Goals of Care Designation PEI: R, M, and C Explained

A Health Care Directive tells PEI hospitals what you want. A Goals of Care Designation tells them what to do. These are two different documents with two different roles, and understanding the gap between them is the difference between a directive that guides clinical care and one that collects dust in your medical file.

What a Goals of Care Designation Is

The Goals of Care Designation (GCD) is a formal medical order written by your physician or nurse practitioner using Health PEI's standard form. It translates your personal wishes — the ones you documented in your Health Care Directive — into one of three clinical categories that hospital staff, emergency responders, and nursing facility teams are trained to follow.

The GCD is saved directly to the provincial Electronic Medical Record (EMR). When an ambulance arrives at your home or you're admitted to the Queen Elizabeth Hospital in Charlottetown or Prince County Hospital in Summerside, the clinical team can access your GCD immediately without hunting for paper documents.

The Three Designations

Designation R — Resuscitation Focus

This is the most aggressive treatment pathway. Designation R means you want all available medical interventions used to preserve your life under any circumstances. That includes:

• Cardiopulmonary resuscitation (CPR)
• Mechanical ventilation and intubation
• ICU admission
• Cardiac defibrillation
• Emergency surgery

Designation R is the default when no GCD exists and no directive has been filed. If you arrive at a PEI emergency department with no documentation, the clinical team will provide full resuscitative care.

Designation M — Medical Care Focus

Designation M authorizes active medical treatment to manage or cure illness — antibiotics, surgeries, diagnostic imaging, hospital admission — but draws a line at resuscitation. Under this designation:

• No CPR if the heart stops
• No mechanical ventilation or artificial life support
• Active treatment continues for curable or manageable conditions
• Diagnostic testing and monitoring proceed normally

This is the designation many people mean when they say they want "everything done" but also "don't keep me on machines." The key distinction from R is that once the heart or breathing stops, the clinical team does not attempt to restart them.

Designation C — Comfort Care Focus

Designation C shifts the entire clinical focus to pain management, symptom relief, and psychological comfort. There is no attempt to cure or control the underlying illness. Specifically:

• No resuscitation
• No ICU transfer
• No diagnostic tests aimed at treatment
• Pain medication, oxygen therapy, and emotional support continue
• Artificial nutrition and hydration are generally excluded in terminal phases

Designation C is what's commonly called "allowing a natural death." Clinical interventions are limited to keeping the patient comfortable.

How This Differs from Your Health Care Directive

Your Health Care Directive is a legal document you create and sign at home. It captures your personal values, treatment preferences, and proxy appointment. But it's not a medical order — hospital staff don't pull it out and follow it line by line during a crisis.

Instead, the directive is the input for a Goals of Care conversation with your physician. During this discussion, your doctor reviews what you've written, asks clarifying questions, and then writes the GCD as a standing medical order on the Health PEI form. The GCD is what the medical team actually follows.

This is why vague directive language creates problems. Writing "no heroic measures" in your directive leaves your physician interpreting what you consider heroic. But writing "I want Designation M — active medical treatment but no resuscitation and no mechanical ventilation" gives the doctor a direct translation to the GCD form.

How to Get a Goals of Care Designation

The process is straightforward but requires you to initiate it:

1. Complete your Health Care Directive with specific treatment preferences using R/M/C language
2. Hand-deliver a copy to your family physician or nurse practitioner
3. Request a Goals of Care conversation — your doctor will walk through your preferences
4. Your physician writes the GCD order on the official Health PEI form
5. The GCD is saved to the provincial EMR, making it accessible to any Health PEI facility

You don't wait for a medical crisis to do this. The conversation happens during a routine appointment, while you're healthy and capable of explaining your reasoning. Waiting until you're in the emergency department means decisions get made under pressure, often by a doctor who doesn't know you and a family member who's guessing at your preferences.

Can a Goals of Care Designation Be Changed?

Yes. A GCD can be updated any time your health situation changes or your preferences shift. A cancer diagnosis, a new chronic condition, or simply a change in perspective after a family conversation can all prompt a new Goals of Care discussion with your doctor.

The updated GCD replaces the previous one in the EMR. There's no multi-step revocation process — your physician writes a new order, and the old one is superseded.

Your underlying Health Care Directive should be updated at the same time if your written preferences no longer match the new GCD. If the directive says Designation R but the clinical conversation results in Designation C, the mismatch can create confusion if a different physician reviews your file later.

The Prince Edward Island Advance Directive & Living Will Kit includes a Goals of Care Translation Worksheet that walks you through each designation in practical terms, so you arrive at your doctor's appointment with clear, clinically aligned preferences ready to be converted into a GCD order.

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