Choosing a Substitute Decision-Maker

Overview

What is a substitute decision-maker?

Your substitute decision-maker (health care agent, representative, or proxy) can make decisions about the kind of care you get as you near the end of your life or anytime you can't speak for yourself. One example is if you are severely injured. In most cases, your decision-maker can't make decisions related to your finances or will unless you give them that authority through a different legal document.

In general, a decision-maker can agree to or refuse treatment. They can also stop treatment on your behalf.

To make these decisions, your decision-maker can use the information in your advance care plan. Your decision-maker can also use statements you have made in the past and what they know about you. Your decision-maker can agree to surgery and can refuse to have you placed on life-support machines. Your decision-maker also can ask that you be taken off life support.

How do you choose a substitute decision-maker?

Choose your substitute decision-maker (health care agent, representative, or proxy) carefully. You can choose a family member or someone else. Talk to the person before you decide. Make sure the person is comfortable with this responsibility.

It's a good idea to choose someone who:

• Is of legal age in your province. This is usually age 18 or 19 years.
• Is someone you trust.
• Knows you well and understands what makes life meaningful for you.
• Understands your religious and moral values.
• Will honour your wishes and do what you want, not what they want.
• Will be able to make hard choices at a stressful time.
• Will be able to refuse or stop treatment, if that's what you would want, even if you might die.
• Will be assertive with doctors if needed.
• Will be able to ask questions of doctors and others to get the information needed to make decisions.
• Lives near you or will travel to you if needed.

Who will make decisions for you if you don't have a substitute decision-maker?

If you don't have a substitute decision-maker or an advance care plan, you may not get the care you want. Decisions may be made by family members who disagree about your medical care. Or decisions may be made by a medical professional who doesn't know you well.

When you name a substitute decision-maker, it is very clear who has the power to make health decisions for you.

Choosing Your Substitute Decision-Maker

Choose your substitute decision-maker carefully. This person may or may not be a family member.

Talk to the person before you make your final decision. Make sure this person is comfortable with this responsibility.

It's a good idea to choose someone who:

• Is of legal age in your province. This is usually age 18 or 19 years.
• Knows you well and understands what makes life meaningful for you.
• Understands your religious and moral values.
• Will do what you want, not what they want.
• Will be able to make difficult choices at a stressful time.
• Will be able to refuse or stop treatment, if that is what you would want, even if you could die.
• Will be firm and confident with health professionals if needed.
• Will ask questions to get needed information.
• Lives near you or agrees to travel to you if needed.

Your family may help you make medical decisions while you can still be part of that process. But it's important to choose one person to be your decision-maker in case you aren't able to make decisions for yourself.

If you don't fill out the legal form and name a decision-maker, the decisions your family can make may be limited.

A substitute decision-maker also may be called a health care agent, representative, or proxy.

Who can be a substitute decision-maker?

For your substitute decision-maker (health care agent, representative, or proxy), you may choose:

• Your partner.
• A child or grandchild.
• Another family member.
• A close friend.
• An attorney.

Most provinces and territories allow you to choose only one person at a time to be your decision-maker. In most cases, your doctor cannot be your decision-maker.

If your province allows, choose one or two other people who can fill the role if your primary decision-maker is not available or is not able to do so.

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Decisions a Substitute Decision-Maker Can Make

Your substitute decision-maker, also called a health care agent, representative, or proxy, can make decisions about the kind of care you get as you near the end of your life. A decision-maker also can make decisions any other time you can't speak or decide for yourself. One example is if you're badly hurt in a car crash.

Provincial laws vary about the types of decisions decision-makers can make. In general, they can agree to or refuse treatment. They can also stop treatment on your behalf. In most cases, your decision-maker can't make decisions related to your finances or will unless you give them that authority through a different legal document.

To make these decisions, your decision-maker can use the information in your advance care plan. Your decision-maker can also use statements you have made in the past and what they know about you. Your decision-maker can agree to surgery and can refuse to have you placed on life-support machines. They also can ask that you be taken off life support if you made this wish clear before you became ill.

Your decision-maker becomes even more valuable if your condition changes. They can talk to your doctors about care options, weigh the risks and benefits, and make decisions based on the specific situation. Your decision-maker can also be more credible in seeking a second opinion or when talking to hospital staff about your care. This can be important if your decision-maker feels that decisions about your health care are not being made in the way that you would wish.

If you don't have a decision-maker or advance care plan, you may not get the care you want if you can't speak or decide for yourself. Decisions about your care may be made by family members who disagree with your wishes. Or decisions may be made by a doctor who doesn't know you. In some cases, the decision may be made by hospital staff or a judge.

In some areas, hospital staff must take steps to keep you alive as long as possible if your wishes aren't known. This means you could be on life support for a long time, even if that isn't what you would want.

When you name a decision-maker, it's very clear who has the power to make health decisions for you.

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What a Substitute Decision-Maker Needs to Know

Talk to your substitute decision-maker (health care agent, representative, or proxy) about your desires, values, fears, and preferences about the types of medical care you would want in different situations.

Make sure your decision-maker knows what you think is an acceptable quality of life. Let them know when you would or wouldn't want treatment. This may depend on your chances for recovery.

Don't assume that someone close to you, like a child or spouse, knows what you would want. Your decision-maker may not know about or share your preferences. So it's important to talk openly about your wishes.

It's not possible to discuss all the situations in which your decision-maker may need to make a decision for you. But the more they know about you and your values, the more likely they will be able to make the kinds of decisions you would make if you could.

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How to Name a Substitute Decision-Maker

You name your substitute decision-maker as part of your advance care plan. In some provinces, you may use a special form. The form may be called a personal directive or representation agreement. Your substitute decision-maker and the form may be called something else in your province.

This form may be available through your provincial health authority, bar association, or office for the aging. Law offices and hospitals also may have these forms or can tell you where to find them.

Read the forms carefully. Some provinces may limit the types of decisions that a decision-maker can make. Or they may limit the decision-maker's power to only those decisions written in your advance care plan. Depending on the laws in your province, you may want to have your decision-maker with you as you write your advance care plan so that they understand your wishes.

You must sign the form to make it valid. You don't need a lawyer or attorney to complete this form. But it must be witnessed by someone other than you and your decision-maker. Some provinces require you to get the form notarized. This means that a person called a notary public watches you sign the form. And then the notary also signs the form. Provinces may also require that at least two witnesses sign the form.

Be sure to tell your family, your doctors, and anyone else who might be involved in your medical care who your decision-maker is. And let them know how to contact your decision-maker.

You can make changes to your personal directive or representation agreement at any time. You can also choose a different person to be your decision-maker.