre-2014 documents, updating to a current ACD is worthwhile. The modern form is more comprehensive, accommodates up to four SDMs, and reflects a decade of legal and clinical development. Legacy documents also don't benefit from the 2024 amendments — including digital copy recognition, which is increasingly important as hospitals move toward electronic records.

Our South Australia Advance Directive & Living Will Kit includes a revocation and update checklist — covering the notification sequence, copy retrieval, and My Health Record update — so your new directive fully replaces the old one everywhere that matters.

See more South Australia guides →