Being a substitute decision-maker

How you can become a substitute decision-maker

You may have been legally appointed to be a substitute decision-maker. This means the person has completed a formal process to appoint you. Depending on the state or territory, a substitute decision-maker for healthcare decisions may be called:

• an enduring guardian
• an enduring power of attorney
• a medical treatment decision-maker
• a person responsible
• an attorney for health matters
• a decision-maker.

You could be identified as someone's substitute decision-maker by the law in your state or territory if that person hadn't already chosen a substitute decision-maker. States and territories have different laws for identifying who a substitute decision-maker is in these circumstances. Each state and territory has its own list of people who can take on the role. There are some differences between states and territories but the list includes:

• a spouse or partner
• an unpaid carer
• a family member or friend who has a close relationship with the person.

You can also be appointed as a substitute decision-maker for the person by a court or tribunal.

Find out more about choosing someone to speak for you.

If someone asks you to be their substitute decision-maker

You must be over 18 to be appointed as a substitute decision-maker, and there are some things to consider before you agree.

You should:

• read and understand the expectations and responsibilities of a substitute decision-maker in your state or territory
• be able to speak up for the person, and make decisions clearly and confidently when talking to health professionals and family members
• have a good understanding of the person’s wishes and preferences for their future health care, so that you can represent and communicate these.

You may have to sign a formal document accepting the appointment. The person should give you a copy of the completed document, and you should keep it in a safe place.

It makes things easier if you live in the same city or region and can be easily contacted, but it’s not a requirement.

What to consider when making decisions

As a substitute decision-maker, you won’t be making decisions based on your own needs or preferences. It’s your job to put yourself in their shoes and make the same decision they would’ve made for themselves.

This means you need to use what you know about their wishes. This includes their values, beliefs and other lifestyle and health care matters that are important to them. You should consider:

• an advance care directive, if they have one
• any other documents they have written which set out their wishes and preferences
• conversations you’ve had with them about what’s important to them
• your knowledge of them from spending time with them, observing them, or talking with others close to them.

If a person has impaired decision-making capacity, you can and should still talk with them about their wishes and preferences. Even if they can't decide on specific things, they may still be able to discuss certain aspects, like their values and what they consider a reasonable outcome. Providing support can help them maximise how much they can participate in these conversations.

Find out more about supported decision making.

Seek as much information as you need from the doctors to understand the health care treatment that’s being offered. Consider:

• what are the possible outcomes
• are there different options or alternatives?

Stand up for the person if needed to make sure their voice is heard. If you have copies of the person’s advance care planning documents, share these with the doctors.

Each state and territory has specific principles or guidelines about how substitute decision-makers should make decisions, so make sure you understand these. Find out more about substitute decision makers in each state and territory.

For more detailed guidance on making health care decisions, see this practical guide from End of Life Law for Clinicians, Queensland University of Technology, designed for families and substitute decision-makers:

Making health care decisions for others: A guide for substitute decision-makers

Multiple decision makers

When people legally appoint their substitute decision-makers, they can choose to appoint more than one person. They can also say how they want their substitute decision-makers to make decisions. That could include:

• one person who makes all the decisions
• multiple decision-makers who work together or separately
• a backup decision-maker who steps in if the first person isn’t able to.

They may also have different responsibilities.

Each state and territory has rules about how one or more substitute decision-makers are involved in making decisions.

Learn more about what is a substitute decision maker?