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Substitute Decision-Maker

​​​Decide who will speak on your behalf

Sometimes a patient becomes incapable of making health care decisions. Being incapable may last a short or long time. It may recur over a period of time. A patient may be incapable for making one kind of decision, but not another kind. While the patient is incapable, someone else must be responsible for making decisions on their behalf. When the patient regains capacity, a Substitute Decision-Maker is no longer needed.

To decide who will speak on your behalf should you become incapable, think carefully about who you feel would understand, honour and follow your wishes, and would be most capable of making medical decisions on your behalf as your Substitute Decision-Maker. This may be a spouse, an adult child, a trusted family member or a good friend. Your Substitute Decision-Maker should be someone you know well and trust, because this person will be making decisions about your health and personal care. It is a good idea to check with the person before appointing him or her as a Substitute Decision-Maker to make sure the person is both willing and able to perform this role.

You can name your Substitute Decision-Maker in a Power of Attorney for Personal Care​. You can appoint 1 person, 2 people or a primary person and a back-up person.

In Ontario, the law provides that even if you do not appoint someone to act on your behalf, you will still always have a Substitute Decision-Maker that the health professional must turn to get consent or refusal of consent to any treatments for you.

Your legally determined Substitute Decision-Maker is the person highest on this list that applies to you:

  • An attorney for personal care with the authority to give or refuse consent to treatment
  • A representative appointed by the Consent and Capacity Board
  • A spouse or partner
  • A child (over 16 years of age) or parent
  • A parent with right of access only
  • A brother or sister
  • Any other relative related by blood, marriage or adoption
  • The office of the Public Guardian and Trustee

If none of your relatives are able or willing to act as a Substitute Decision-Maker, the Public Guardian and Trustee will make decisions for you.

When you have decided on your Substitute Decision-Maker, it can be helpful for both of you to talk about future care. By expressing your wishes to your Substitute Decision-Maker, you can make sure that this person understands and respects how you feel, and will make decisions that are right for you. This conversation will also give your Substitute Decision-Maker a chance to ask questions and to confirm that he or she understands what kind of care and treatment you want.​