Substitute Decision Makers

Substitute Decision Makers

Who Can Make Health Care Decisions for You if You Cannot

If you need health care and are able to accept or refuse the care, you will always be asked.

If you are too sick to speak for yourself and make this decision, your health care providers will look to other sources to make or guide the decision based on your wishes. In BC they will look to:

1. Your Representative

If you have a Representation Agreement, the person you appointed in it to represent you (your Representative) will be asked to make health care decisions for you.

If you don’t have a Representative
2. Your instructions in an Advance Directive

If you have an Advance Directive (a written legal document) that contains instructions related to the health-care decision that needs to be made, your health-care provider will follow those instructions.

If you don’t have an Advance Directive
3. A Temporary Substitute Decision Maker

Your health-care provider will identify a person to speak for you (your Temporary Substitute Decision Maker) by following a list defined by law.

Health care providers may call a person making decisions for you your Substitute Decision Maker. In BC, this may mean your Representative or your Temporary Substitute Decision Maker.

For more information about each option, click on the names above or keep scrolling down the page.

Choosing who will make health care decisions for you, if you cannot, is a key part of Advance Care Planning.

Did you know?

In BC, the law for health care decisions is different than the law for legal or financial decisions. For legal and financial decisions, you can use an Enduring Power of Attorney (EPOA) to appoint someone (called your attorney). Your Attorney cannot make health or personal care decisions for you.

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A Representation Agreement is a written legal document that names one or more people to make health care decisions on your behalf, if you are not able to make those decisions yourself. The person you name in a Representation Agreement is called your Representative. Health-care providers may call this person your Substitute Decision Maker.

You can make a Representation Agreement with or without the help of a lawyer or notary public.

There are two types of Representation Agreements:

A Representative appointed by a Section 9 Representation Agreement:

  • can make personal care and health care decisions for you, including decisions to refuse life support;
  • cannot make any legal or financial decisions for you.

You must be capable to make a Section 9 Representation Agreement.

A Representative appointed by a Section 7 Representation Agreement:

  • can make personal care, routine financial and some health care decisions for you;
  • cannot refuse life support treatments.

You can make a Section 7 Representation Agreement even if you have diminished capability.

How to choose a good Representative

Think who the best person is to speak for you. Choose a capable adult who:

  • knows you well and understands your values, beliefs and wishes;
  • you can trust to honour your wishes and instructions, even if they differ from their own;
  • is calm in a crisis and can handle conflict;
  • can communicate your wishes clearly and advocate for you; and
  • is willing and available to take on the role.

Once you know who you want to be your Representative, discuss this with them to make sure they are ok with having this role and make sure they know your health care wishes.

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An Advance Directive is a written legal document in which you can give or refuse consent for a specific health care treatment you may be offered in the future when you are not capable of providing consent.

You Advance Directive must be:

  • clear about the specific treatments you are addressing;
  • in writing;
  • signed, witnessed and dated.

You may not use an Advance Directive to ask for:

  • medical treatments not recommended by your health care provider;
  • something prohibited or required by law; or
  • medical assistance in dying.

If your Advance Directive is unclear or does not cover the specific situation you are in, your health care providers will obtain consent from your Representative if you have appointed one, or a Temporary Substitute Decision Maker if you have not.

You should talk with your health care provider about what to write in your Advance Directive so that it is clear and specific.

Your general wishes about future health care decisions, including what matters most to you, should not be recorded on an Advance Directive. You can record these wishes in an Advance Care Plan.

If you have both a Representation Agreement and an Advance Directive

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.

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Temporary Substitute Decision Maker (TSDM)

The Temporary Substitute Decision Maker List ensures all British Columbians have somebody to make decisions for them if needed.

A Temporary Substitute Decision Maker is selected by your health care provider from a list defined by law. Your health care provider can only choose a person lower down on the list if all the people above them are unavailable, unwilling or do not qualify.

A Temporary Substitute Decision Maker is only selected if:

  • you have not appointed a Representative who is available and authorized to make the decision needed; and
  • you do not have an Advance Directive that addresses the specific health care needed.
Temporary Substitute Decision Maker List

The first person on the list below who is willing, available and qualifies:

  1. Your spouse (including common-law, same-sex. Length of time living together does not matter)
  2. Your child (equally ranked)
  3. A parent (equally ranked)
  4. A sibling (equally ranked)
  5. A grandparent (equally ranked)
  6. A grandchild (equally ranked)
  7. Anyone else related to you by birth or adoption
  8. A close friend
  9. A person immediately related to you by marriage (in-laws, step-parents, step-children)
  10. Public Guardian and Trustee (PGT) of BC or a person appointed by PGT

To qualify, the person must be:

  • 19 years of age or older;
  • capable;
  • have no dispute with you; and
  • in contact with you in the past year.

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