Decision Making and Care Planning
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The substitute decision maker informs the health care team

Sometimes a patient may be unable to communicate their needs. Their family, with the support of the health care team, may need to make decisions in the patient’s best interest.

Role of a substitute decision maker

A temporary substitute decision maker may be needed to make necessary legal decisions on behalf of the patient. This may or may not be the same person as the spokesperson. The health care team will keep both of these individuals, and any other representative the family identifies, fully informed of conditions and plans for treatment.

The substitute decision maker:

  • Informs the health care team if the patient has legally documented wishes about being put on life support
  • Informs the health care team about the patient’s thoughts or wishes about being put on life support when no legal documentation exists
  • Makes decisions based on the patient’s best interests when the substitute decision maker has no knowledge of the patient’s wishes regarding life support

Identifying a substitute decision maker

If the patient signed a legal representation agreement naming a decision maker, this person will be required to sign consents on behalf of the patient.

If the patient hasn’t identified a substitute decision maker, the first person who qualifies and is available (in the following order) will be assigned the role:

  1. Spouse
  2. Child
  3. Parent
  4. Sibling
  5. Anyone related by birth or adoption

Qualifications to be a substitute decision maker include:

  • At least 19 years of age
  • In contact with patient within last 12 months
  • No dispute with patient
  • Capable of performing the role: giving, refusing or revoking consent
  • Willing to comply with substitute decision maker duties

If no one qualifies, then a person will be authorized by the public guardian and trustee.

Advance care planning

The doctor will discuss the patient’s condition and treatment plan with the family. As appropriate, limitations to treatment may be discussed.

You may wish to discuss plans for future health care. One important consideration is making informed decisions about Cardiopulmonary Resuscitation (CPR). CPR is not always appropriate for all patients.

 

MoH     PCQO