Substitute Decision Maker Nova Scotia: Who Decides When Your Parent Can't

The hospital is asking for consent to proceed with surgery. Your parent cannot speak for themselves. There is no personal directive naming a healthcare delegate. Who has the legal authority to say yes?

Nova Scotia's Personal Directives Act answers this with a statutory decision-maker (SDM) hierarchy — a fixed priority list that healthcare providers follow to find the nearest available person authorized to consent on the patient's behalf.

The Statutory Priority List

When no personal directive exists, the healthcare provider moves down this list until they find someone who meets all three qualifying criteria:

The first person on the list who meets the criteria becomes the decision-maker. You do not get to choose. If your parent's spouse is available and willing, adult children cannot override them even if the children disagree with the spouse's decisions.

The Three Qualifying Criteria

Simply being on the priority list is not enough. The statutory decision-maker must:

1. Be at least 19 years old
2. Have had personal contact with the incapable adult within the past 12 months — phone calls, visits, or other meaningful communication count, but the contact must be verifiable
3. Be willing and capable of making decisions in accordance with the parent's known values, beliefs, and prior wishes

If the highest-priority person fails any criterion — they are under 19, had no contact in the past year, or refuse the responsibility — the provider moves to the next category.

What a Statutory Decision-Maker Can Do

The SDM can authorize:

• Medical treatments and surgical procedures
• Consent to home care services
• Admission to a continuing care facility (residential care or nursing home)
• Palliative and end-of-life care decisions

The Critical Limitation

A statutory decision-maker has zero authority over financial matters. They cannot access bank accounts, collect pensions, pay bills, file tax returns, sell property, or manage investments. For financial authority, the family must either have an existing enduring power of attorney or apply to the Supreme Court for a Representation Order under the Adult Capacity and Decision-making Act.

This is the gap that traps families: the hospital consents are handled by the SDM, but the bills pile up because no one has legal authority to access the parent's money.

What If Multiple Siblings Disagree?

If two adult children are both at priority level 2 and disagree on a healthcare decision, the healthcare provider typically works with the child who was identified first or who has the closest relationship with the parent. Persistent disagreements may require court intervention or referral to the Public Trustee.

A personal directive eliminates this ambiguity entirely by naming one specific delegate with clear instructions about the parent's wishes.

Avoiding the Statutory Default

The SDM hierarchy is a safety net, not a plan. It puts the right person in charge only by accident — the priority order may not reflect your parent's actual preferences. The Nova Scotia Power of Attorney & Personal Directive Kit covers how to create a personal directive that names the right delegate, alongside the enduring power of attorney that covers the financial side the SDM hierarchy cannot touch.

See more Nova Scotia guides →