Types of substitute decision makers

When an adult is unable to make decisions about their health care, a family member, close friend or unpaid support person may be able to make decisions about significant medical treatment on their behalf without a formal guardianship appointment (with the exception of procedures that require special authorisation); see Consent for health care for people with developmental disability. State-based legislation specifies the hierarchy of persons who can fulfil this role (eg spouse, de facto partner, carer, close friend, relative). Depending on the state or territory, this person may be called the ‘informal decision maker’, ‘person responsible’, ‘statutory health attorney’ or ‘medical treatment decision maker’. In some cases, this person may have been formally appointed by the person with developmental disability.

Medical information provided to a substitute decision maker should be limited only to that needed to make an informed decision about the treatment proposed.

A paid support person (eg a disability support worker) cannot consent to medical treatment, intervention or testing for an adult with impaired capacity to make decisions. When consent is not required (eg in an emergency or for minor, uncontroversial procedures), they can support the adult while they receive health care.

If there is no appropriate person responsible, a guardian may need to be appointed to make healthcare decisions for the person with developmental disability; see When does a guardian need to be appointed?. For more information about legal authorities and their functions, see Legal resources on decision making for people with developmental disability.