Someday, you may need to make medical decisions on behalf of a family member or friend, perhaps during a time of crisis. Would you know what to say or do?
A Substitute Decision Maker (or SDM) is an individual chosen to make medical decisions on behalf of another person if they are unable to do so for themselves. It’s an important part of advance care planning, a process of reflecting on and communicating your future health care wishes to others. Legal requirements regarding Substitute Decision Makers are different in each province and territory.
If you are a Substitute Decision Maker (or think you might be) for a friend or family member, it’s important to ask yourself these questions:
- 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 in my province/territory?
Louise Hanvey, the Project Director for the Advance Care Planning in Canada Initiative, says that the most important step for Substitute Decision Makers is to get talking. “Research has shown that advance care planning significantly reduces stress, depression and anxiety in family members and caregivers who know the wishes of their family members and friends, and can act with confidence if needed.” 
The initiative’s Speak Up website (www.advancecareplanning.ca) has a number of resources, including workbooks, videos, wallet cards and conversation starters, as well as resources and information about legal requirements for each province and territory. A national interactive workbook is also available at www.myspeakupplan.ca.
Ms. Hanvey notes that Substitute Decision Makers shouldn’t forget about their own wishes either. “You never know what the future brings,” she says. “Make sure that your family and friends know what’s important to you.“
Heyland, DK, Allan DE, Rocker G, Dodek, P, Pichora D, Gafni A. Discussing prognosis with patients and their families near the end of life. Impact on satisfaction with end of life care. Open Medicine 2009, 3(20:71-80)