Your substitute decision maker is someone who will make health care decisions for you if you’re unable to speak for yourself.

Learn what’s involved in choosing a substitute decision maker and the importance of talking to others who are important to you as part of your Advance Care Plan

What is a substitute decision maker?

In British Columbia, a substitute decision maker is a family member or close friend who has the legal right to make health care decisions on your behalf if you cannot speak for yourself. They must honour your wishes so it’s important they know what your wishes are.

There are two different types of substitute decision makers: 

  • Temporary substitute decision maker
    A capable adult chosen by a health care provider from a list of your family or friend relations who is willing and able to make health care treatment decisions on your behalf if you are unable to speak for yourself.
  • Formal substitute decision maker
    An adult you have specified in a Representation Agreement or appointed by the courts. 

It is important that your list of temporary substitute decision makers, your formal substitute decision makers and others in your life know about the care you might want in the future. Here’s how to start the conversation with them.

How to decide on a substitute decision maker


Are you a substitute decision maker?

What is a temporary substitute decision maker?

In British Columbia, to qualify as a substitute decision maker, the person: 

  • must be 19 years old
  • capable
  • willing
  • have no dispute with you
  • have been in contact with you in the year before you need the health care

If a temporary substitute decision maker is needed to make a health care decision for you, your health care provider will choose the first person on a list of your family/friend relations who is qualified, willing and available. The order of the people who qualify is determined by B.C. law and is as follows:

  • Your spouse (married, common-law, same sex – length of time living together doesn't matter) 
  • A son or daughter (19 or older, birth order doesn’t matter) 
  • A parent (either, may be adoptive) 
  • A brother or sister (birth order doesn’t matter) 
  • A grandparent 
  • A grandchild (birth order doesn’t matter) 
  • Anyone else related to you by birth or adoption 
  • A close friend 
  • A person immediately related to you by marriage (in-laws, step-parents, step-children, etc.) 

If you know that you want a particular person to make your health care decisions, then you should consider naming that person legally as your substitute decision maker using a Representation Agreement.

What is a representation agreement?

If you want to specify someone to make health decisions for you, you must complete a Representation Agreement.

If you select a representative, it is important to thoroughly discuss your health care preferences with them as well as others in your life, such as when to continue or stop life support measures, and to document these preferences.

What are life support measures?

Life support measures replace or support a body’s natural functioning. When patients have a treatable condition, life support measures can be temporarily used until the body is able to function on its own, again. Sometimes, though, the body never regains its ability to function without life support. 

It’s important to gather the facts when making decisions about life support measures, including the benefits and burdens they will offer you.

Examples of life support measures include:  

Cardio pulmonary resuscitation (CPR) 

Kidney dialysis

Tube feeding (artificial hydration and nutrition)

What should you consider when choosing a representative? 

It is important the person whom you choose as a representative know what your wishes are so they can honour them. Having conversations is the best way to ensure this.

To make these decisions, they can use the information in your Advance Care Plan, statements made by you in the past, and what he or she knows about you personally. 

To choose your substitute decision maker, it helps to consider: 

  • Do I trust this person to make health care decisions that reflect my wishes?
  • Can they communicate clearly with my health team?
  • Can they make difficult decisions during stressful times?
  • Is this person willing and available to speak for me if I couldn’t speak for myself?

What do you need to do as a substitute decision maker?

You must be willing to accept the role of substitute decision maker for the person who has asked you to be their substitute decision maker. You need to thoroughly discuss their health care preferences with them, such as when to continue or stop life support measures, and to document these preferences.

For more information, view  the video: Are you a Substitute Decision Maker? 

How do I make a representation agreement? 

There are two types of Representation Agreements: one, known as a Section 7, allows for the representative to make personal care and some health care decisions excluding refusal of life support or life-prolonging treatments; the other, known as a Section 9, allows for personal and health care decisions including accepting or refusing life support and life prolonging treatments. 

For more information about Representation Agreements, visit the Advance Care Planning page on HealthLink BC