Online Wills & Holistic Legacy Preservation

Step-by-step: creating a dementia-ready advance directive (digital-first)

Step 1 — Clarify values while capacity is strong

Begin with what matters most, not with procedures. Use prompts:

• “If I could not recognise family or engage meaningfully, what trade-offs would I accept?”
• “Is being at home, with comfort measures, more important than hospital-based life prolongation?”
• “Which spiritual, cultural, or community practices should guide my care?”

Write a short values statement in your own words (2–6 sentences). This anchors later choices when particulars get messy. Advance Care Planning Australia offers conversation guides and forms to help start and structure these discussions (advancecareplanning.org.au).

Tip: If memory is already fluctuating, record a brief video statement alongside your written directive. This humanises your choices and helps proxies advocate with confidence.

Step 2 — Translate values into medical preferences

With dementia, decisions often centre on:

• Resuscitation (CPR) in advanced disease or late dementia.
• Mechanical ventilation for pneumonia or other respiratory failure.
• Artificial nutrition and hydration (feeding tubes) in advanced dementia.
• Hospital transfers for acute infections vs symptom control at home/hospice.
• Antibiotics when burdens outweigh benefits (e.g., repeated infections at end of life).
• Pain and symptom control priorities; use of palliative sedation in refractory suffering (jurisdiction-specific and specialist-led).

The Alzheimer’s Association outlines common scenarios and how to record healthcare wishes that reflect personal goals (https://www.alz.org/). Palliative Care Australia provides a values-based frame for relief of suffering, dignity, and family support across settings (palliativecare.org.au).

Keep language conditional and contextual (“If I am in advanced dementia with no meaningful interaction…”). Absolutes age badly; scenario-linked preferences age

better.

Step 3 — Choose your healthcare proxy (substitute decision-maker)

Pick someone who:

• Understands your values and can articulate them under pressure.
• Will advocate respectfully with clinicians.
• Has the emotional bandwidth for tough calls and family pushback.
• Will keep documents current and accessible (digital + paper).

Have a dedicated conversation with your nominee. Share your values statement, talk through common dementia scenarios, and confirm they accept the role. Then appoint them using your jurisdiction’s recognised enduring power of attorney (medical) or equivalent. Advance Care Planning Australia centralises state/territory specifics and forms (advancecareplanning.org.au). The NIA discusses how to select and brief a healthcare proxy and why to review the choice over time (advance care planning).

Step 4 — Address guardianship and legal authority

If no suitable proxy exists—or where additional decisions (accommodation, services) require authority—understand the guardianship pathway in your state. Good planning avoids default tribunals later. Record who should be considered if guardianship becomes necessary and ensure your directive references legal authority clearly.

Step 5 — Draft the directive (plain, precise, jurisdiction-aware)

Use recognised templates or clinical forms for your state/territory. Key sections:

• Identity and capacity statement at the time of signing.
• Values summary (your compass).
• Medical preferences (including any advance refusal under defined conditions).
• Proxy details, contact information, alternates.
• Clinical team coordination instructions: GP/specialist names, preferred palliative providers, where to send the document.
• Sharing consent: explicit permission to share the directive across providers and systems.
• Review cadence (e.g., annually, or after hospitalisation).

Healthdirect summarises what makes a directive valid and how witnessing works in each jurisdiction (https://www.healthdirect.gov.au/)  Advance Care Planning Australia hosts jurisdictional forms and practical “how-to” resources (advancecareplanning.org.au).

Step 6 — Execute it correctly (witnessing, signatures, digital options)

Follow your state’s witnessing requirements (eligible witnesses, not related, etc.). If using digital signatures or digital witnessing, verify that your jurisdiction recognises these for health directives; laws vary and can change. Keep an original signed copy even if you create a fully digital workflow. The NIA stresses legality and clarity in execution (advance care planning).

Step 7 — Digitise and distribute (so people can actually use it)

A directive nobody can find is theatre. Create a distribution plan:

• Upload the signed directive (PDF) to a digital legacy vault (e.g., Evaheld Vault) with role-based access for your proxy, key family members, and clinicians.
• Add your directive to My Health Record (or your national clinical repository) so emergency teams can see it.
• Store aligned items together: online directives, online estate documents, online executor tools, online testament (for estate matters), and a digital asset inventory (for photos, cloud accounts, social media).
• Issue an Emergency Access Card or wallet card that states: “Advance Directive stored in [vault name]; proxy: [name + phone].”
• Record a short video summarising your values and priorities; store it alongside the directive to support ethical consent interpretation if disputes arise.

Step 8 — Build a dementia-specific treatment plan with your clinicians

Work with your GP, geriatrician, or palliative team to translate preferences into a treatment plan clinicians can action (e.g., resuscitation status, hospital-transfer thresholds, community palliative referral triggers). Palliative Care Australia emphasises early integration of palliative services—symptom control, caregiver education, and psychosocial support—not just end-stage care (palliativecare.org.au).