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→3. Temporary Substitute Decision Makers
A TSDM has authority to decide whether to give or refuse consent, in accordance with the adult patient’s wishes, values and beliefs. The authority of a TSDM to give or refuse consent is generally valid for 21 days, but this time period may be extended upon written confirmation by the health care provider (ss 17 and 19, HCCFA). If the health care provider has reasonable grounds to believe that the adult patient may be capable during this time period, the health care provider must again determine the adult’s capability in accordance with s 7 of the HCCFA. If an adult patient is deemed to be capable again, consent must be given or refused by the adult patient. For more information, refer to section [[Representation Agreements (15:V)#1. Temporary Substitute Decision-makers (TSDM) | V.H.1: Temporary Substitute Decision-makers (TSDM)]] in this chapter.
=== 4. Representation Agreement (RA) ===
An adult who meets the requisite mental capacity test may create a Representation Agreement (RA), which is a legally-binding document that appoints a substitute or supportive decision-maker and provide instructions with respect to health care decisions, personal care, and/or routine financial decisions. See s 7 and 9 of the ''Representation Agreement Act'', RSBC 1996, c 405 [RAA]. Section 7 and 9 RAs deal with different types of decisions (see section V.A: Types of Representation Agreements) and are subject to distinct different mental capacity standards. In British Columbia, an adult is presumed to have capacity, unless proven otherwise. According to s 3(1) of the [RAA], an adult is presumed to be capable of:
*making, changing or revoking a s 7 or s 9 RA;
*making decisions about personal care, health care and legal matters; and
*conducting the routine management of their own financial affairs.
An adult who has diminished capacity may still be allowed to make, change or revoke a s 7 RA, even when the adult is incapable of: (s 8(1), RAA)
*making a contract;
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