What Happens When Substitute Decision-makers Can't Agree On a Decision?

Sometimes two or more people have to make health care decisions for someone else (for example, 2 parents deciding for a child, 3 adults deciding for a parent with dementia). The Health Care Consent Act requires that they make the decision together. No substitute decision-maker is favoured over the other, even if they are older, have a closer relationship with the patient or are more knowledgeable about health care.

But what if they just cannot agree?

The situation can play out in several ways including the following:

1. One substitute decision-maker can pursue a legal process to effectively outrank the other (such as guardianship or proposed representative)
2. The Office of the Public Guardian and Trustee can be asked by the health care provider proposing the treatment to make the decision. This is more likely if there is an urgent decision needed and the patient's wellbeing could be seriously compromised by the delay.
3. The substitute decision-makers remain at an impasse and treatment is not provided.
4. If there is a Power of Attorney for Personal Care, it might include a mechanism for breaking ties.