Overview

What is a substitute decision-maker?

Your substitute decision-maker (SDM) (health care agent, proxy, surrogate) 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 general, a substitute decision-maker can agree to or refuse treatment. He or she can also stop treatment on your behalf.

To make these decisions, your substitute decision-maker can use the information in your advance care plan. Your substitute decision-maker can also use statements you have made in the past and what he or she knows about you. Your substitute decision-maker can agree to surgery. He or she can refuse to have you placed on life-support machines. Your substitute 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, proxy, surrogate) 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 he or she 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 he or she wants.
• 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 substitute 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 substitute decision-maker, the decisions your family can make may be limited.

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

Who can be a substitute decision-maker?

For your health care agent (health care proxy, health care surrogate), you may choose:

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

Most states allow you to choose only one person at a time to be your health care agent. In most cases, your doctor cannot be your health care agent. In some states, a person who works at the health care facility where you might be treated may not be your agent, unless you are related to the person by blood or by marriage.

If your state allows, choose one or two alternate agents who can fill the role if your primary agent is not available or is not able to do so.

Decisions a Substitute Decision-Maker Can Make

Your substitute decision-maker, also called a health care agent, proxy, or surrogate, can make decisions about the kind of care you get as you near the end of your life. He or she also can make decisions any other time you can't speak for yourself. One example is if you're severely injured.

Provincial laws vary about the types of decisions substitute decision-makers can make. In general, they can agree to or refuse treatment. They can also stop treatment on your behalf.

To make these decisions, your substitute decision-maker can use the information in your advance care plan (living will). Your agent can also use statements you have made in the past and what he or she knows about you. Your substitute decision-maker can agree to surgery. He or she can refuse to have you placed on life-support machines. Your substitute decision-maker also can ask that you be taken off life support if you made this wish clear before you became ill.

Your substitute decision-maker becomes even more valuable if your condition changes. He or she can talk to your doctors about care options. Your substitute decision-maker can weigh the risks and benefits and can make decisions based on the specific situation. He or she 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 substitute 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 substitute decision-maker or an advance care plan, you may not get the care you want if you can't speak 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 will be made by hospital staff.

In some provinces, 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 substitute 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, proxy, surrogate) about your desires, values, fears, and preferences about the types of medical care you would want in different situations.

Make sure your substitute decision-maker knows what you think is an acceptable quality of life. Let your substitute decision-maker 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 substitute 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 substitute decision-maker may need to make a decision for you. But the more your substitute decision-maker knows about you and your values, the more likely he or she 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 on a legal form. The form is usually called a proxy 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 bar association, medical 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 substitute decision-maker can make. Or they may limit the substitute 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 substitute decision-maker with you as you write your proxy directive or representation agreement so that he or she understands 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 substitute 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 he or she 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 substitute decision-maker is. And let them know how to contact him or her.

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