How do substitute decision-makers make decisions?

All substitute decision-makers must follow the principles set out in the Act when deciding whether or not to consent to medical treatment for a person at the end of life. These principles include:

making decisions that are least restrictive of the freedom of decision and action of the person with impaired capacity or decision-making ability;
promoting that person’s best interests; and
ensuring the wishes, directions, preferences and values of the person are, if possible, carried out.

A guardian will be acting in the best interests of the person when they act in ways including:

in consultation with the person, taking into account his or her wishes, directions, preferences and values (including those in the person's Advance Care Directive),
as an advocate for that person, and
protecting the person from neglect, abuse or exploitation.

They must also take reasonable steps to ascertain if the person has an Advance Care Directive.

When determining whether medical treatment would be in the person's best interests, a person responsible and the Tribunal must take into account:

the person's wishes, directions, preferences and values, including those in an Advance Care Directive (if possible);
the consequences to the person if the treatment is not provided;
any alternative treatment that is available;
the nature and degree of significant risks of any treatment; and
that treatment must only be carried out to promote and maintain the health and wellbeing of the person
any other matters set out in the regulations.

The Tribunal must also consider whether the proposed treatment can be postponed on the ground that better treatment may become available and whether the person is likely to become capable of consenting to the treatment.

If a substitute decision-maker has difficulty making a decision and needs assistance, he or she may apply to the Tribunal for advice or directions.