Hamilton Health Sciences
Palliative Care at HHS

Advance Care Planning and Substitute Decision Maker Resources

Advance care planning is the process of reflection  and communicating personal care preferences. By doing so others will know your wishes if  you become incapable of making medical treatment decisions. Two of the most critical components of  advance care planning is to identify a substitute decision maker, and communicate your wishes, values and health preferences with them.  By doing so the person who may be asked to make medial decisions on your behalf will have a clearer understanding of  what your healthcare choices would be. 

Often people find it difficult to talk about death and dying.  These fears may inhibit us for engaging in advance care planning. A number of resources are available to assist in making this process easier, engaging and interesting. In the process we learn a lot about ourselves, our loved ones and the complexities of our medical system become a bit easier to understand.

Hamilton Health Sciences (HHS) is committed to educating our patients, families, staff and volunteers about the importance of advance care planning (ACP).

Two of the most critical components of  advance care planning are to identify a substitute decision maker (SDM), and to communicate one’s wishes, values and health preferences with them.

What is a substitute decision maker (SDM)?

A substitute decision maker (SDM) is an individual chosen to make medical decisions on behalf of another person if they are unable to do so for themselves. This is an very difficult role for someone to do on your behalf. In order to make their job easier it is important that you share your health preferences with your SDM while you are capable. By doing so your SDM will have a very clear idea of the choices you would make for yourself. Some of the medical decisions that may be proposed by the health care team are such things as medications, feeding tubes, breathing tubes, CPR, medical procedures such as surgery, and living options if we can no longer care for ourselves in our own home. Your SDM should have an understanding of your health preferences so that they make the right decisions for you.

What happens if I don’t appoint  anyone to make decisions on my behalf? The Ontario Health Care Consent Act provides a list of eligible decision makers, in ranking order,  who can be your substitute decision maker. If you appoint a substitute decision maker they are called your Power of Attorney for person care (POAPC) and are placed at the top of the ranking order.

In becoming a SDM it is important for one to consider the person’s previously desired wishes and to act in the best interests of the individual. The following questions should be asked by a SDM to ensure they are making choices for another individual that are consistent with that individuals values, wishes and health preferences:

  • Do I understand what’s important to my loved one? Do I know their health and personal care wishes?
  • Am I willing to communicate those wishes, even if they aren’t what I would choose?
  • Am I able to communicate clearly with health care professionals and ask questions?
  • Can I make difficult decisions, even during stressful times?
  • Do I know the legal requirements of my roles as a SDM  in my province/territory?

As part of the Advance Care Planning Initiative in Canada, the Speak Up campaign and HHS have several valuable resources available here.  

To view the Speak Up - Start the converstation about end-of-life care click here

To view the video on What is your role in Health Care Decision-Making in Ontario click here

To view the Cancer and Advance Care Planning document click here

To view Your Conversation Starter Kit click here

To view Your Conversation French Starter Kit click here

To view Your Conversation Mandarin Starter Kit click here

To view Your Conversation Spanish Starter Kit click here

To view How to Talk To Your Doctor click here

To view How to Talk To Your Doctor French click here

To view How to Talk To Your Doctor Spanish click here

To view the Pediatric Starter Kit:  Having the Conversation with Your Seriously Ill Child click here

To view the Hear our Voice, a workbook for parents and guardians to support Advance Care Planning for children and youth, click here

To view the *New* Advanced Care Planning Workbooks click here

Hamilton Health Sciences • Hamilton, Ontario • 905.521.2100

Disclaimer: Hamilton Health Sciences (HHS) offers Google Translate to better facilitate access for our community. However, HHS makes no claims regarding the accuracy of translations. Any and all health information should be verified by a health care professional.