What is Advance Care Planning?

In Ontario, Advance Care Planning (ACP) is

Confirming your substitute decision maker(s) (SDMs)
Communicating your wishes, values and beliefs about care to help
your SDM(s) make health and personal care decisions for you if you
become mentally incapable of doing so for yourself.

Why is this Important?

In Ontario, the law requires all health care providers to get informed consent, or refusal of consent, before providing a patient with any treatment or care. Health practitioners must tell you about your illness and what may be done to treat you. You then have the right to make a decision and agree to or refuse the treatments offered. This is called health care consent: it is a basic patient right to decide what health care to receive.

Only in emergencies, to save a life or to reduce suffering, can people be treated without informed consent. Consent always comes from a person: either the mentally capable person or their substitute decision maker(s).
If you are not mentally capable, the health practitioner will turn to another person, your substitute decision maker, who will then speak for you and make the decision about your care.

Advance care planning is not about decisions. It is about preparing you, and your future substitute decision maker(s), for a time when you may not be able to make your own health or personal care decisions because of your lack of mental capacity. At that time, your future SDM would step in to give or refuse consent for treatment.


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 Hirearchy 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.

If you would like a more detailed description of the hierarchy click here.


For more information on Health Care Consent and Advance Care Planning, please see the Ontario Health Care Consent Advance Care Planning workbook