How to choose a Substitute Decision-Maker

Learn how to choose the individual who will make medical decisions for you if you become unable to do so.

Substitute Decision-Makers are responsible for making decisions on your behalf in the event that you are unable to communicate your wishes. The Substitute Decision-Maker, or SDM, will often refer to any written instructions (such as those in an Advance Care Plan, Advance Care Directive, or Living Will) as well as any conversations had between the two of you.

  • Choose someone who knows you well, who respects your religious beliefs or spiritual values and whom you trust to carry out your wishes
  • Keep in mind that there are some requirements to be an SDM. The person you appoint must be:
    • Over 16 years of age
    • Mentally capable and readily available to be contacted
    • Legally able to have access to you
  • You also cannot appoint anyone who provides you with healthcare or support services for compensation unless that person is also your spouse, relative or partner
  • It is important to consider how your SDM will react in emergency or traumatic situations; ideally the person will remain calm and value your medical priorities and values over their feelings of grief, loss, and fear
  • If your SDM is not meeting their obligations and you feel as though you made the wrong decision, you can change your mind
  • Speak with your SDM often and make sure your Advance Care Plan is up to date (ideally every 3 to 5 years). It is helpful to update your Advance Care Plan at the following times:
    • Decade (on your 60th birthday, 70th birthday, etc.)
    • Death (if your SDM dies, you should choose another; also, if a close relative or friend dies, it is a good time to consider your values and priorities)
    • Divorce (if your partner is your SDM, you may want to consider choosing another)
    • Diagnosis
    • Deterioration
    • Developments in medical treatments and technology