What is a Substitute Decision Maker?

In South Australia, when you complete an Advance Care Directive Form, you are required to appoint at least one Substitute Decision Maker. This is the person who will make decisions on your behalf if you are unable to do so due to incapacity, whether temporarily or permanently.

Both you and your Substitute Decision Maker must sign the Advance Care Directive, with them signing before you.

Who Can Be a Substitute Decision Maker?

Any adult aged 18 years or over with legal capacity can act as your Substitute Decision Maker. It is common to appoint adult children or close friends to this role. The person or people you appoint should have a clear understanding of what an Advance Care Directive is, its intended purpose, and the circumstances in which it may be used.

It is recommended that you speak with the person or people you are considering to ensure they are willing and able to take on the responsibility. You can nominate more than one person who can be appointed to act jointly or severally with your other appointed decision-makers.

Who Cannot Be Appointed as a Substitute Decision Maker?

The following cannot be appointed:

Doctor
Nurse; or
Paid professional carer.

Family members who are paid a Carer’s Allowance by Centrelink can be appointed.

What Can a Substitute Decision Maker Decide?

When contacted, the Substitute Decision Maker must:

Only make a decision when the person who appointed them cannot, whether it be temporary or permanent.
Support that person to make their own decisions if they are able to.
Produce an original or certified copy of the person’s Advance Care Directive.
Only make decisions that they have been appointed to make.
Try to contact any other decision-makers who have been appointed to make the same types of decisions.
Only make a decision on their own if no other Substitute Decision Maker with the same decision-making responsibility can be contacted, or if the decision is urgent.
Inform any other decision-makers of the decisions made.
Try to make a decision you believe the person would have made in the same circumstances.

A Substitute Decision Maker is authorised to make all of the decisions you have asked them to make on your behalf, but cannot:

Make a decision that would be illegal
Refuse food and water to be given to them by mouth
Refuse medicine for pain or distress (e.g. palliative care)
Make legal or financial decisions (unless also granted Power of Attorney for financial matters)

When Does a Substitute Decision Maker Start Making Decisions?

A Substitute Decision Maker does not begin acting immediately after being appointed. Their authority only takes effect when you lose the ability to make or communicate your own decisions. This could happen temporarily, such as during surgery or a medical emergency, or permanently, such as in cases of dementia or serious brain injury.

As long as you are capable of making your own decisions, the people you’ve appointed have no authority to act on your behalf.

How to Change a Substitute Decision Maker

You can update or revoke your Advance Care Directive at any time, provided you still have decision-making capacity. If you choose to change your Substitute Decision Maker, it is important to destroy any previous copies of your directive and inform your GP, hospital, and any other relevant healthcare providers of the updated version.

If you are uncertain about how to make changes or need assistance completing a new Advance Care Directive, legal advice can be helpful to ensure your preferences are accurate and recorded.