This document was developed by Ethics Nova Scotia Health in conjunction with Legal Services. This is a guide only. Staff are responsible for ensuring compliance with relevant Nova Scotia Health policy and professional standards.
This education guide is developed for Nova Scotia Health staff and team members. If you are a family member or a substitute decision-maker (SDM), please see our patient and family guide Making Health Care Decisions for Someone Else: Acting as a Substitute Decision-Maker (SDM).
This is a CONTROLLED document for internal use only. Any documents appearing in paper form are not controlled and should be checked against the electronic file version prior to use.
Select a tab for the definition
Adult: A person who is 19 years of age or more.
Best Interest: In practice, the term is often used to mean an all-things-considered assessment of what is optimal for a patient, given the available options. A legal definition is available in section 54B in the Hospitals Act.
Capacity: An ability to understand the information relevant to the situation and an ability to appreciate the consequences of decision-making. Note: this term may be defined differently depending on the applicable legislation.
Common-law partner: With respect to a patient, a common-law partner is a person who has cohabitated with the patient in a conjugal relationship for at least one year.
Delegate: A person 19 years of age or older who is authorized in a Personal Directive (PD) to make personal care decisions on another person’s behalf when that person lacks capacity to make these decisions on their own. The delegate is usually a family member or friend but does not have to be. Sometimes an alternate delegate is named in case the first delegate is not able to act. A delegate is also referred to as a substitute decision-maker or SDM.
Ethics support: Available to help healthcare teams, patients and families identify and analyze the values at play and in tension, and to explore ethics dimensions and options available. For more information, visit https://www.nshealth.ca and search "ethics".
Family: In this document, the term "family" is meant to be understood broadly to include those whom a patient identifies as being within their immediate support network.
Healthcare team: Includes all healthcare providers who contribute to looking after a patient. This may include doctors and nurses, respiratory or occupational therapists, physiotherapists, social workers, care coordinators, personal support workers, and more.
Mature minor: In Nova Scotia, a person under the age of 19 who has the capacity to make their own healthcare decisions.
Next of kin: Next of kin is not a legal term, but a term that has been used in health care and continues to be used informally. Typically, this refers to a person (not necessarily a family member) identified by the patient as someone who is their support person and who should be called, for example, if the patient requires supplies brought in or transportation after a procedure. Note that this may not be their legal substitute decision-maker should the patient lose decision-making capacity.
Personal Directive: A personal directive is a legal document in which a person with capacity to make personal care decisions sets out what they would want for their health care and/or personal care and/or who they want to make these decisions on their behalf in the event they are no longer capable of making those decisions on their own.
Power of Attorney: Power of attorney is a document that legally designates one or more people to make decisions related to property and finances of another person.
Substitute Decision-Maker (SDM): Someone who has authority to make personal care and/or healthcare decisions on behalf of a person who lacks capacity to make these decisions on their own.
Statutory Hierarchy: If (i) the patient has not named a delegate in a personal directive, and (ii) there is no Representation Order or legally appointed guardian, the SDM is determined in accordance with the (iii) statutory hierarchy, as outlined below:
Spouse: With respect to a patient, a spouse is a person who is cohabitating with the patient in a conjugal relationship as married spouse, registered domestic partner, or common-law partner.
