Making Sense of Low Back Pain
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Whose Decision is it Anyway?

Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Baycrest Geriatric Health Care System; Professor of Medicine, University of Toronto, Toronto, ON.

Abstract
One of the most challenging and at the same time hopefully rewarding activities is to be the substitute decision maker (SDM) for someone important to you such as a parent. The assumption is by designating a child or children to be one's substitute they will make the right decisions and keep your wishes or best interests at the centre of the decision-making. This unfortunately is not always the case and for a variety of reasons some of which are just a misunderstanding of the legislation and the meaning of the Health Care Consent Act some SDMs start making decisions based on their personal preferences and biases and not of the person they are meant to represent. This can lead to varying degrees of conflict sometime so serious that health care professionals may explore the steps that might be needed to remove the SDM from the role and find a more appropriate substitute. This is not something one likes to do and with proper explanation it usually can be avoided. The most important point is that the patient must always be the centre of the decision-making process.
Keywords: substitute decision-maker, capable patient, consent, Public Guardian.