How Will My SDM(s) Make My future Decisions?

  • Your SDM only makes your healthcare decisions when you have been found incapable of making that decision.
  • Your healthcare provider will suggest a treatment plan to your SDM and it will be up to your SDM to decide if they agree (consent) to that treatment or plan. 
  • Your SDM must make the decision that is best for YOU. This is based on YOUR values wishes and beliefs. 
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    The law tells SDMs what they need to think about when making decisions for you.

    They must consider:

      1. Your prior capable wishes
      2. Your best interests

How will ACP and my wishes help my SDM in a future goals of care conversation?

  • Healthcare providers will provide information on your current condition and discuss treatment options with your SDM. 
  • Your SDM's role is to determine the option that is best for you. They will think about your wishes and values and tell the healthcare team this as part of a goals of care conversation. 
  • Since you will be incapable of participating at the time, it is important to share information on your values, and what is important to you during the ACP process.



It is important to note that you and your SDM(s) can only consent or refuse consent to a treatment. 

You or your SDM cannot demand a treatment: it is up to the health care provider to determine what treatments will be offered based on your health condition.

 

 

How will my values be used to make my healthcare decisions?

  • Making healthcare decisions is about more than just the medical facts.
  •  A person's values and goals are an important part of the process.
  • If you are capable of making your own decisions, you bring your values and goals to the conversation.
  • But once you have lost capacity, it will be your SDM's role to share them with your healthcare providers. 

 

Your SDM's role:

  • Think about your values, goals and beliefs
  • How do they apply to the decision?
  • Decide if the risk are acceptable 

 

Healthcare team role:

  • Explain the medical facts about your condition
  • Explain all treatment options
  • Explain all side effects and benefits of the treatment options

 

 

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Think about how you might talk with your SDM about your wishes

  • ACP conversations with your SDM are one way you can express these wishes. 
  • Try to imagine what will be the most helpful to them in the future.
  • You cannot predict what kinds of decisions they will have to make. Imagine how your wishes might be used for a variety of situations. 
  • This is why talking about what you can put up with and what you cannot is more helpful than talking about treatments.

 

 

Some helpful hints for how to share your wishes:

  • Instead of saying " I don't want a feeding tube" you might tell them "If I am unable to recognize anyone or communicate with people and am dependent for all care, I would not want treatments that would prolong my life" 

  • Saying "no heroics" is often not enough guidance for your SDM in the future. Help them understand what you mean when you say this.  

 

 

 

 

Wishes can be made just by talking to your SDM(s)

  • You do not need to write these wishes down for them to "count". 
  • In Ontario, wishes can be made by telling your SDM, writing them down, recording in video or any way you choose
  • Your SDM must consider your most recent wishes. It doesn't matter if you wrote them down or not.
  • If you do choose to write things down, talk with your SDM so they understand what you have written.

 

 

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How are best interests decided?

  • It will be your SDM's role to decide on your best interests at the time a decision is being made. 
  • They will base this on what they know about you as person and any ACP conversations you may have had.
  • Best interests are used for decision making when here are no prior capable wishes that apply to the situation. Or those wishes are impossible to follow. 
  • An example of an impossible wish might be wanting to get all your care at home. There may come a time when this is not possible for financial reasons or because your family are physically unable to provide the care.

 

 

 

When thinking about best interests, your SDM must consider:

  • Will the treatment or plan:
    • Improve your current condition or well-being? 
    • Prevent worsening of the current condition or well-being? 
    • Slow down the process of getting worse? 
  • Will you get better, worse or stay the same if the treatment or plan is not followed? 
  • Do the benefits outweigh the risks of harm? (**risks/benefits as you would see them) 
  • Is there a less aggressive option that might be as beneficial?

 

 

Frequently Asked questions

 

 

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