Dying with Dignity and Advance Directives in PEI

Where Advance Directives and MAID Intersect

Medical Assistance in Dying (MAID) is legal across Canada under the Criminal Code amendments passed in 2016 and expanded in 2021. PEI residents can access MAID through Health PEI, and the province follows the federal framework — a person must make a voluntary request, have a grievous and irremediable medical condition, and meet the safeguards specified in the legislation.

The question that comes up frequently in advance care planning is whether you can request MAID through an advance directive — writing in your Health Care Directive today that you want MAID administered in the future if you develop dementia, lose capacity, or reach a condition you consider intolerable.

The current answer is no. Under existing Canadian law, MAID requires the person to give informed consent at the time the procedure is administered. A proxy cannot consent to MAID on someone's behalf. An advance directive cannot authorize a future MAID request. The person must be capable of consenting at the moment of the procedure (with one specific exception, discussed below).

This is the single most misunderstood aspect of advance care planning in Canada, and it's worth understanding exactly what your directive can and cannot do in this area.

What the Law Currently Allows

The 2021 amendments to Canada's MAID legislation (Bill C-7) created two tracks.

Track 1: Natural death is reasonably foreseeable. The person has a serious illness, disease, or disability; their condition is in an advanced state of irreversible decline; their suffering is intolerable to them; and their natural death is reasonably foreseeable (though no specific prognosis or timeline is required). Under this track, a person who has been assessed and approved for MAID can sign a waiver of final consent — meaning that if they lose capacity between the approval date and the scheduled procedure date, MAID can still be administered without requiring the person to reconfirm consent at the last moment.

This waiver is the closest thing to an "advance" MAID request that currently exists in Canadian law. But it only applies after a full MAID assessment has been completed and both clinicians have approved the request. You can't write a prospective waiver into your Health Care Directive years before you need it.

Track 2: Natural death is not reasonably foreseeable. For people whose condition is serious and incurable but not terminal — chronic pain conditions, certain disabilities — a 90-day assessment period applies, and the person must give final consent on the day of the procedure. No waiver of final consent is available under this track.

What Advance Directives Can Do

Even though your Health Care Directive cannot authorize a future MAID request, it can do several things that shape end-of-life care in ways that align with a dignity-focused approach.

Refuse life-sustaining treatment. Your directive can specify that you refuse CPR, mechanical ventilation, dialysis, feeding tubes, and other interventions that would prolong life. In PEI's Goals of Care framework, choosing Designation C (comfort care only) means the medical team provides pain management and symptom relief without pursuing curative treatment or resuscitation. This is not MAID — it's allowing natural death to occur without medical intervention to prevent it.

Request aggressive pain management. Your directive can instruct your proxy and care team to prioritize pain relief even if the medications used carry a risk of hastening death. This is the principle of "double effect" — administering medication with the primary intent of relieving suffering, even though a foreseeable side effect may be shortened life. This is legally and ethically distinct from MAID and is standard practice in palliative care.

Specify conditions for transitioning to comfort care. Your directive can include conditional instructions: "If I am diagnosed with advanced dementia and can no longer recognize my immediate family, I want Designation C (comfort care only). Do not treat infections with antibiotics. Do not insert a feeding tube. Provide pain and anxiety medication only." These instructions don't authorize MAID, but they direct the care team toward comfort-focused care rather than life-prolonging treatment.

Document your values. Even if your directive can't trigger a MAID request, it can clearly express your values and preferences. "I value quality of life over length of life. I do not want to live in a state where I cannot communicate, feed myself, or recognize my family." This language doesn't have legal force in the MAID context, but it guides your proxy in making other medical decisions and creates a record of your perspective.

The Advance Request Debate

Canada has been debating whether to allow advance requests for MAID — the ability to consent to MAID in a written directive that takes effect after the person loses capacity — since the original legislation was passed. A parliamentary committee studied the issue and recommended expanding MAID to include advance requests for people diagnosed with conditions that will cause them to lose capacity, most notably dementia.

As of mid-2026, advance requests for MAID are not permitted under Canadian law. The federal government delayed the expansion of MAID eligibility for mental illness (originally scheduled for March 2023, then March 2024, then 2027) and has not introduced legislation enabling advance requests.

If advance MAID requests are eventually authorized, the interaction between a person's Health Care Directive and their MAID advance request will need to be clearly defined — whether they're the same document, separate documents, and what safeguards apply. For now, these are separate legal frameworks.

What to Do Today

Given the current legal landscape, the practical approach for PEI residents who want to plan for a dignified end of life is to focus on what your Health Care Directive can control:

Choose your Goals of Care Designation thoughtfully. Understand the difference between Designation R (all interventions), M (active treatment without resuscitation), and C (comfort care only). For someone whose priority is dignity and comfort over life extension, Designation C — recorded in the Health PEI electronic medical record — ensures the care team's focus is on symptom management and comfort rather than curative or life-prolonging treatment.

Be specific about treatments you refuse. Rather than writing "no extraordinary measures" (which is vague and difficult for clinicians to interpret), list specific interventions: no CPR, no mechanical ventilation, no feeding tube, no dialysis, no ICU transfer. Each refusal narrows the treatment options in a way that aligns with a comfort-focused approach.

Appoint a proxy who shares your values. Your proxy will be making decisions in situations your directive doesn't specifically address. Choose someone who understands your perspective on quality of life, dignity, and suffering — and who can follow your instructions even when family members or the medical team suggest a different course.

Have the MAID conversation with your doctor. If your condition makes you a potential candidate for MAID in the future, discuss the eligibility criteria and process with your physician now. If your natural death is reasonably foreseeable, you can begin the assessment process and potentially sign the waiver of final consent — which is the only currently legal way to ensure MAID is available even if you lose capacity temporarily before the scheduled date.

Stay informed about legislative changes. The advance MAID request conversation is ongoing at the federal level. If the law changes, updating your Health Care Directive to include an advance MAID request may become an option.

The PEI Advance Directive & Living Will Kit helps you document treatment refusals, Goals of Care preferences, and proxy instructions in the specific language PEI's healthcare system uses — giving your care team clear, actionable guidance regardless of where the MAID debate lands.

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