Who can I choose to be my substitute decision maker?

What is a Substitute Decision Maker?

A Substitute Decision Maker is someone you choose and trust to make decisions on your behalf to implement the wishes set out in your Advance Care Directive.

Who should I appoint as my Substitute Decision Maker?

Choosing who you appoint as your Substitute Decision Makers is a very important decision. Family members or trusted friends are often the common choice. Whoever you choose though, it must be someone over 18 years of age who has decision making capacity.

Importantly, you cannot appoint your doctor, nurse or a paid professional carer.

You should bear in mind that your SDM stands in your shoes (that is, they have the same authority that you do to make health and lifestyle decisions on your behalf) should you no longer have decision making capacity. Decision making capacity means if you are unable to make your own decisions either temporarily (for example, you may be unconscious or seriously ill or in the early stages of dementia) or permanently (for example, you no longer understand the consequences of, and cannot freely communicate, your decisions). 

Your SDMs will be making decisions for you on a broad range of matters including your medical treatment, where you live and your day to day care, so you need to choose someone who understands your values and beliefs and who you trust will carry out your wishes. Your SDM does not make financial decisions; that is handled through a Power of Attorney.

How many Substitute Decision Makers can I appoint?

There is no limit as to the number of SDMs you can appoint, although for practical reasons it is best to limit your appointment to two or three.

The more people you appoint, the more difficult it is going to be to contact them all in the event of an emergency and also to get them all to agree on a decision (if you chose that they can only act unanimously – see our article “Do my Substitute Decision Makers have to all agree ”). If you only want to appoint one SDM, you should think about a back-up in case that person is unavailable or they die before you.

What details do I need to include about my SDM?

You will need to include the full name, address, date of birth and a contact telephone number for each of your SDMs. Although the form does not specify it, a mobile phone number for your SDM is preferable to a home telephone number so that your SDMs can be contacted quickly in the case of an emergency.

Do I have to appoint an SDM in my Advance Care Directive?

If you are unsure who to appoint as your SDM, you can complete an Advance Care Directive (ACD) setting out your wishes without appointing anyone to act for you. If you do not appoint an SDM your next of kin or family members will be asked to make decisions for you based on the wishes set out in your ACD and any medical decisions made must honour your stated wishes as far as possible.

What other considerations are there for choosing a Substitute Decision Maker?

If you have a family member you would like to be involved in making decisions on your behalf, but it is impractical for you to appoint them as your SDM (for example, if you have a child who travels overseas regularly and who may not be available to make decisions for you) you can direct your SDMs to consult with them whenever practicable. This means that if they are available they should be consulted. If they are not available your SDMs do not have to worry about tracking them down.

Talk to your Substitute Decision Makers before you appoint them

It is important that you discuss your wishes with your SDMs before you appoint them, in case they do not want to make decisions for you. Some people will find making decisions for someone else confronting, in particular on end of life decisions. They might find it even more confronting if you have not made an ACD and they have to make decisions for you in an emergency, without knowing what your wishes are. If your chosen SDM is not comfortable making these types of decisions for you, you should consider appointing someone else.

Want to know more about completing your Advance Care Directive and, in particular, appointing your Substitute Decision Makers? Get in touch with today’s blog writer, Associate in Wills & Estate Planning, Julie-Ann Sparkes.

You can complete an Advance Care Directive online with acdAssist

acdAssist is a guided question and answer process, that you can complete at your own speed and in your own words. It is designed to identify your wishes and needs to those who you choose to make decisions for your care when you are no longer able to make those decisions yourself. These are then included in an Advance Care Directive for you to sign.