Updating and Revoking an Advance Directive in Northern Ireland

An advance directive drafted at fifty may not reflect what you want at sixty-five. A new diagnosis changes the calculus. A grandchild changes your feelings about how long you want to fight. A medical advance makes a previously refused treatment far less invasive than it was when you wrote the document.

Northern Ireland's common law framework makes updating and revoking an ADRT straightforward — possibly too straightforward, because the ease of revocation is itself a vulnerability if not managed carefully.

When to Review

Review your ADRT in any of these situations:

• Annually, regardless of changes. A document reviewed and re-signed every year is dramatically harder to challenge than one signed once and left untouched. Annual reviews demonstrate continuing intent.
• After a new diagnosis. Any significant health development may change which treatments you'd accept or refuse, or the circumstances under which your refusals apply.
• After a major life event. Marriage, divorce, the birth of a child or grandchild, the death of a spouse — these can shift your priorities in ways that affect end-of-life preferences.
• If medical treatments change. A treatment you refused five years ago may have improved significantly, with fewer side effects or higher success rates. Conversely, you might want to add refusals for newer interventions.
• If your clinical team raises concerns. Your GP or specialist may flag that the language in your ADRT is ambiguous or doesn't match the treatments you'd actually face given your current conditions. Take their input seriously.

How to Update

You have two options for modifying an ADRT:

Option 1: Create a new document. This is the cleanest approach. Draft a new ADRT from scratch, incorporating your revised decisions. Sign, date, and have it witnessed following the same protocol as the original. Then destroy all copies of the old document and distribute the replacement.

Option 2: Add a signed addendum. For minor changes — adding a treatment refusal, adjusting the circumstances clause — you can attach a dated, signed, and witnessed addendum to the existing document. This is quicker but carries a risk: multiple addenda create a complicated document that emergency teams may struggle to interpret under time pressure.

For any change that affects life-sustaining treatment refusals, a fresh document is strongly preferable. Clinical teams under pressure need to read a single, clear, self-contained directive — not a patchwork of amendments.

How to Revoke

Under NI common law, you can revoke an ADRT at any time while you have mental capacity. Revocation can be:

• Written. A signed and dated statement that you revoke the ADRT. This is the safest method because it creates a clear documentary record.
• Verbal. You can verbally tell your clinical team or family that you've changed your mind. This is legally effective but creates evidential problems — in a dispute, it becomes one person's word against a written document.
• By conduct. Acting in a way that's clearly inconsistent with the ADRT. For example, if your ADRT refuses chemotherapy but you've been actively receiving and consenting to chemotherapy since writing it, a clinical team may reasonably conclude the directive no longer represents your wishes.

The low bar for revocation is a double-edged sword. It protects your autonomy — you can always change your mind — but it also means that an offhand comment to a nurse ("I'm not sure about that living will any more") could be enough for a clinical team to question whether the document is still valid.

The Destruction Protocol

When you revoke or replace an ADRT, don't just file the new one and forget the old. A superseded document floating around in someone's drawer or a hospital record can create dangerous confusion.

1. Destroy all physical originals. Shred every copy of the old document that you control directly.
2. Notify your GP surgery. Ask the practice manager to remove the old ADRT from your electronic health record and replace it with the new one (or confirm its removal if you're revoking without replacement). Get written confirmation.
3. Notify every copy holder. Go through your distribution log and contact every person and institution that received a copy. Collect and destroy their copies, or instruct them to destroy and confirm.
4. Update your HSC Trust records. If a copy was filed with a hospital team, notify them directly.
5. Record the revocation. Keep a dated, signed record of what you revoked and when, in case the validity of the new document (or the absence of any document) is ever questioned.

The Review Log

Maintaining a chronological review log attached to your ADRT creates a powerful evidence trail. Each entry should include:

• The date of the review
• Your signature confirming you've reconsidered and reaffirmed (or amended) your decisions
• A witness signature
• A brief note of any changes made or a statement that no changes were required

This log serves as ongoing proof that the document reflects your current, considered wishes — not a decision made years ago that you forgot about. Clinical teams faced with a document that includes a recent review signature are far more likely to treat it as valid and applicable without challenge.

Our Northern Ireland Advance Decision to Refuse Treatment guide includes a structured review log, a destruction protocol checklist, and distribution tracking templates to ensure every version change reaches every copy holder.

See more Northern Ireland guides →