Health-care decisions in the hospital
Making health care decisions can feel overwhelming at times. Learn more about how you can choose the care that is right for you and your loved one.
Health care is a partnership between patients, their loved ones and their health care team.
Doctors will provide the information you need about the risks, benefits and alternative treatments so that you can choose the proper care for your loved one if they cannot speak for themselves.
Some of the most complex decisions are whether to use life support or life-prolonging medical interventions, such as a ventilator, tube feeding, kidney dialysis, or CPR to restart the heart and lungs. The health care provider will offer these treatments when they believe they are medically appropriate.
There are options to help patients make decisions and ensure that their loved ones have access to information regarding their care.
Advance care planning
Advance care planning gives you a say about the health care you would like to receive as a patient if you get very sick and cannot speak for yourself. It's a way to reflect on the values most important to you, and to discuss your wishes with those close to you to make future health care decisions.
Adults who can make their own health care decisions – especially those with chronic or complex health conditions – are encouraged to start the advance care planning process. If your loved one can’t make their own decisions, you must appoint a substitute decision-maker.
An advance care plan can address different situations, such as your hospital care during and after routine surgery, care in the event of an accident, or end-of-life care decisions.
Appoint a spokesperson
We know access to information is one of a family’s most essential needs. Having a family spokesperson is very important. A spokesperson is one person who will act as the point of contact for friends and family. This person can speak with the doctor or nurse about the patient’s condition and is responsible for relaying these updates to family and friends. A spokesperson is different than the Temporary Substitute Decision Maker (TSDM), as the spokesperson can only relay information to family members. They cannot make any medical decisions for the patient unless they are also the TSDM.
Role of the spokesperson
- Be the primary person to communicate with the health care team about the patient’s condition and care plan
- Coordinate visitations and relay information with extended family and friends
- Update family and friends regularly
Temporary Substitute Decision Makers (TSDM)
Sometimes, your loved one cannot make decisions about their care. In these cases, a temporary substitute decision-maker (TSDM) may be needed to make necessary legal decisions on behalf of the patient.
When a person is unconscious or critically ill and cannot make medical decisions for themselves, a TSDM is identified, as outlined by the Health Care Consent Act. This is different than the spokesperson. *For more information on the Health Care Consent Act, please review the Consent to Health Care Pamphlet.
The TSDM is responsible for signing for medical procedures, providing additional information to the doctors and nurses and advocating for the patient’s care wishes.
Periodic progress reports will be given to the spokesperson/or the TSDM by one of the doctors or nurses. Formal, sit-down family meetings will be arranged as needed or upon your request. If you wish to meet with any other health care team member, please just ask.
The spokesperson for your family can call for an update, but please be mindful that the bedside nurse who provides telephone updates may be providing hands-on care at the time of your call. When this happens, you may be asked to call back at a later time.
Frequently asked questions
Who can be the substitute decision maker?
The person, the patient, has identified a decision maker in their legal representation agreement. This person will be required to sign consent on behalf of the patient.
The substitute decision-maker must be:
- At least 19 years of age
- In contact with the patient within the last 12 months
- No dispute with the patient
- Capable of performing the role of giving, refusing or revoking consent
- Willing to comply with substitute decision-maker duties
What if a substitute decision maker hasn’t been identified?
If a substitute decision-maker hasn’t been identified, the first person who qualifies and is available (in the following order) will be assigned the role:
- Anyone related by birth or adoption
What if no one qualifies to be the substitute decision maker?
If no one qualifies, then a person will be authorized by the Public Guardian and Trustee.
The doctor will discuss the patient’s condition and treatment plan with the family. As appropriate, limitations to treatment may be discussed.
Decision aid tool
The Ottawa Foundation for Informed Medical Decision Making has published a guide to preparing you, as the substitute decision maker, to consider care options for your family member during critical illness. It will help you share your views with other family members and the health care team. It can also guide you through difficult decisions during family meetings.
We’ve put together a brochure outlining what you need to know about the law, when consent is required, when it's not required, substitute decision makers and more.
Cardio-Pulmonary Resuscitation (CPR) decisions
Our goal is to respect your wishes and provide the proper care at all times, while supporting you and your family during your illness.
Frequently Asked Questions
What is Cardio Pulmonary Resuscitation (CPR)?
‘Cardio’ means heart. ‘Pulmonary’ means lungs. ‘Resuscitation’ means to try and restart a person’s heart beat and breathing when they stop
CPR may include:
- pressing on the chest to pump blood through your heart to your body
- forcing air into your lungs to get oxygen to your brain
- giving medications to try and restart your heart
- using electric shock from a machine to try and restart your heart
How well does CPR work?
Cardio Pulmonary Resuscitation (CPR) can work for reasonably healthy adults, and only if others are there when it happens, and someone starts CPR immediately. CPR is not usually effective if someone does not start CPR right away. It is also not generally effective for:
- adults with medical conditions that have already caused damage to their heart, lungs, kidneys, or brain
- adults who are at the natural end of their life
If a patient’s heart stops for more than 5 minutes, there is a good chance they will have brain damage or die. Of the adults who have CPR right away, only 2 to 3 out of 20 adults (10 to 15%) are likely to survive. Only 1 out of 20 (5%) of those who survive will recover well enough to return home.
The actions involved in CPR can cause broken ribs and damage to the brain, throat, voice, lungs, and kidneys.
What if CPR is not to be done?
You will continue to get excellent medical care, including:
- support for your breathing
- medications for blood pressure support
- medication for pain and comfort
Our goal is to respect your wishes, provide the proper care, and support you and your family during your illness.
What is DNACPR or DNR?
Do Not Attempt Cardio Pulmonary Resuscitation or Do Not Resuscitate are orders the doctor can write after discussing with the patient and family. A DNR does not affect any treatment other than CPR. DNR patients can continue getting chemotherapy, antibiotics, dialysis, or other appropriate treatments.
Talk with your doctor. Ask what would be best for you should your heart stop.