Being a Substitute Decision Maker (SDM) is an important role to play in someone’s life.  If a person becomes mentally incapable of making their own health care decisions, either temporarily or permanently, their legal SDM will be called upon to speak for them.

No one can be forced to act as an SDM, so it is important to consider whether this is a responsibility that you are willing and able to take on.  You need to be prepared to:

  1. Make decisions the way the person would make them if they were capable, even if you don’t approve of the decision, it is emotionally difficult for you or when other family members disagree with the decision.
  2. Be available as needed.  There may be many decisions that need to be made over time, especially if the person is entering long-term care.  You need to have the time to meet with doctors, learn about treatment options and make yourself available whenever a decision needs to be made.
  3. Take the time while the person is still capable to understand what they will want when the time comes for you to make decisions and provide consent on their behalf.   Advance Care Planning isn’t just one conversation.  It is many, over time and as things change, so that you truly understand what is important to the person in terms of quality of life and how you will respect their values, wishes and beliefs.

You may also want to consider:

  1. Encouraging the person, while still capable, to have conversations with their other loved ones as well,  so that there is an understanding about why you have been chosen as the SDM and so that other family members are aware of what the person would want and will accept and support the decisions you make, knowing that you are following the wishes of their loved one.
  2. Keeping a copy of the Power of Attorney for Personal Care document in which you are named so that it can be produced if needed to prove your authority to make decisions.
  3. Suggesting that an alternate person also be named in the Power of Attorney for Personal Care in case you become incapable yourself and are unable to make decisions for the person.

Accepting the role of SDM is a big responsibility, but it can bring great comfort to your loved one to know that you understand and will respect their wishes for their health care if a time comes when they need you to speak for them.

Written by: Dale Gellatly from Hospice Wellington

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