I have appointed Substitute Decision Makers in my Advance Care Directive.Do they have to agree?

Once you have made the important decision who to appoint as your Substitute Decision Makers in your Advance Care Directive, you should then decide how you want them to act. Remember your SDMs will have the legal authority to make decisions for you should you lose capacity. You can appoint your SDMs to act in any of the following ways:

1. Sole SDM

You can appoint one person to make all decisions for you. If you do so, you should also think about appointing a back-up in case your sole SDM is unavailable or they pre-decease you. For example, your spouse can act solely and then your children must act either together or separately if your spouse is unable to act.

2. Together

You can appoint your SDMs to act together which means that they must all act and must all agree on the decisions they make for you. If you think that it may be difficult to contact all of your SDMs, you can stipulate when they must act together; for example, separately in an emergency but together at all other times.

You can also appoint back-ups in case your first choice SDMs are all unavailable or have died before you.

Appointing SDMs to act together may slow down the process or can result in your SDMs disagreeing. If you think that there may be some disagreement between your SDMs, you can appoint one of them to have the final say. Remember it is your wishes that are important not the wishes of your SDM.

3. Together or separately

You can appoint your SDMs to act either together or separately, which means that they can either all act together or they can act individually if one person cannot be contacted.

Don’t forget that your SDMs must ‘step into your shoes’ when making decisions for you and should comply with the wishes set out in your Advance Care Directive (ACD).

If you do not specify how your SDMs are to act then they will be appointed either together or separately.

4. No SDM appointed

You do not have to appoint anyone as your SDM if you choose not to. You may simply give instructions in your ACD as to what your wishes are. If you have made an ACD but have not appointed anyone to act as your 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 medical decisions must honour your stated wishes as far as possible.

Can I direct my Substitute Decision Makers to consult with specific people?

If you have directed your SDMs to consult with a specific family member whenever practicable (for example a child who travels frequently), your SDMs must make every effort to contact them. If they are not available, your SDMs can continue to act without consulting them.

What if one of my SDMs cannot be contacted?

If you are unable to make decisions for yourself, your health care provider (doctors, nurses etc) will contact one of your SDMs to make the decision for you. That SDM must then try to contact all other SDMs appointed to act with them.

If the decision is urgent and no other SDMs can be contacted, an individual SDM can make decisions for you. They must then inform the other SDMs of their decision.

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-AnnSparkes

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.