Making healthcare decisions for someone else

Sometimes a person is unable to make their own healthcare decisions, for example because of a serious injury or illness. When this happens and it is not an emergency, someone else may need to make medical treatment decisions on their behalf. This person is often called a substitute or surrogate decision-maker.

The exact rules, titles and legal documents vary by country and region, so it is worth checking what applies where you live. The general principles below are widely shared.

Who makes decisions in an emergency#

In a medical emergency, the treating doctors and medical team may make decisions about urgent care, such as giving consent for surgery, medication, life support or procedures needed to keep someone alive. In these situations there is usually no time to consult others first.

In non-emergency situations, the doctor in charge of your treatment will explain your condition and the available options, and then ask for a decision to be made.

Appointing a decision-maker in advance#

While you are still able to make decisions, you can usually appoint a person you trust - often a close friend or family member - to make healthcare decisions for you if you later become unable to. In many places this is done by completing a formal legal document.

A person appointed in this way is expected to act in a way that promotes your wellbeing. This means considering your medical preferences, values and beliefs, and making the decision they believe you would have made if you were able to.

When no one has been appointed#

If you are unable to make decisions and no formal appointment has been made, a person close to you will usually be asked to make medical treatment decisions on your behalf. In most circumstances this is a family member or your main carer.

Many systems set out an order of priority among the people who have a close and continuing relationship with you - for example, a legally appointed guardian, then a spouse or partner, a primary carer, an adult child, a parent or an adult sibling. The exact order, and how it is applied, depends on local law.

Whoever takes on this role should make the decision the person would make for themselves, as far as that can be known. This is why it is so important to talk about a person’s medical wishes with them in advance, so their views are understood.

Recording your own wishes#

You can also write down your wishes for future care. A document of this kind (sometimes called an advance care directive or advance directive) lets you set out the treatment you would or would not want if you could not make decisions yourself, for example if you were unconscious after an accident.

If such a document contains valid, specific instructions consenting to or refusing certain treatment, those instructions generally cannot be overridden by your medical team or your decision-maker. An advance directive can also record your values, beliefs and preferences, which helps guide your decision-maker and gives them confidence that they are making the choices you would want.

Questions worth discussing#

If you are appointing someone, or being appointed as someone else’s decision-maker, it helps to talk through a few questions together:

• What is most important to the person in terms of their health and health outcomes?
• What are their main fears or worries?
• What trade-offs are they willing to make to achieve the outcomes they want - for example, would staying at home matter more than having intensive care close at hand?

Having these conversations early makes it far easier to make decisions that reflect what the person truly wants.

Key points#

• In a medical emergency, the medical team may make decisions about urgent treatment.
• You can formally appoint a trusted friend or family member to make healthcare decisions for you if you become unable to.
• If no one has been appointed, the role usually falls to a family member or primary carer.
• It is important to discuss a person’s medical wishes with them so their views are understood.
• The specific laws, documents and titles vary by country and region.

Where to get help#