You will always be asked to make decisions about your health care as long as you can understand information about your care options and can communicate your wishes. However, if you are too sick to make this decision and speak for yourself, you will need someone to speak to your health-care providers and make decisions for you. This is your substitute decision maker.
Choosing who would make future health-care decisions for you, if you can’t do it yourself, is a key part of Advance Care Planning.
Your expressed values, wishes and beliefs, like those expressed during Advance Care Planning, will help your substitute decision makers and health-care providers make decisions about your care that aligns with what matters most to you. Your substitute decision maker may also consult other people in your life to learn about what matters most to you and what care you would want.
If a decision is needed and you have trouble understanding information, even with support, your substitute decision maker should still try to ask you about your wishes
As well as consulting with you to the greatest extent possible, your substitute decision maker must consider your previously expressed wishes or instructions when making a decision. If your substitute decision maker doesn’t know your wishes, they must make decisions they believe to be in your best interests.
Your substitute decision maker’s role is to speak and advocate for you when you are unable to speak for yourself. They will provide consent for medical care or treatments and make sure your wishes are known. They must honour your wishes and instructions.
Note: there is only one way to choose who your substitute decision maker is in BC – by appointing a Representative in a Representation Agreement.
Enduring Power of Attorney doesn’t cover health matters. The person you appoint in an Enduring Power of Attorney (Your Attorney) can take care of your legal and financial matters but can’t make health or personal care decisions for you.
If you are mentally incapable of making decisions for yourself and have no other legal documents in place, the BC Supreme Court may appoint a committee to make personal, medical, legal, and financial decisions for you. A committee is made up of one or more people (e.g., family member or close friend) or bodies such as the Public Guardian and Trustee of BC Once a committee is appointed, health-care providers must obtain consent from the committee.
It is usually a last resort in Advance Care Planning, as:
Learn more about committeeship on Peopleslawschool.ca.
Your Representative is a person appointed by you in a Representation Agreement to make personal and health-care decisions for you, if you can’t make these decisions on your own.
You can name one or more Representatives in your Representation Agreement. You can also name Alternate Representatives to act if your Representative can’t.
A Representation Agreement is a legal document, but you do not need a lawyer or notary to prepare a Representation Agreement.
See here for requirements for making a Representation Agreement.
For more information on Enhanced Representation Agreements, see our three-part resource:
An Advance Directive is a legal document that includes instructions from you to your health-care providers about specific treatments that you accept or refuse. These instructions are only used when you can’t make decisions for yourself, and there is no Representative appointed*.
An Advance Directive deals only with a specific treatment; do not record your general wishes or what matters most to you in life in an Advance Directive. You can record this information in an Advance Care Plan.
The instructions in your Advance Directive must be clear about the specific treatments you refuse or accept. See here for more information and other requirements for making an Advance Directive.
It is hard to cover every possible decision in an Advance Directive. If your Advance Directive is unclear or does not cover the specific situation you are in, your health-care provider will ask your Representative or Temporary Substitute Decision Maker for consent. Therefore, even with an Advance Directive, it is still important to consider who your substitute decision maker will be!
Your Representative will still be asked to make decisions, unless you state in your Representation Agreement that they should not be asked about decisions covered in your Advance Directive. Your Representative must still treat your Advance Directive as your wishes when making decisions.
Without a Representative or an Advance Directive, your health-care provider will need to identify someone to make those decisions for you. In health-care, this person is called your Temporary Substitute Decision Maker. The selected person is the first person to qualify as your Temporary Substitute Decision Maker on a list defined by BC law.
The list of potential Temporary Substitute Decision Makers is defined by BC law to make sure all British Columbians have somebody to make decisions for them if needed.
Your health-care provider can only move to a person lower down on the list if all the people above them are unavailable, unwilling or do not qualify.
The first person on the list below who is willing, available and qualifies will be your Temporary Substitute Decision Maker:
Your health-care provider will contact the Public Guardian and Trustee if:
Production of this document has been made possible thanks to funding from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada.