Substitute Decision Makers in Ontario Law

In Ontario law, a Substitute Decision Maker ("SDM") is a person who makes health and personal care decisions on your behalf when you are unable to do so.

If you do not name a person or more than one person to act as your SDM in your Power of Attorney for Personal Care, the Health Care Consent Act has provided a hierarchy of individuals who can possibly act as automatic SDMs. The higher on the list the individual is, the more likely the person can automatically be your SDM in Ontario.

The hierarchy for automatic SDMs is as follows:

  1. Spouse or Partner

  2. Parents or Children

  3. Parent with right of access only

  4. Siblings

  5. Any other relatives

  6. Public Guardian and Trustee (SDM of last resort)

In most cases, it is better to directly appoint a SDM in your Power of Attorney, so you can more easily control who gets to manage your health and personal care decisions once you are unable to do so. Sometimes, the automatic SDM is not someone you would necessarily want to manage such intimate decisions.

You can read more about Powers of Attorney here and have us create a Power of Attorney for you here.

Disclaimer: This blog post is for general information purposes only and is NOT intended to be relied upon for legal advice, or to be construed as legal advice. Please consult with us directly through email ( for legal advice about your specific situation.

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