Should I review my Advance Decision after making a health and welfare LPA?

Yes. If you create, amend or revoke a Lasting Power of Attorney for health and welfare, review your Advance Decision to ensure both documents work together and do not contain conflicting instructions.

Does moving house or changing GP affect my Advance Decision?

Yes. Moving home, changing GP practice, entering a care home or being admitted to hospital are practical triggers to review and redistribute your Advance Decision so the right people can access the latest version quickly.

Should I update my Advance Decision before hospital treatment or surgery?

You should review it before major surgery, chemotherapy, dialysis, ventilation, resuscitation planning, palliative care discussions or any treatment where your stated refusals may become relevant.

Is pregnancy a trigger to review an Advance Decision?

Pregnancy can affect whether an Advance Decision is followed in some situations, especially where it includes refusals of life-sustaining treatment. If pregnancy is possible or confirmed, review the wording and seek medical or legal advice.

What review triggers matter for life-sustaining treatment refusals?

To refuse life-sustaining treatment, an Advance Decision must be in writing, signed, witnessed, and state that the refusal applies even if life is at risk. Review this wording carefully after any change in health or wishes.

Do I need to sign and witness an updated Advance Decision?

Yes. If your review results in any substantive change, sign and date the updated document. If refusing life-sustaining treatment, make sure the signature and witness requirements are met again.

Who should be told when I update my Advance Decision?

Tell your GP, relevant consultants, hospital, care home, health and welfare attorneys, next of kin and trusted contacts. Give them the updated version and make clear that previous copies should no longer be used.

What is the difference between reviewing and amending an Advance Decision?

A review note confirms you have checked the document and still agree with it; an amendment changes the content. If the wording changes, it is usually safer to create a new signed and dated Advance Decision.

Can I revoke my Advance Decision instead of updating it?

Yes. You can revoke an Advance Decision at any time while you have mental capacity, including orally or in writing. Written revocation and notifying everyone with a copy reduces the risk of confusion.

How can I create an updated UK Advance Decision document?

Use a dated, clearly worded document that identifies the treatments refused, the circumstances where refusals apply, your signature, witness details where needed, and distribution notes. An AI document generator can help create a structured UK Advance Decision for review.

EN-GB>Wills>Advance Decision>UK Advance Decision Review and Update Triggers

United Kingdom Advance Decision Review and Update Triggers

Created: 12 Jun 2026

This structured dataset helps readers understand when a British advance decision may need reviewing or updating, supporting clearer planning and more reliable healthcare choices. For broader context, visit AI Generated British Advance Decision.

Review trigger	Reason for review	May require new version	Practical action
Time-based review
Annual review date reached	Regular review helps confirm the decision still reflects current wishes.	false	Read the document, date the review, and tell key people it remains current.
Two years since last review	A long gap may raise doubts about whether wishes are still settled.	false	Carry out a full review and record the review date.
Health change
Diagnosis of a serious illness	The refusal may need to address realistic treatments for the new condition.	true	Discuss likely treatments with the clinical team and update refusals if needed.
Terminal diagnosis	End-of-life treatment choices may become more immediate and specific.	true	Review with palliative care staff and share the latest version with services.
Diagnosis of dementia or cognitive impairment	Review while capacity is clear can reduce later validity disputes.	true	Review promptly, consider capacity evidence, and store the final version safely.
Fluctuating capacity becomes a concern	Capacity at the time of making or amending the decision may be questioned.	true	Review during a lucid period and ask a professional to record capacity.
Treatment change
Planned major surgery	Surgery may involve ventilation, transfusion, resuscitation, or intensive care.	true	Give the surgical and anaesthetic teams a copy before admission.
Health change
Emergency or unplanned hospital admission	Hospital staff need current and accessible evidence of refusals.	false	Ask staff to place the latest copy on the medical record.
Treatment change
Admission to intensive care or high dependency care	Intensive care can involve treatments commonly refused in advance decisions.	true	Clarify whether refusals apply to ventilation, CPR, dialysis, or artificial nutrition.
Health change
Significant change in prognosis	Different outlook may change the balance of acceptable treatment burdens.	true	Ask the consultant to explain likely scenarios and revise wording if needed.
Treatment change
New treatment becomes available	The document may refuse or omit a treatment now clinically relevant.	true	Check current NICE or clinician advice before confirming or changing the refusal.
Treatment option is withdrawn or no longer suitable	Refusals may need updating to reflect available and clinically suitable care.	true	Ask the treating team whether the treatment list is still accurate.
Major medication change	Medication changes may affect emergencies, side effects, or treatment preferences.	false	Check whether the advance decision needs to mention medication-related emergencies.
Change of wishes
Change in CPR preferences	CPR refusal may be life-sustaining treatment and needs strict wording.	true	Create a new signed and witnessed version if refusing CPR in advance.
Change in ventilation preferences	Ventilation may be life-sustaining and must be clearly refused if intended.	true	Specify the circumstances and include the life-risk statement if required.
Change in artificial nutrition or hydration wishes	Clinically assisted nutrition or hydration may be life-sustaining treatment.	true	Use precise wording and obtain witness signature for life-sustaining refusal.
Change in dialysis preferences	Dialysis may become relevant after kidney disease or acute kidney injury.	true	Discuss likely dialysis scenarios with a kidney specialist and update if needed.
Change in blood transfusion preferences	Transfusion may arise in surgery, trauma, childbirth, or cancer care.	true	State exactly which blood products are refused and when.
Change in antibiotics preferences	Infections may be treatable but burdensome in advanced illness.	true	Clarify whether refusals apply to all antibiotics or only specified situations.
Change in chemotherapy or cancer treatment wishes	Cancer treatment options, side effects, and prognosis can change quickly.	true	Review wording with oncology before refusing or accepting future treatments.
Personal circumstances, Change of wishes
Change in religious or ethical beliefs	Treatment refusals may depend on beliefs about specific interventions.	true	Update refusals and tell clinicians if beliefs affect emergency treatment.
Change of wishes
You change your mind about any refusal	An advance decision should reflect current and settled wishes.	true	Revoke or replace the document and retrieve old copies where possible.
You want to add a new refusal	New refusals must be specific enough to be valid and applicable.	true	Draft a new version identifying the treatment and circumstances clearly.
You want to remove a refusal	Old copies could wrongly suggest treatment must still be refused.	true	Make a replacement document and notify everyone who held the old one.
Personal circumstances, Health change
Pregnancy or planning pregnancy	Treatment priorities and foreseeable emergencies may change during pregnancy.	true	Review with maternity clinicians and clarify whether refusals apply in pregnancy.
Treatment change, Personal circumstances
Upcoming childbirth or caesarean section	Birth can involve transfusion, anaesthesia, surgery, or emergency resuscitation.	true	Give the maternity unit a copy and align it with the birth plan.
Personal circumstances
Moving home	New GP, hospital, or carers may not know the document exists.	false	Give copies to the new GP and update emergency contact details.
Legal or administrative change, Personal circumstances
Moving from England or Wales to Scotland or Northern Ireland	Mental Capacity Act rules apply to England and Wales, not all UK jurisdictions.	true	Take local legal and clinical advice and consider a jurisdiction-specific document.
Personal circumstances, Health change
Moving into a care home	Care staff need clear instructions and access in emergencies.	false	Place a copy in the care plan and tell the GP and care manager.
Legal or administrative change
Changing GP practice	The new practice may not have the document on record.	false	Ask the new GP to add the latest version to your records.
Legal or administrative change, Treatment change
New consultant or specialist team	New clinicians may need context to judge applicability.	false	Review the document at the next appointment and provide a copy.
Legal or administrative change
Creating a Health and Welfare LPA	Later LPA authority may override an earlier advance decision if inconsistent.	true	Check consistency and state whether attorneys can decide on life-sustaining treatment.
Health and Welfare LPA is registered	Registered attorneys may need the latest advance decision for future decisions.	false	Give attorneys a copy and explain how it limits or guides decisions.
Legal or administrative change, Personal circumstances
Changing or replacing an attorney	New attorneys need current instructions and may affect document consistency.	true	Review alongside the LPA and provide the attorney with the latest copy.
Personal circumstances, Legal or administrative change
Attorney dies or can no longer act	Decision-makers and contact routes may no longer be reliable.	false	Update contact details and consider whether a new LPA is needed.
Personal circumstances
Marriage or civil partnership	Family contacts and views about treatment may change.	false	Decide whether to add your spouse or civil partner as a contact or copy holder.
Divorce, dissolution, or separation	A former partner may no longer be an appropriate contact or copy holder.	false	Update contacts and retrieve copies if the person should no longer be involved.
Family disagreement about care wishes	Disputes can make clarity, evidence, and circulation more important.	true	Reconfirm wishes in writing and give copies to clinicians and attorneys.
Death of a close family member or trusted contact	Named contacts or copy holders may need replacing.	false	Update emergency contacts and redistribute copies.
Legal or administrative change
Emergency contact details change	Clinicians may be unable to locate the latest document quickly.	false	Update the contact sheet and notify GP, hospital, and care providers.
Original or copies are lost	The document may not be available when treatment decisions are needed.	true	Create and distribute a replacement if the signed version cannot be found.
Old versions are still circulating	Conflicting versions may cause uncertainty in urgent treatment decisions.	false	Mark old versions revoked and ask copy holders to destroy or replace them.
Signed document is damaged or illegible	Clinicians may be unable to verify wording, signature, or witness details.	true	Sign and witness a clear replacement version.
Life-sustaining refusal lacks witness signature	A life-sustaining treatment refusal must be signed and witnessed.	true	Prepare a compliant new version with signature, witness, and life-risk statement.
Life-sustaining refusal lacks life-risk statement	The decision must state it applies even if life is at risk.	true	Create a new compliant version before relying on that refusal.
Wording is vague or too broad	Unclear wording may make validity or applicability harder to establish.	true	Rewrite to identify specific treatments and specific circumstances.
Legal or administrative change, Change of wishes
Advance statement conflicts with the Advance Decision	Conflicting preferences can confuse best-interests decisions and care planning.	true	Align both documents and label which document controls treatment refusals.
Treatment change, Legal or administrative change
DNACPR decision differs from the Advance Decision	CPR records should not contradict a binding refusal or current wishes.	true	Ask the GP or clinical team to reconcile the DNACPR and Advance Decision.
ReSPECT form is created or updated	Emergency care recommendations should reflect any binding treatment refusals.	false	Ensure the ReSPECT form refers to the latest Advance Decision.
Treatment change, Health change
Palliative or end-of-life care plan is made	Care plans should match binding refusals and comfort-care preferences.	false	Ask the palliative care team to cross-reference the Advance Decision.
Legal or administrative change, Personal circumstances
Concern about pressure or undue influence	Validity may be challenged if the decision was not made freely.	true	Review privately and seek independent clinical or legal support.
Change of wishes
Recent actions suggest different wishes	Later inconsistent conduct can affect whether the decision remains valid.	true	Confirm current wishes in writing and replace the document if necessary.
You verbally revoke or alter the decision	Advance decisions can be withdrawn or altered while capacity is present.	true	Record the revocation and inform everyone holding copies.
Health change, Treatment change
Mental health admission or treatment planning	Some treatment under mental health law may override ordinary refusals.	true	Get specialist advice on how refusals interact with mental health legislation.
Legal or administrative change
Court of Protection dispute is likely	High-stakes disputes need clear evidence of validity and applicability.	true	Seek legal advice and gather evidence of capacity and settled wishes.
Legal name change	Records may not clearly link the document to your current identity.	false	Attach evidence of name change or sign a replacement version.
NHS or medical record details are corrected	Incorrect identifiers can make retrieval or matching harder in emergencies.	false	Update the document cover sheet and ask records teams to file it correctly.
Digital storage or access method changes	Emergency access may fail if links, apps, or passwords change.	false	Check that paper and digital copies are accessible to relevant people.
Online GP record access changes	Visibility of the document in records may change after system updates.	false	Ask the practice to confirm the latest version is visible on your record.
Care transfers to a different NHS trust or board	Records may not transfer automatically between providers.	false	Provide the latest copy at the first appointment or pre-admission assessment.
Treatment change, Legal or administrative change
Starting private healthcare	Private providers may not have NHS-held copies.	false	Give the private provider a copy and confirm it is in their records.
Health change, Treatment change
New serious allergy or adverse reaction	Treatment refusals may need to distinguish allergy risk from broader refusal.	false	Update medical records and check whether the document needs clarification.
Health change
Stroke or major neurological event	Future capacity, swallowing, ventilation, and rehabilitation choices may change.	true	Review during recovery if capacity is present and update treatment scenarios.
Heart failure or serious cardiac event	CPR, ventilation, defibrillation, and intensive care choices may become relevant.	true	Discuss likely emergencies with cardiology and revise refusals if needed.
Severe lung disease or worsening breathlessness	Non-invasive or invasive ventilation may become foreseeable.	true	Clarify ventilation preferences and share with respiratory services.
Advanced kidney disease diagnosis	Dialysis and intensive care decisions may become foreseeable.	true	Discuss dialysis scenarios with renal clinicians and update the document.
Cancer progresses or recurs	Treatment aims may shift from cure to control or comfort.	true	Review with oncology or palliative care after prognosis discussions.
Increasing frailty or repeated falls	Emergency admissions, surgery, and resuscitation decisions may become more likely.	false	Review with GP or geriatric team and update care records.
Health change, Treatment change
Sepsis or severe infection episode	Future infection treatment, fluids, ICU, or antibiotics may need clarification.	true	Clarify whether refusals apply to severe infections or only end-of-life situations.
Treatment change
Feeding tube is proposed	Tube feeding may need separate consideration from ordinary eating and drinking.	true	Specify whether clinically assisted nutrition is refused and in what circumstances.
Organ transplant assessment begins	Transplant care involves intensive treatment and long-term medication decisions.	true	Review refusals with the transplant team before assessment decisions are made.
Change of wishes, Legal or administrative change
Organ donation wishes change	Donation wishes may affect end-of-life discussions and family communication.	false	Update the NHS Organ Donor Register and ensure documents are consistent.
Treatment change
Joining or leaving a clinical trial	Trial treatments may change foreseeable risks and emergency interventions.	true	Ask the trial team whether refusals affect trial treatment or emergencies.
Personal circumstances, Legal or administrative change
Extended travel or living abroad	Foreign healthcare systems may not recognise an English or Welsh document.	false	Carry copies and seek local advice for longer stays abroad.
Key carers do not read English confidently	Carers may not communicate the document accurately in emergencies.	false	Keep the signed English version and add a reliable translation if useful.
Personal circumstances, Health change
New home care package starts	Home carers need to know who to contact and where the document is kept.	false	Add a copy or note to the care folder and update contact instructions.
Health change, Treatment change
Hospice referral or admission	Hospice care should align symptom relief with refused treatments.	false	Give the hospice a copy and discuss any boundaries around hospital transfer.
Legal or administrative change, Treatment change
Ambulance care plan or special note is created	Emergency responders need quick access to treatment refusals.	false	Ask clinicians to ensure ambulance records note the latest Advance Decision.
Legal or administrative change
Relevant law or official guidance changes	Legal requirements or clinical practice may affect wording or reliance.	true	Check current MCA guidance and consider legal advice before updating.
Time-based review, Personal circumstances
Major age milestone or retirement	Care priorities, contacts, and health risks may have changed.	false	Use the milestone to check wishes, contacts, and copy holders.
Health change, Treatment change
Swallowing problems or dysphagia develop	Feeding, fluids, aspiration treatment, and tube feeding may become relevant.	true	Clarify assisted nutrition, hydration, and infection treatment preferences.
Change of wishes, Treatment change
Pain relief or sedation preferences change	Comfort-care wishes should sit consistently alongside treatment refusals.	false	Update any advance statement or care plan and check the refusal wording.
Health change, Personal circumstances
Major change in disability or independence	Views about acceptable quality of life or treatment burden may change.	true	Reflect on current wishes and revise refusals if assumptions have changed.

When Should You Review An Advance Decision In The UK?

An Advance Decision should be reviewed whenever the document may no longer match your current wishes, treatment options, diagnosis, or the people who may need to rely on it. A review is especially important after a major health change, a new treatment option, a move into care, or any change affecting who holds copies of the document.

When Is A New Advance Decision Needed?

A new signed and witnessed version may be needed if you change a refusal of life-sustaining treatment, add or remove treatments, change the circumstances in which a refusal applies, or create conflicting documents such as a Health and Welfare Lasting Power of Attorney. Under the Mental Capacity Act 2005, a refusal of life-sustaining treatment must be in writing, signed, witnessed, and contain a statement that it applies even if life is at risk.

What Practical Steps Help Keep An Advance Decision Effective?

Review regularly: a planned review every year, or after any major change, helps show the decision still reflects your wishes.
Update key people: give the latest version to your GP, hospital team, care home, attorneys, family members, and anyone named as an emergency contact.
Destroy or clearly revoke old versions: keeping outdated copies can create uncertainty in urgent care.
Check for conflicts: make sure your Advance Decision is consistent with any Health and Welfare LPA, advance statement, DNACPR form, ReSPECT form, or care plan.
Seek clinical input: ask a relevant healthcare professional to explain how your refusals apply to your current diagnosis, treatment choices, and likely emergencies.

Advance Decision Review and Update Triggers

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FAQs

When should I review my Advance Decision in the UK?

Review your UK Advance Decision whenever your health, treatment preferences, personal circumstances or the law changes. Common triggers include a new diagnosis, surgery, pregnancy, moving home, changing GP, appointing or changing attorneys, or any change in views about life-sustaining treatment.

How often should an Advance Decision be updated?

What changes mean I should update my Advance Decision?

How do I replace an old Advance Decision with a new one?

Is an old Advance Decision still legally valid?

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