Making a decision for someone else

Being appointed as a substitute decision-maker

Sometimes, you may need to be involved in advance care planning for a friend or family member who is no longer able to make medical decisions. You may have been legally appointed to be their substitute decision-maker.  

A substitute decision-maker is not necessarily someone's next of kin. They can be: 

1) A substitute decision-maker chosen by the person. Depending on the state or territory, they may be called: 

  • enduring guardian
  • medical enduring power of attorney
  • an agent
  • a decision-maker.

2) A substitute decision-maker assigned to the person by the law in the absence of an appointed substitute decision-maker (a default substitute decision-maker). States have different legislation and considerations for appointing a substitute decision-maker, and may allow for more than one substitute decision-maker. They may be: 

  • spouse or de facto spouse
  • unpaid carer
  • nearest relative or friend who has a close personal relationship with the person.

3) A substitute decision-maker appointed for the person (e.g. a guardian appointed by a guardianship tribunal)

Standing in their shoes

A substitute decision-maker will be called upon when these people have lost their competence or capacity.

The best way to approach this is to try to make the decision the person themselves would have made if they had been able to. This means "standing in the shoes" of the person and seeing the choice to be made from the perspective they would have had.

Work out if the person is able to make the decision

If someone has lost the capacity to make their own medical decisions, they cannot legally nominate someone to be their substitute decision-maker. It is important to then consider whether a person could make their own decision if they had additional support. Even if the person cannot make the decision themselves, you may be able to get some information from them about their preferences.

Family members and friends can still let doctors know what sort of treatments and care they believe this person would want. This advice is based on what you know about the person and what they have said to you in the past. Health professionals can also assist with assessing and supporting a person to make the required decision.

Making healthcare decisions for someone else can be difficult. If you are in a situation needing to do this, ask doctors, nurses and care workers for information. Ask for advice, based on what you know about the person.

Consider any written or spoken preferences of the person

The person may have written down their preferences in relation to what they do, or do not, want in an Advance Care Directive. These preferences must be respected when relevant decisions are made on their behalf.

A person's preferences may directly relate to specific medical interventions or they may be more general: documenting the person’s values and what is important to them and their goals for care. People undertake advance care planning both to assist family and people who may have to make decisions for them and also to ensure they receive care in line with their preferences.

Preferences may not have been written down but have been expressed through conversations. Speak with friends, family members or the person’s GP to see if they the person expressed anything relevant previously.

Consider what is important to the person

Consider the cultural, spiritual, religious and other preferences of the person and whether these might influence what care is wanted.

If there are no written wishes, consider how the person lived their life and how they made decisions in the past. What things are important for them to live well?

Consider the likely outcomes and whether the person would want, or tolerate, these outcomes.

You should refuse health care that is likely to result in outcomes that the person wanted to avoid. Remember that you are trying to make the decision the person would have made, not the decision you want or would make for yourself in the same situation.

Making a health decision

Ask questions and listen to the advice of health practitioners about health care options and likely outcomes. The doctor, nurse or care worker can explain what is likely to happen in the future and can discuss treatment and care options available.

If relevant, follow the person’s written or spoken preferences or instructions. If you cannot work out what the person would have decided, make the decision that you believe is best for them. Where there are several options the person would accept, choose the one that gives them the most independence but still provides good care and maximises their health and well-being (as they would see it).

Make the decision that the person would make if they had the same information and advice that you have. Working with their care team, and based on what you know to be the person's views, you should be able to help document their wishes.

Make sure to use the right forms for your state or territory because each state has different legal requirements. Also, whether you are legally appointed decision-maker will affect what options you have for writing an Advance Care Directive (depending on the state/territory where the person is being care for).

Making a decision about living arrangements

Living arrangements may depend on the availability of family or a carer. The abilities and personal circumstances of those providing care and their preferences must be considered. For example, while most people would prefer to remain at home rather than entering residential care, they may also put a high value on their family and would not wish to cause ‘burn-out’ or impose an extended duty of care on those they love.

If possible, follow the person’s written or spoken preferences. Discuss with family members and others. Consider costs linked to decisions – you may need to speak to the financial decision-maker. Choose the option that gives the most independence but still provides care and maximises well-being.

For more information and assistance

  • Access information and documents for your state or territory in our website's resource section
  • Visit your doctor/GP for assistance
  • Call the Advance Care Planning Advisory Service:
    • Phone 1300 208 582, 9am to 5pm, Monday through Friday.
    • If you need a telephone interpreter for this service, call 13 14 50, state your desired language and wait on the phone (up to 3 minutes). You can then ask the interpreter to call the Advance Care Planning Advisory Service on 1300 208 582.
Fact sheets

Advance care planning fact sheets

  • Fact sheet

    Advance care planning fact sheet for individuals and family

    Advance Care Planning Australia

    Information about advance care planning for individuals and their families.
  • Fact sheet

    Advance care planning fact sheet for substitute decision-makers

    Advance Care Planning Australia

    Information about advance care planning for substitute decision-makers.
  • Fact sheet

    Advance care planning and dementia - for substitute decision-makers

    Advance Care Planning Australia

    This fact sheet about advance care planning and dementia outlines the role and considerations of a substitute decision-maker and the decisions they make for someone on their behalf.