Goals of Care Designation in Alberta: What the R, M, and C Codes Actually Mean
Ask most Albertans what "R1" or "C2" means and you'll get a blank look — yet these two-character codes are what Alberta paramedics, ER physicians, and care facility staff actually follow in a crisis. They're part of the Goals of Care Designation (GCD) system, and if you've done any end-of-life planning in this province, understanding them is not optional.
What a Goals of Care Designation Is
A GCD is a medical order — not a legal document you write yourself. It's completed and signed by a physician or nurse practitioner after a conversation with you (or, if you've lost capacity, with the Agent named in your Personal Directive). It translates your values and wishes into a standardized clinical instruction that any Alberta Health Services provider can read at a glance.
This is the crucial difference from a Personal Directive:
- A Personal Directive is a legal document. It names your decision-maker and records your instructions. You sign it with a witness.
- A GCD order is a clinical document. It tells the medical team what to actually do — intubate or not, ICU or not, transfer to hospital or not. A physician or NP signs it.
In an emergency, clinicians don't have time to parse a multi-page legal document. They read the GCD. That's why you need both, and why the GCD sits as the first page in your Green Sleeve.
The Three Categories: R, M, and C
Every designation falls into one of three approaches to care. The goal of treatment — not just the interventions — is what separates them.
Resuscitative Care (R1, R2, R3)
The goal is to cure or control your illness, accepting invasive life-sustaining measures.
- R1 — Full resuscitative care: chest compressions, intubation, ICU admission, major surgery. Everything is on the table.
- R2 — The same aggressive care, but chest compressions are excluded. Intubation, ICU, and surgery remain available.
- R3 — ICU admission and active care continue, but both intubation and chest compressions are excluded.
Medical Care (M1, M2)
The goal shifts to medical treatment and symptom management, excluding ICU-level resuscitation.
- M1 — Active medical and surgical treatments continue, but ICU admission and all resuscitative measures are excluded.
- M2 — Maximal symptom management and maintaining function. Curing the underlying illness is no longer the expectation; comfort and function are the goals.
Comfort Care (C1, C2)
The goal is comfort and dignity, not cure.
- C1 — Comfort-focused therapies, symptom control, and support for any length of clinical trajectory.
- C2 — Immediate comfort measures for someone whose death is expected within hours or days. Transfer to hospital is typically bypassed in favour of keeping the person comfortable where they are.
Why This Replaced the Old "DNR"
Terms like "Do Not Resuscitate" are binary and increasingly outdated under AHS clinical policy. A DNR answers exactly one question — compressions, yes or no — and says nothing about ICU care, hospital transfers, surgery, or what should happen instead. The GCD framework covers the full picture: what clinicians should do, not just what they shouldn't.
This also means a GCD is not automatically about refusing care. R1 — full resuscitation — is a perfectly valid designation. The point is that the choice is yours, recorded, and followed.
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How to Get a GCD Order
- Do your own thinking first. A Personal Directive is the natural starting point: it forces you to consider scenarios, record instructions, and name the Agent who would speak for you.
- Book the conversation. Ask your family physician or nurse practitioner for an advance care planning conversation. If you're entering a hospital or care facility, the attending care team can do it there.
- The clinician writes the order. Based on the conversation, they complete and sign the GCD order form with the designation that matches your wishes.
- It goes in your Green Sleeve, first page out. The Green Sleeve lives on or near your refrigerator — Alberta EMS are trained to look there — and travels with you to every hospital visit and appointment.
- Review it when things change. A GCD is revisited at health transitions: a new diagnosis, a hospitalization, a move into a care facility, or a significant decline. It's a living clinical order, not a one-time signature.
If You Lose Capacity Without a GCD
Without a Personal Directive naming an Agent, your family cannot simply step in. Under Alberta's Adult Guardianship and Trusteeship Act, healthcare providers can turn to a statutory list of nearest relatives for a specific one-time decision — but that person cannot make ongoing decisions, and cannot consent to withdrawing or withholding life support. Ongoing authority requires a court guardianship application: slow, expensive, and public.
The combination — Personal Directive plus a current GCD in a Green Sleeve — is what prevents that outcome.
The Bottom Line
The GCD is where your wishes become medically actionable. If you remember one thing: the legal document (Personal Directive) names who decides, and the GCD order tells clinicians what to do. You need both, and they live together in the Green Sleeve on your fridge.
The Alberta Advance Directive & Living Will Kit includes a plain-English GCD code worksheet to prepare for the conversation with your doctor, plus the Personal Directive forms and Green Sleeve setup checklist that complete the system.
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