In Ontario, you can choose someone (or more than one person) to be your Substitute Decision-Maker(s) by preparing a Power of Attorney for Personal Care.
A Power of Attorney for Personal Care is a document, in writing, in which you name someone to be your "attorney." The word attorney does not mean lawyer. In this case, an attorney is a type of Substitute Decision-Maker.
To be valid, the document must:
- be signed by you voluntarily, of your own free will;
- be signed by you in the presence of two witnesses;
- be signed by the two witnesses in front of you.
Also, you must be mentally capable of understanding and appreciating what kind of document you are signing and what you are doing by signing such a document.
To assign Power of Attorney to your Substitute Decision-Maker, you can use a Power of Attorney kit. These kits are available from UHN Patient and Family Libraries, and the Ministry of the Attorney General's Office. You do not have to consult a lawyer about your power of attorney for it to be valid, but it may be a good idea to talk to a lawyer if your wishes or financial matters are complicated.
How Do I Make Decisions for a Loved One?
As a Substitute Decision-Maker, you should base your decisions on your loved one's previously expressed wishes. To help make your decisions, ask yourself what your loved one – the patient – would say if he or she could speak. Would your loved one want this treatment?
If the patient did not express his or her wishes and you do not know what he or she would say or want, you must make decisions in the patient's best interests. This means making decisions that may improve your loved one's condition, prevent it from getting worse or improve quality of life. Consider your loved one's values and beliefs when you make your decisions.
What If There Are Disagreements About Decisions?
If there is more than one Substitute Decision-Maker, they may disagree on what decisions to make about the patient's care or treatment. There are professionals here at the University Health Network who can help you resolve disagreements. If the Substitute Decision-Makers still find it difficult to agree, we will refer you to the office of the Public Guardian and Trustee or the Consent and Capacity Board.
Very rarely, the health care team may think the decisions made by the Substitute Decision-Maker are not in the patient's best interests or do not respect the patient's values and beliefs. In this case, the health care team and Substitute Decision-Maker will meet to discuss the decisions. The health care team may apply to the Consent and Capacity Board if the discussions do not resolve the disagreement.
We are committed to making sure that patients and Substitute Decision-Makers know their rights and obligations. You can talk to the staff at UHN if you have questions. Doctors, nurses, social workers, chaplains and bioethicists can help you make the choices your loved one would want.
