DNR Order PEI: Do Not Resuscitate in Prince Edward Island

PEI doesn't use a standalone DNR form the way some jurisdictions do. Instead, resuscitation preferences are handled through Health PEI's Goals of Care Designation system — a clinical framework that covers not just CPR but the entire spectrum of treatment intensity. Understanding how this system works is essential if you want to refuse resuscitation, because a verbal request or a note in your wallet isn't enough to create a binding medical order.

How PEI Handles Resuscitation Decisions

Rather than issuing a simple yes-or-no DNR order, Health PEI uses a three-tier Goals of Care Designation (GCD) that your physician writes as a formal medical order:

Designation R (Resuscitation) — All available interventions, including CPR, chest compressions, cardiac defibrillation, mechanical ventilation, intubation, and ICU admission. This is the default if no GCD exists.

Designation M (Medical) — Active medical treatment including antibiotics, surgery, and diagnostic testing, but explicitly no CPR and no mechanical life support if the heart or breathing stops.

Designation C (Comfort) — Focus entirely on pain management, symptom relief, and psychological comfort. No resuscitation, no ICU transfer, no diagnostic tests aimed at treatment. Artificial nutrition and hydration are generally excluded in terminal phases.

If what you want is "do not resuscitate," that's either Designation M or Designation C, depending on whether you still want active medical treatment for curable conditions. Designation M says "treat my illness, but if my heart stops, let me go." Designation C says "focus on comfort only."

Your Right to Refuse Treatment

PEI law grants every capable adult the right to refuse any medical treatment, including life-sustaining treatment. This right is embedded in the Consent to Treatment and Health Care Directives Act — consent must be informed and voluntary, and refusal of consent must be respected.

This means you can refuse CPR, refuse mechanical ventilation, refuse artificial nutrition and hydration, and refuse any other intervention. Your refusal doesn't require a medical justification. You don't need to prove that the treatment would be futile — you can refuse treatment that might save your life if that's your informed choice.

The refusal becomes most powerful when it's documented in two places: your written Health Care Directive and your physician's Goals of Care Designation in the provincial EMR.

Making It Official

A resuscitation preference becomes a binding medical order through this sequence:

Step 1: Document it in your Health Care Directive. Write your preference using Health PEI's R/M/C language. "I choose Designation M" or "I choose Designation C" is clearer than "DNR" because it communicates the full scope of treatment you accept or refuse, not just the resuscitation piece.

Step 2: Discuss it with your physician. Your doctor will review your directive, ask clarifying questions about specific scenarios (artificial feeding, ICU admission, antibiotic treatment), and ensure your decision is informed.

Step 3: Your physician writes the GCD order. The Goals of Care Designation is entered on the official Health PEI form and saved to the provincial Electronic Medical Record. This is the step that converts your personal preference into an active clinical order.

Step 4: Confirm EMR access. Ask your doctor: "Is this Goals of Care order accessible to emergency responders and other Health PEI facilities through the EMR?" The whole point of the GCD system is that any Health PEI clinical team can see your order immediately, whether you're at the Queen Elizabeth Hospital in Charlottetown, Prince County Hospital in Summerside, or receiving care from Island EMS.

What About Emergency Situations

If paramedics arrive at your home and you're in cardiac arrest, they need to know your resuscitation preferences immediately. PEI's system relies on:

• The GCD in the provincial EMR — accessible to EMS personnel
• A Health PEI Advance Care Planning wallet card — carried in your wallet, alerting responders that you have a directive on file
• A visible copy of your directive — the standard PEI advice is a clear sleeve on the refrigerator

Without any of these, EMS will provide full resuscitative care by default. They're trained to save lives, and in the absence of documentation, they resuscitate. This is why a verbal family member saying "they didn't want CPR" isn't sufficient to stop resuscitation — paramedics need a documented medical order.

Can Your Family Override a DNR?

If you have a valid Health Care Directive and a GCD on file specifying Designation M or C, your family cannot legally override your refusal of resuscitation. Your proxy's role is to implement your documented wishes, not to substitute their own preferences.

In practice, family members who disagree with a comfort-care decision sometimes create pressure on the clinical team. But the legal framework is clear: your documented wishes, expressed through the directive and the GCD, take precedence over family objections.

Where complications arise is when there is no valid directive, no appointed proxy, and the default substitute decision-maker hierarchy activates. If multiple family members disagree about resuscitation, the dispute escalates to the Public Guardian and Trustee — which is exactly the situation a Health Care Directive with a proper proxy appointment is designed to prevent.

The Prince Edward Island Advance Directive & Living Will Kit includes a Goals of Care Translation Worksheet that walks through each resuscitation scenario and a Doctor Conversation Guide with specific language for communicating your Designation M or C preference to your physician.

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