Decision-Making Responsibility for Medical, Education and Religion Decisions in Ontario

What "Major Decisions" Actually Means

When an Ontario court grants decision-making responsibility under the Children's Law Reform Act (CLRA), section 18(1) defines exactly what that authority covers. It is not a vague grant of "custody." It is the legal authority to make major decisions in six specific domains:

1. Health care — medical treatment, surgeries, dental care, mental health services, vaccination decisions
2. Education — school enrollment, special education assessments, choice of school (public, private, French immersion, home schooling)
3. Culture — cultural activities, community participation, preservation of the child's cultural identity
4. Language — language of instruction, heritage language programs
5. Religion — religious upbringing, participation in religious communities, faith-based education
6. Spirituality — spiritual practices and traditions, particularly relevant for Indigenous children under the CLRA's cultural preservation obligations

Under section 20(2), a person with decision-making responsibility assumes the legal rights and responsibilities of a parent regarding the child's care and upbringing. A court order can establish your authority, but institutions may require a certified copy with specific terms before recognizing it.

Sole vs Joint Decision-Making

The court can allocate decision-making responsibility in several ways:

Sole decision-making responsibility means one person — you — makes all major decisions across all six domains. This is the most common arrangement when a grandparent or relative is the primary caregiver and the parents are unable or unwilling to participate in decision-making.

Joint decision-making responsibility means you share major decisions with one or both parents. In practice, this requires the adults to communicate and agree on medical, education, and other major choices. If they cannot agree, either party can bring the dispute back to court.

Split decision-making is less common but possible. The court can assign different domains to different people — for example, you make education and health decisions while a parent retains authority over religious upbringing. This is unusual and typically reserved for cases where a parent has specific cultural or religious ties the court wants to preserve.

What This Means Day to Day

Medical Decisions

With decision-making responsibility, you can:

• Consent to medical treatment, including surgeries and dental work
• Access the child's medical records
• Choose the child's family doctor, dentist, and specialists
• Make decisions about mental health treatment and counselling
• Consent to vaccinations

A certified copy of your court order may be needed to establish your authority with a hospital or walk-in clinic. Ask the provider what the order must say. Updating the child's OHIP card may also involve separate requirements.

Administering medication already prescribed may be part of routine care. A non-parent should not assume that contact time alone gives authority to consent to new medical treatment or access records; check the court order and the provider's requirements. Choosing a new doctor, consenting to surgery, or enrolling the child in a therapy program are major decisions covered by decision-making responsibility.

Education Decisions

Decision-making responsibility gives you the authority to:

• Enroll the child in school or withdraw them
• Choose between public, Catholic, private, or French immersion schools
• Consent to special education assessments (IPRC placements)
• Authorize field trips and extracurricular activities
• Attend parent-teacher conferences and access the child's Ontario Student Record

Schools may require proof of legal authority before accepting enrollment from a non-parent. Ask the school board whether it needs a certified copy of the order and confirm that the order's terms cover the decision.

Religious and Cultural Decisions

Section 24(3) of the CLRA requires the court to consider the child's cultural, linguistic, religious, and spiritual identity when making best interests determinations. When you hold decision-making responsibility for religion, you can choose the child's religious upbringing and community participation.

If the child has an established religious identity — they have been attending a mosque, church, synagogue, or temple — the court may expect you to maintain that connection, particularly if it serves the child's stability and wellbeing. The best interests analysis looks at continuity for the child, not the caregiver's preferences.

For Indigenous children, the CLRA includes specific provisions requiring courts to consider the child's connection to their Indigenous community, culture, and heritage. A non-Indigenous relative seeking decision-making responsibility for an Indigenous child should expect the court to scrutinize how the child's cultural identity will be preserved.

When Parents Disagree With Your Decisions

If you hold sole decision-making responsibility, a parent cannot override your major decisions. They may disagree, but the court order gives you final authority. If a parent attempts to interfere — enrolling the child in a different school, consenting to medical treatment without your knowledge — the order is your protection.

Under joint decision-making, disagreements require negotiation. If you cannot reach agreement on a major decision, either party can file a motion asking the court to decide the specific issue. This is time-consuming but ensures no one acts unilaterally on contested decisions.

Building Your Case

When you file your Form 35.1 affidavit, the care you have provided in these domains strengthens your application. If you have been the person taking the child to doctor's appointments, attending school meetings, and managing their daily routine, document that history. The court wants to see that decision-making responsibility reflects the child's lived reality, not just a legal arrangement.

The Ontario decision-making order toolkit includes guidance on documenting your care history and preparing the affidavit evidence that supports your application across all six decision-making domains.

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