Dementia and end-of-life care
Appointing substitute decision-maker(s)
The Substitute Decision-Maker (SDM) is the person chosen to make personal care decisions, including medical decisions, for the person with dementia when they are no longer considered capable of making them alone. The laws regarding substitute decision-makers vary from province to province across Canada. You can read more about the laws in your province here.
Who should this person be?
The substitute decision-maker should be someone whom the person with dementia trusts to carry out their wishes, such as a family member or a close friend. If the person with dementia does not appoint a substitute decision-maker, most provinces and territories have a priority list, usually starting with family members. It is important to understand that the people in the list will be asked in priority sequence to act on behalf of the person, regardless of how close their relationship was to the person.
In making decisions about end-of-life care, guidance can be found in written documents, known as advance directives, and conversations in which the person expressed their wishes. If the person’s wishes have not been written down or expressed verbally, decisions will need to be made based on the person’s lifelong desires and values and what you think the person would want. You may have to weigh the risks and benefits of the decision, and assess how it will affect the person’s quality of life and well-being.
Next section: Medical care decisions