It is important to acknowledge that our health can change without warning. You never know when someone will have to speak for you. In Ontario, there are specific laws about when and who can make health care decisions on your behalf, should you become mentally incapable of doing so. We encourage you to browse the resources available below and participate in the appropriate Advance Care Planning conversations. It can be difficult to have these conversations with your family or friends, but they prove to be helpful in the time needed.

Your Substitute Decision Maker must know what’s important to you – what quality of life means to you – so they can step into your shoes and make future health care decisions that you would make for yourself if you could. It’s not about specific health care decisions, it’s about sharing an understanding of what values and wishes can inform future health care decisions.

Why is this important now?

In Ontario, Advance Care Planning involves two steps. In the first step you identify who will be your Substitute Decision Maker(s) or SDM(s). There are two ways to identify who would be your SDM in Ontario:

  1. The Health Care Consent Act provides a hierarchy (ranked listing) of your possible automatic SDMs (see illustration) The individual(s) highest on this list who meets the requirements to be a SDM in Ontario is your automatic SDM. You don’t have to do anything to have this automatic SDM make decisions for you when you are mentally incapable of doing so because this SDM has the right to act for you by this law. Or if you prefer to have someone else other than your automatic SDM then:
  2. You can choose and name a person, or more than one person, to act as your SDM by preparing a document called a Power of Attorney for Personal Care (POAPC). This legal document can be done with the assistance of a lawyer or you may do it yourself by accessing the document on the Ontario attorney general website. In the second step you have important conversations with your SDM(s) and others to share information about what’s important to you, your wishes, values and beliefs, and anything else that you think will help your SDM(s) understand how you would like to be cared for.

Having a conversation before a medical crisis occurs allows time for reflection about how a serious illness may impact your health and your life. It helps you:

  • Think about your values and goals
  • Reflect on healthcare choices you may have to make if you become severely ill
  • Consider the person(s) who can make decisions for you if you cannot make them yourself, and
  • Talk with this person(s) and other family or friends about your goals, values, and preferences for medical or personal care if you were to become ill

Who should you include in this discussion?

These discussions must be with your SDM(s) and other loved ones who can support your SDM(s) at a time of crisis. It’s important that your SDM knows what’s important to you – what quality of life means to you – this prepares them to step into your shoes if needed and make future health care decisions that you would make for yourself. It’s not about specific health care decisions or treatments, it’s about sharing an understanding of what values and wishes can inform future health care decisions.

It is important that your SDM(s) is someone who is willing to:

  • Accept this role
  • Talk with you about your goals, values, and preferences
  • Follow your decisions (even if they do not agree with them), and
  • Make decisions in difficult moments (such as stressful times, differing opinions, crisis situations)

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