By Sheli O’Connor, Program Lead, Conversations Worth Having

Did you know that every person in Ontario has an AUTOMATIC Substitute Decision Maker?

Many individuals assume that the only way to become a Substitute Decision Maker (SDM) is to be named the attorney for the Power of Attorney for Personal Care. However, in Ontario, being named in a Power of Attorney document is only one way that a loved one can confirm you as their future SDM.

Actually everyone has an automatic Substitute Decision Maker provided by law, if the patient becomes mentally incapable of making their own health care decisions, and you could be that person without even knowing it.

Want to see the hierarchy of substitute decision makers? Check out Ontario’s hierarchy of decision makers created under the Health Care Consent Act on our website at

If you are a Substitute Decision Maker (or think you might be) for someone, have a conversation with that person and 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 make decisions guided by 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 what the legal requirements are in Ontario?

92% of respondents to a Waterloo Wellington community survey said that they believe having ACP conversations makes it easier for their loved ones. This has been supported by research demonstrating that advance care planning significantly reduces stress, depression and anxiety in family members and caregivers who know the wishes of their loved ones and can act with confidence if needed (1)(2). These are Conversations Worth Having.

For more information, videos and resources related to Substitute Decision Making in Ontario visit our website or contact the Conversations Worth Having team at 519-743-4114.


April 16th is National Advance Care Planning Day

Here in Waterloo Wellington we have launched Conversations Worth Having, a 3 year project to increase awareness and understanding of Advance Care Planning in Ontario. Check out our website for events that we are running in honour of National Advance Care Planning Day!


Ask us about our SDM Wallet Cards

And… If you have a story to tell we would love to hear from you!

1 Heyland, DK, Allan DE, Rocher 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)

2 Detering, Hancock, Reade and Silvester. The Impact of advance care planning on end of life care in elderly patients: randomized controlled trial. BMJ, 2010.

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