Nine types of substitute decision-makers (SDM)

For most people, their SDM will be their closest living relative. These are the automatic SDMs

There are also three types of legally appointed SDMs and an SDM of last resort.

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Court Appointed Guardian

  • This person is appointed by the Superior Court of Ontario.
  • They will have a documented Court Order confirming their role.
  • This order also tells you what kind of decisions they can make.
  • Unless the court sets limits, a Guardian of the person can make all personal care decisions including:
    • shelter (where a person lives)
    • nutrition
    • hygiene
    • clothing
    • safety
    • health care decisions (treatments, admission to long-term care and personal assistance services in LTC)
  • This is NOT the same as a Guardian of Property or a Statutory Guardian



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Attorney for Personal Care

  • Appointed by the person while they are capable
  • This is done by doing paperwork called a Power of Attorney for Personal Care.
  • This document should specify what type of healthcare decisions the POA can make
  • You cannot just tell a healthcare provider that you want someone as your Attorney for Personal Care.
  • May choose to appoint more than one person in this role.
  • The Power of Attorney document must indicate which kinds of health and personal care decisions that a Attorney can make on behalf of the incapable person. 
  • This is NOT the same as an Attorney for Property
  • Removing someone as an Attorney for Personal Care must be done in writing



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Representative Appointed by the Consent and Capacity Board

  • The Ontario consent and Capacity Board (CCB) will appoint a Representative ONLY if an application has been submitted to them.
  • A Representative can only make healthcare decisions:
    • treatment
    • admission to long-term care
    • personal assistance services within long-term care.
  • People who can apply to the CCB to have a Representative appointed:
    • family or friend of the person who is at least 16 years old
    • the incapable person themselves



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Spouse or Partner

Two people are considered spouses if they are:

  1. Married to each other; or
  2. Have lived together in a common law relationship for at least a year or
  3. The parents of a child together or
  4. Have entered into a cohabitation agreement under the Family Law Act  

Two people are considered partners if they:

  1. Are in a close personal relationship and have lived together for at least one year
  2. Both consider it to be the most important relationship they are in

This does not have to be a romantic relationship. It could be two close friends who have lived together for more than a year. But it is more than a roommate relationship



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Parents or Children

  • A person is a child of his or her birth parents.
  • A person is also a child of parents as a result of an adoption.
  • The definition of child may include step children if the stepparent helped raise and care for the child when still a minor.
  • The children of people that become spouses later in life when their children are all adults would not be considered in this definition of “child”
  • Please see the resource guide for further definitions of children and parents related to assisted reproduction, and other parenting agreements.
  • There may be multiple people in this category who will all share decision-making
  • Example: 60 year old person with both parents in their 80s and two adult children in their 20's



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Parent with right of access only

  • A parent who does not have custody or decision-making authority but who is allowed visitation rights with their child(ren)



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  • All siblings (either by birth or adoption) equally share decision-making



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Any other relative

  • Anyone who is related to the person by blood, adoption or marriage.



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Public Guardian and Trustee

  • The Public Guardian and Trustee is person employed by the Ontario government.
  • When they act as an SDM they have the same duties and responsibilities as other SDMs.
  •  The PGT can also become the SDM if two or more SDMs that are equal ranking (for example two Attorneys for Personal Care or three adult children) but they cannot agree on a decision for the person.