What is a substitute decision-maker?

Because critically ill patients are often unable to speak for themselves, we need to identify a Substitute Decision Maker. The selection of a Substitute Decision Maker is guided by the Health Care Consent Act. A Substitute Decision Maker is appointed according to the following heirarchy:

  1. Power of Attorney
  2. Spouse (living together in a married or common-law relationship)
  3. Parent or child
  4. Siblings
  5. Other relatives

Anyone can appoint an individual to act as a Substitute Decision Maker, prior to a need arising. A person appoint to make decisions about health care is called an "attorney for personal care". This appointment can be written into a legal document, called a "Power of Attorney". The person given Power of Attorney for personal care may be different than the person given Power of Attorney for financial issues. The appointment needs to be made when an individual is competent and capable of making this decision. Critically ill patients are often too ill or under the influence of medications that limit their ability to make informed decisions.

A Substitute Decision Maker must be willing, available and capable of taking on this responsibility. If the individual identified does not meet this criteria, we move down the list to identify the most appropriate Substitute Decision Maker. If a patient does not have a Power of Attorney for Personal Care or an appropriate family member, a guardian can be appointed by the court. A social worker can help you to identify the Substitute Decision Maker for patients in CCTC.

LHSCPatients, Families & Visitors

Last Updated March 23, 2009 | © 2007, LHSC, London Ontario Canada