Direct answer
In Ontario, a substitute decision-maker (SDM) makes a health-care decision only after a person is found incapable for that decision. The Health Care Consent Act has a ranked list. The SDM must follow known prior capable wishes or act in the person's best interests.
Substitute decision-making in Ontario starts when a health practitioner finds that a person is incapable of a specific treatment decision. Capacity is decision-specific. A person may be capable for some decisions and not others.
The SDM hierarchy includes a guardian of the person, attorney for personal care, Consent and Capacity Board-appointed representative, spouse or partner, child or parent, parent with access only, sibling, other relative, and the Public Guardian and Trustee as fallback. The SDM must meet the HCCA eligibility rules and follow prior capable wishes or best interests.
The best way to ensure an autistic adult's preferences are respected is to create a power of attorney (POA) for personal care while they have capacity. The POA allows the person to choose who will make decisions for them if they become incapable. It can include specific instructions about medical treatments, living arrangements, and personal care preferences.
A POA for personal care can be created by any adult with the capacity to understand its nature and effect. Many autistic adults have this capacity. Work with a lawyer to create the document. Include detailed instructions about the person's preferences, values, and prior wishes to guide future decision-making. Review and update the POA periodically.
HCCA
Health Care Consent Act, S.O. 1996, c. 2, Schedule A — Substitute Decision-Making Provisions
SDA
Substitute Decisions Act, S.O. 1992, c. 30 — Power of Attorney for Personal Care
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Commitment to Accuracy: Our data is verified against official government reports (FAO, MCCSS), peer-reviewed scientific literature, and accessible public records. Last updated: March 24, 2026.
How many children are on the Ontario autism waitlist in 2026?
As of May 13, 2026, 91,974 children are registered with the Ontario Autism Program. However, only 20,711 (22.5%) have an active Core Funding Agreement. This represents approximately 290% growth in registrations since 2019, with 71,263 children still waiting for essential funding.
Source: MCCSS FOI via OAC · Mar 2026, FAO Report 2024 · Verify Link
How long do families wait for Ontario autism services?
Ontario autism wait times for core clinical services now exceed 5+ years (2026). Most families currently receiving invitations registered in 2020 or earlier. This delay far exceeds the sensitive early intervention window recommended by developmental specialists.
Source: MCCSS FOI via OAC · Mar 2026, FAO Report 2024 · Verify Link
Is the Ontario Autism Program underfunded?
Yes. The Financial Accountability Office (FAO) determined that $1.35 billion annually is needed to serve all registered children at 2018-19 service levels. The 2026-27 Ontario Budget allocated $965 million, leaving an estimated $385M+ annual shortfall. This gap is the primary driver of the perpetual 91,974+ child waitlist.
Source: Financial Accountability Office of Ontario [FAO] · Verify Link
Written by Spencer Carroll
Founder & Autism Advocate