Choosing someone to speak for you

What is a substitute decision-maker?

A substitute decision-maker makes decisions about your health care if you have a serious illness or injury. Depending on your state or territory, they are 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.

Appointing a substitute decision-maker is a formal legal process. Each state and territory has its own form and process.

A person must be over 18 to be your substitute decision-maker. They may need to sign a legal form, agreeing to the appointment. They must be willing and able to make decisions for you.

You may also be familiar with other roles where a person is permitted under the law to make decisions on someone else’s behalf. For example, a financial power of attorney enables a person to make financial decisions. A guardian can make personal and lifestyle decisions for the person. The names and the powers of the roles are different in each state and territory.

Why appoint a substitute decision-maker

Appointing a substitute decision-maker can:

• help you make your wishes known to others so you get the care you want
• give your substitute decision-maker the confidence to make difficult decisions for you, guided by your values and preferences
• lower the chances of conflict, stress and anxiety among the people who care about you.

What to think about before you choose someone

There’s a few things to consider before deciding who the right person is for you.

It’s important to appoint someone who:

• you trust to protect your rights and interests
• will make the choices you’d make
• understands what matters to you, and what you’d want.

It doesn’t have to be your spouse or a relative. It may be that a friend or someone in your chosen family is the person that knows you best and is best placed to speak for you.

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

Your substitute decision-maker must follow your wishes. They can consider the wishes of your family and people who care about you, but they might need to override them.

Read about the process for your state or territory.

What you should talk about

Make sure the person you choose agrees to being a substitute decision-maker, and understands what it will involve.

Take the time to talk with them about your values and preferences. They should understand what matters most to you about your health care, including at the end of life. It’s important that you’re both honest about your views and choices, and where they differ.

You should also discuss your health, and any specific instructions you have.  If you have an advance care directive or other advance care planning document, give them a copy. Help them understand their responsibilities of being a substitute decision maker. Doing this can help them prepare to make decisions or speak for you in the future.

What happens if you don’t appoint a substitute decision-maker?

Your state and territory has rules about who’ll make decisions if you're unable and you haven’t formally appointed a substitute decision-maker. The law requires that there’s always an identified decision-maker to consent to, or refuse, medical treatments. 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:

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

A court or a tribunal may also appoint a person as guardian to make decisions. They may also appoint the public guardian if there is no-one else to take on the role.