Substitute Decision Maker Manitoba: How to Choose and Appoint One

What a Substitute Decision Maker Does in Manitoba

When you can no longer make or communicate your own medical decisions — after a stroke, during surgery, in advanced dementia — someone else needs to speak for you. In Manitoba, that person is called a proxy under The Health Care Directives Act, though "substitute decision maker" and "healthcare proxy" describe the same role.

Your proxy's job isn't to decide what they think is best. It's to make the decision you would have made, based on the wishes you've documented in your Health Care Directive and the values you've expressed to them over time. When your directive doesn't address a specific situation, the proxy applies their knowledge of your beliefs, priorities, and personality to make a judgment call. This is called the "substituted judgment" standard, and it's the legal foundation of the role in Manitoba.

Who Can Serve as a Proxy

Manitoba law sets a few baseline requirements for proxy eligibility:

• Must be at least 18 years old — even though you can create a Health Care Directive at 16 in Manitoba, the person you appoint as proxy must be an adult
• Must be mentally competent — able to understand medical information and make reasoned decisions under pressure
• Must be willing to serve — you should always confirm with someone before naming them, because a proxy who's never seen the directive and doesn't know they've been appointed is functionally useless in a crisis

There's no requirement that a proxy be a family member. You can appoint a trusted friend, a colleague, a clergy member, or anyone else who knows your values well enough to represent them. In some families, the person closest to you emotionally isn't the best person to make hard medical calls under pressure — and that's a completely valid reason to choose someone else.

Consecutive vs. Joint: The Decision Most People Skip

Your Health Care Directive can name more than one proxy, but you need to specify how they share authority. Manitoba law gives you two options:

Consecutive appointment means your proxies act in order — your first-named proxy makes all decisions, and the second (or third) only steps in if the first is unable or unwilling to act. This is Manitoba's default if you don't specify. It's simpler, faster in emergencies, and avoids deadlocks.

Joint appointment means all named proxies must agree on every decision together. This sounds collaborative, but it creates real problems in practice. If two joint proxies disagree about whether to continue life support, the clinical team can't act on either instruction — and the family may end up in the Court of King's Bench asking a judge to appoint a litigation guardian to break the tie.

For most families, consecutive is the better choice. Name the person you trust most as primary proxy, and a backup who can step in if the primary is travelling, ill, or emotionally unable to make the decision. If you genuinely want two people involved, consider naming them consecutively but asking in your directive that the primary proxy consult with the secondary before major decisions — this preserves clear legal authority while respecting both relationships.

What Happens If You Don't Appoint Anyone

If you lose capacity without a Health Care Directive naming a proxy, Manitoba's health system uses the applicable next-of-kin rules to identify a default substitute decision-maker. The exact person and authority depend on the circumstances, so ask the treating team who is authorized to act.

This default system sounds reasonable until you hit a conflict. If you have three adult children and they disagree about your treatment — one wants aggressive intervention, one wants comfort care, the third is unreachable — the clinical team is stuck. Healthcare providers in Manitoba cannot choose which relative's decision to follow when multiple people at the same priority level disagree. The dispute resolution path is a formal care conference, possibly a clinical ethics consultation, and ultimately a court application for a sole litigation guardian. All while you're lying in a hospital bed without documented wishes.

Appointing a proxy in a Health Care Directive eliminates this entirely. One person has clear legal authority. The clinical team knows who to call. Decisions happen in minutes, not weeks.

Practical Tips for Choosing the Right Person

Beyond the legal requirements, think about what actually makes someone effective in this role:

Geographic proximity matters. Your proxy may need to be physically present at the hospital for urgent decisions. Someone in Vancouver is a less practical choice than someone in Winnipeg, even if the Vancouver relative knows you better.

Emotional resilience matters. Making a decision to withdraw life support or decline treatment for a parent or spouse is devastating. Some people simply cannot do it, no matter how well-prepared they are. Choose someone who can hold your values steady under extreme emotional pressure.

Communication matters. Your proxy will need to advocate clearly with medical teams, push back on recommendations that conflict with your wishes, and explain your preferences to other family members who may disagree. Quiet compliance and medical deference don't serve you well in this role.

Have the conversation. Don't just name someone on paper. Sit down and tell them what you want — what quality of life means to you, where you draw the line on intervention, how you feel about resuscitation, ventilation, and feeding tubes. The more context they have, the more confidently they can represent you.

The Manitoba Advance Directive & Living Will Kit includes a proxy appointment worksheet that walks through the consecutive-vs-joint decision, documents the conversation between you and your chosen proxy, and provides a template for the formal appointment language that Manitoba law recognizes.

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