Help Making Health Care Decisions

Who makes my health care decisions?

You do. You can say yes or no to any treatment that your health care team offers, so long as you are capable to do so. In Ontario, a law called the Health Care Consent Act lays out the rules for decision making.

What does it mean to be capable of making a treatment-related decision?

In Ontario, a person is considered capable of making a treatment-related decision if they have:

• the ability to understand the information related to the treatment; and
• the ability to appreciate the consequences of the decision being made about the treatment.

Capacity is decision and time specific.

What if I'm found incapable of making a treatment-related decision?

Your health care provider should inform you that you have been found incapable and that you have a right to appeal this finding. You can do this by submitting a Form A to the Consent and Capacity Board. Your health care provider will then turn to your substitute decision maker for any treatment decisions. Your substitute decision maker should make decisions based on your wishes, values and beliefs.

Who is my substitute decision maker?

Everyone in Ontario who becomes incapable will have a substitute decision maker to make decisions on their behalf. The Health Care Consent Act lists people who can be substitute decision makers and includes people who are appointed or related to the incapable person. Your substitute decision maker would be the person(s) who is ranked highest on this list and is willing, capable and available to make a health care decision for you when you are incapable.

What if I want to choose someone as my substitute decision maker?

If you would like to appoint someone you trust to be your substitute decision maker, you can choose to create a legal document called a Power of Attorney for Personal Care. For more information about power of attorney documents, visit the Public Guardian and Trustee website.

Do you need to have a lawyer to create a Power of Attorney for Personal Care?

No. You can create a Power of Attorney for Personal Care without a lawyer and can use the Power of Attorney Kit found on the Government of Ontario's website. However, in some cases, speaking to a lawyer may be advisable.

Can I share my wishes, values or beliefs with my health care team?

Yes. We want to know what matters to you so we can ensure your treatment aligns with what is important to you. We have a place in your health care chart to document your wishes, values and beliefs.

Who makes treatment decisions?

In Ontario, every person can make their own decisions about health care and treatment when they are capable of doing so. If the patient is not capable, a substitute decision maker (SDM) makes decisions about treatment. The person(s) ranked highest on the list below would be the patient's SDM:

Rank of substitute decision makers from the Health Care Consent Act:

1. A guardian with the authority to give or refuse consent to treatment
2. An attorney for personal care with the authority to give or refuse consent to treatment
3. A representative appointed by the Consent and Capacity Board
4. A spouse or partner
5. A child or parent
6. A parent who has only a right of access
7. A sister or brother
8. Any other relative (related by blood, marriage or adoption)
9. Public Guardian and Trustee

To act as an SDM, you must be willing, capable and available to make decisions on behalf of the patient.

How does the substitute decision maker decide? What if they don't know what the patient would want?

There are rules in law about making health care decisions for someone else.

• The SDM must make decisions based on the patient's prior expressed wishes. For example, if you were your mother's SDM you might ask yourself: “Has my mother talked about this situation? What did she say?” Or “Would my mother say she would want this treatment?”
• If the SDM does not know of a wish applicable to the situation, or if it's impossible to follow the wish, the SDM must act in the patient's best interests.

“Best interests” are determined by considering:

• the values and beliefs the SDM knows the patient held when capable; and
• the treatment decisions that will improve or change the patient's condition for the better.

An SDM is entitled to information about the nature of the treatment; expected benefits, risks and side effects; alternative courses of action; and the likely consequences of not having the treatment.

Can living wills help?

Wishes expressed by the patient when they were capable can help the SDM understand what the patient would want in different situations. Wishes can be expressed by a patient in their power of attorney, in another written form (e.g. a living will), or shared verbally.

What happens when there are disagreements?

Sometimes when there is more than one substitute decision maker, disagreements about treatment decisions may occur. We are pleased to help resolve these disagreements and have trained professionals here to help you.

If you still cannot agree, you have two choices:

• a public official in the office of The Public Guardian and Trustee will make the decision, or
• the Consent and Capacity Board may appoint a representative to make the decision. The representative may or may not be one of the prior substitute decision makers.

Where can I get more information or help with substitute decision making?

Please contact our Ethics team at 905-494-2120 ext. 56630 or ethics@williamoslerhs.ca. You can also contact the Consent and Capacity Board's Toronto regional office at 416-327-4142.