What It Means to Be a Substitute Decision Maker in Ontario: Rights, Responsibilities, and Considerations

Becoming a Substitute Decision Maker (SDM) in Ontario is a significant responsibility that involves making decisions on behalf of someone who is incapable of making their own decisions. This role can arise under the Substitute Decisions Act (SDA), the Mental Health Act (MHA), or the Health Care Consent Act (HCCA), depending on the type of decisions that need to be made.

This blog explores what it means to be an SDM, the positive and negative aspects of the role, and practical tips for fulfilling these responsibilities with compassion and confidence.

What is a Substitute Decision Maker (SDM)?

An SDM is a person appointed to make decisions about personal care, treatment, or property for someone who has been found incapable of doing so themselves. This can happen if the person has a cognitive impairment, mental health condition, or physical disability that affects their ability to understand or make informed decisions.

When Might You Become an SDM?

• Through a Power of Attorney (POA)

  • If someone has prepared a valid Power of Attorney for Property or Personal Care.

• By Appointment

  • If the Consent and Capacity Board (CCB) or a court appoints you.

• Statutorily: 

  • If the Public Guardian and Trustee (PGT) assigns you due to an emergency or lack of a POA.

The Role of an SDM Under Different Laws

1. Substitute Decisions Act (SDA)

• Governs SDMs for property management and personal care.

• Requires SDMs to act in the person’s best interests, considering their wishes, values, and beliefs.

2. Mental Health Act (MHA)

• Involves SDMs for individuals detained involuntarily in psychiatric facilities.

• SDMs make decisions about treatment, discharge planning, and consent to treatment.

• Utilizes various Mental Health Act Forms that can be heard by the Consent and Capacity Board (CCB):

  • Form A: Application for psychiatric assessment.

  • Form C: Renewal certificate for continued involuntary admission.

  • Form G: Consent to treatment for an incapable person by an SDM.

  • Form 3: Certificate of involuntary admission.

  • Form 4: Certificate of renewal.

  • Form 5: Change from involuntary to voluntary status.

  • Form 45: Community Treatment Order (CTO).

3. Health Care Consent Act (HCCA)

• Focuses on medical treatment decisions.

• Requires SDMs to follow the capable wishes of the individual or act in their best interests if no prior wishes are known.

Positive Considerations of Being an SDM

• Protecting a loved one: 

  • Ensures that someone you care about receives appropriate care.

• Respecting wishes: 

  • Allows you to advocate for their preferences and dignity.

• Providing stability: 

  • Offers a trusted person to make decisions during difficult times.

Challenges and Negative Considerations

• Emotional burden:

  • Making decisions about care or finances can be stressful.

• Conflicting opinions: 

  • Other family members might disagree with your choices.

• Legal and financial risks: 

  • Mismanagement can lead to legal liability.

Tips for Being an Effective SDM

• Communicate openly with healthcare providers and family members.

• Be willing to ask questions and advocate.

• Document decisions and the reasons behind them.

• Seek professional advice when necessary.

• Stay informed about the individual’s condition and treatment options.

Final Thoughts: Supporting Your Loved One with Confidence

Being an SDM is both a privilege and a responsibility. With the right information, support, and legal guidance, you can ensure that your loved one’s rights and preferences are respected. If you have questions about your role as an SDM, reach out to us for advice and support.