The Substitute Decision Maker Hierarchy

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What is a Substitute Decision Maker? 

The term used in Ontario law for the person who would make health and personal care decisions on your behalf when you are unable to do so is “Substitute Decision Maker” (SDM).

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. 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).

The Substitute Decision Maker Hierarchy in Ontario 

As previously mentioned, everyone in Ontario has a SDM even if he or she has never prepared a Power of Attorney for Personal Care appointing someone to act in that role.  The Health Care Consent Act includes a hierarchy of SDMs that includes:

  • three different types of SDMs that get authority through different types of legal processes,
  • family members that get authority to automatically act as SDMs without being appointed – you don’t have to do anything; and
  • an SDM of last resort.

The person, or persons, in your life ranked highest in the Substitute Decision Maker Hierarchy who meet(s) the requirements to act as a substitute decision maker will be your SDM(s) for health care.

Requirements to be a Substitute Decision Maker in Ontario:

  1. Being mentally capable of understanding the treatment/care being proposed and appreciating the consequences of consenting or refusing the treatment decision
  2. Be at least 16 years old (unless you are the parent of the incapable person)
  3. Not prohibited by court order or separation agreement from acting as SDM
  4. Available in person, by phone or via electronic communication
  5. Willing to act as SDM

Additional Resources:

Power of Attorney for Personal Care booklet, click here.

Detailed description of the hierarchy, click here.

Advance Care Planning, click here. 

Start the Conversation, click here

Ontario Health Care Consent Advance Care Planning workbook, click here.