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If You Don't Appoint a Substitute Decision-Maker

What happens if a Power of Attorney for Personal Care is not completed?

Ontario law does not ensure there will be a substitute decision-maker to make all your personal care decisions for you unless you appoint a substitute decision-maker through a Power of Attorney for Personal Care.

However, the law does make sure that there will always be a substitute decision-maker to make some health decisions for you, but this includes decisions only about:

  • your health care, (e.g. treatments)
  • your admission to a long-term care facility, and
  • the personal assistance services you will receive in a long-term care facility.

If you have not designated a substitute decision-maker through a Power of Attorney for Personal Care, a health care provider must turn to the hierarchy of substitutes named in the law to make the above types of health decisions. The highest ranking person on this list who is available, capable and willing to make these decisions will become your substitute decision-maker for treatment.

  • Your spouse, common-law spouse or partner
  • Your child (if they are 16 years of age or older) or parent
  • Your parent with right of access only
    Custodial parents rank ahead of non-custodial parents
  • Your brother or sister
  • Any other relative by blood, marriage or adoption
  • The Office of the Public Guardian and Trustee.
    The provincial Public Guardian and Trustee is the substitute decision-maker of last resort if there is no other appropriate person to act for you.

If there are two or more persons (for example two sisters and one brother) described in the same subsection of the above hierarchy, who meet the requirements to give or refuse consent on an incapable person's behalf, they may share the decision-making responsibility or may choose to designate a spokesperson. If there is a disagreement among equally ranked decision-makers that cannot be resolved, the Office of the Public Guardian and Trustee may be asked to make the decision.

If you have not appointed a substitute decision-maker anyone, including your family or friends, can apply to the Consent and Capacity Board to become your substitute decision-maker for medical treatment, admission to long-term care facility, and personal assistance services in a long-term care facility. They do not have to pay anything to do this. This is known as your board-appointed representative. A board-appointed representative ranks above your spouse, partner and other family members in the hierarchy of substitute decision-makers named in the law.

If you have not appointed a substitute decision-maker, almost anyone, including family members and friends, can apply to the Superior Court of Ontario to be appointed as your "Guardian of the Person" with authority for treatment. Like an attorney for personal care, a Guardian of the Person may be authorized to make the full range of personal care decisions for you, in keeping with your known wishes. A "Guardian of the Person" with authority for treatment ranks highest on the hierarchy of substitute decision-makers named in the law.

Note: The above hierarchy of substitutes named by the Ontario law does not take effect if you have designated a substitute decision-maker with decision-making authority for health care through a Power of Attorney for Personal Care (see "How to Give Your Substitute Decision-Maker Power to Act for You"  for more information on how to designate a substitute decision-maker). It is important to designate a substitute decision-maker through a Power of Attorney for Personal Care to ensure you have a person of your choice making decisions about both your health care and other aspects of your personal care.