• It is good idea to involve your SDM as much as possible in these conversations.
• ACP is meant to prepare your SDM to make your healthcare decisions in the future if you loses capacity to make your own decisions.
• If you are not comfortable including your SDM in ACP conversations, think if there is  someone else you would prefer in the role.
• Your SDM may have to make some hard choices. Knowing about the person and their values can make this easier. 

Yes. Any SDM can choose not to make your healthcare decision. If this happens, your healthcare provider will ask the next person lower down on the hierarchy list to make your healthcare decision.

• If you are not happy with your automatic SDM, you may appoint an Attorney for Personal Care.
• You must be capable at the time you appoint an Attorney for Personal Care.
  

• Looking at the list of people who can make decisions, a person may have more than one person at the same level (e.g children or siblings)
  



• If they are highest on the list, they would automatically make decisions. They must make decisions together (jointly) or decide among themselves which one will act as your SDM.

• For example, if a person has three children (#5 on the list), all three are entitled to act as SDM(s). They must act jointly and agree on any decisions for a person's health care or they can agree that only one of them will make decisions. The health professionals cannot pick which one of the three should make decisions. The three children must decide among themselves whether they will all act together or if only one of them will.

An Attorney for Personal Care (POAPC) is one type of SDM. They are the second highest on the list of SDMs.

• A Power of Attorney for Personal Care ONLY gives the person the ability to make decisions about healthcare. They cannot make decisions about your property or finances.
• For property and finances, a person must prepare a Power of Attorney for Property.
• A person does not need to choose the same person for both. Each is appointed in a separate document.
•  For more information:
  • Advocacy Centre for the Elderly
  • Attorney General of Ontario
  • Community Legal Education Ontario
    
    

If people who are equally entitled to act as SDM(s) cannot agree on the decisions about your treatment, you may have several options depending on your clinical setting:

• Make sure you have explored the underlying illness understanding and underlying reasons behind the disagreement as there may misunderstandings that are leading to the issue.
• If you have access to bioethics consultation, they may be able to support the SDM(s) to reach consensus.
• If you cannot reach agreement among the SDM(s), the Public Guardian and Trustee is required to act as SDM. The Public Guardian and Trustee does not choose between the disagreeing decision-makers but makes the decision instead.