Health Care Decision Maker Alberta: Who Decides When Your Parent Can't

The Decision-Making Hierarchy

Alberta law establishes a strict hierarchy for healthcare decision-making when a parent loses the capacity to consent. The system does not allow families to informally choose who decides. There is a ranked order, and the healthcare team follows it:

1. Personal Directive agent — the person the parent named in their PD to make non-financial decisions
2. Court-appointed guardian — a guardian appointed by the Court of King's Bench under the AGTA
3. Specific Decision Maker (SDM) — a relative selected by the healthcare provider under Section 96 of the AGTA for a one-time decision

If your parent has a Personal Directive, the named agent decides. If there is no PD but a court-appointed guardian exists, the guardian decides. If neither exists, the healthcare provider activates the Section 96 Specific Decision-Making pathway.

How Specific Decision-Making Works

Section 96 of the Adult Guardianship and Trusteeship Act provides a fast-track mechanism for urgent healthcare decisions when no PD agent or guardian exists. It does not require court involvement — the healthcare provider manages the entire process.

Step 1: Clinical capacity assessment. A physician, nurse practitioner, or dentist (for dental care only) assesses the patient and completes Form 10: Capacity Assessment Report — Specific Decision-Making.

Step 2: Selecting the relative. The healthcare provider selects a Specific Decision Maker from a ranked statutory hierarchy. Within each tier, the eldest relative of full blood is preferred:

1. Spouse or adult interdependent partner
2. Adult son or daughter
3. Father or mother
4. Adult brother or sister
5. Grandfather or grandmother
6. Adult grandson or granddaughter
7. Adult uncle or aunt
8. Adult nephew or niece
9. The Public Guardian (last resort)

The selected relative must be over 18, have been in contact with the parent in the past 12 months, have no active disputes with the parent, and be willing to act.

Step 3: Statutory declaration. The selected relative completes Form 6, Part 2 — a statutory declaration confirming their relationship and willingness to act. The healthcare provider completes Form 6, Part 3, authorizing the specific treatment or placement.

What Specific Decision-Makers Can and Cannot Do

The SDM's authority is limited to the single healthcare decision or temporary residential placement at hand. It is not a general appointment — each new decision requires a new Form 6 process.

SDMs cannot consent to:

• End-of-life decisions (withdrawing life-sustaining treatment)
• Psychosurgery
• Non-medically necessary sterilization
• Tissue transplants (unless part of a life-saving measure)
• Experimental clinical research

These limitations exist because Section 96 is designed for specific, time-sensitive healthcare decisions and temporary placements, not the kind of irreversible, life-altering choices that require the accountability of a formal guardianship order or Personal Directive.

The 7-Day Objection Window

The adult, any relative, or a person with a close relationship to the parent can challenge either the capacity assessment or the SDM's decision. If an objection is raised, the healthcare provider must not act on the decision.

The objector then has seven days to either file for judicial review with the Court of King's Bench or initiate a formal capacity assessment. If neither happens within seven days, the objection expires and the SDM's decision stands.

This window matters for families with sibling disagreements. If one sibling is selected as SDM and another disagrees with the treatment decision, the objecting sibling has a narrow window to intervene — and the consequences of inaction (the objection expiring) are real.

The Gap Between SDM and Personal Directive

The Section 96 pathway fills emergency gaps, but it is not a substitute for a Personal Directive. Each new medical decision requires a new form process. The parent has no say in who is selected — the statutory hierarchy determines the order, and the healthcare provider makes the pick. And the authority excludes the most consequential decisions.

A Personal Directive gives the parent control over who decides, extends authority to all personal matters (not just healthcare), and includes the ability to specify treatment preferences, end-of-life instructions, and residential placement wishes.

For families caught in the Section 96 loop — repeatedly going through the Form 6 process for each new medical decision — the practical solution is either to execute a Personal Directive (if any capacity remains) or to apply for a guardianship order through the Court of King's Bench.

The Alberta Power of Attorney & Personal Directive Kit covers the Personal Directive execution process that establishes permanent decision-making authority, so families do not have to rely on the one-decision-at-a-time SDM pathway.

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