Living with Chronic Pain

Differences Between a Substitute Decision Maker and a Power of Attorney for Personal Care


What is a substitute decision maker (SDM)?

A substitute decision maker (SDM) is a person chosen by an individual to make health care decisions on their behalf in the event they become unable or incompetent to make their own health care decisions. This may occur due to a serious injury or illness. The SDM is typically identified prior to making any major health declarations. An SDM may be referred to as an alternate decision maker, or as a health care representative, agent or proxy.

What is a power of attorney?

A power of attorney is a written, legal document giving a person or organization the authority to make personal care decisions on an individual's behalf if they become incapable of making their own decisions. There are two types of power of attorney: personal care and property. Personal care power of attorney includes health care, medical treatment, nutrition, housing, clothing, hygiene, etc.


While a SDM is the person appointed to make health care decisions, a power of attorney is the legal documentation stating who is appointed to make those decisions. A power of attorney can also make decisions concerning personal care, such as clothing, housing, nutrition, etc.


Both an SDM and power of attorney uses an individual’s advance care plan, (personal directive, advance directive, or living will), past statements, or personal knowledge to make informed health care decisions. Both can refuse or agree to medical treatment, (e.g., medications, surgery, life support, etc.), on an individual’s behalf. The power of attorney or SMD should be a trusted friend or family member who is well-informed about the individual's health care desires and preferences.

Additional source: Legal Line

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