Goals of Care Designation in Saskatchewan: How It Works With Your Directive

Most Saskatchewan residents don't know that their health care directive and their Goals of Care Designation are two different documents with two different purposes — and that having one without the other leaves a gap in their medical plan.

The Difference

A Health Care Directive is a legal document. You write it, you sign it, and it documents your treatment preferences and names your proxy. It's governed by The Health Care Directives and Substitute Health Care Decision Makers Act, 2015. It tells the world what you want.

A Goals of Care Designation (GCD) is a clinical medical order. Your physician writes it after a conversation with you (or your proxy), and it translates your wishes into actionable clinical instructions that medical teams can follow during an emergency. It tells the care team exactly what to do.

Think of it this way: your directive says "I don't want to be kept alive on machines if there's no reasonable chance of recovery." Your GCD translates that into a specific clinical level of intervention — for example, medical management only (no CPR, no intubation) or comfort care measures exclusively.

Why the GCD Matters

A directive written in your own words can be ambiguous in a clinical setting. What does "no extraordinary measures" mean? Does it include antibiotics? Dialysis? A blood transfusion? Medical teams interpreting your directive in real time, under pressure, can reach different conclusions depending on the phrasing.

The GCD resolves that ambiguity. It uses standardized clinical levels of intervention that Saskatchewan medical teams are trained on:

• Full resuscitative care — all interventions including CPR, intubation, ICU admission
• Medical management — active treatment of reversible conditions, but no CPR or mechanical ventilation
• Comfort care — symptom management only, focused on quality of life and pain control

When EMS or hospital staff encounter a patient with a GCD on file, they know exactly which interventions to initiate or withhold. There's no interpretation required.

How to Get a GCD

A GCD is established through a conversation with your primary physician, nurse practitioner, or hospital care team. You can't create one yourself — it requires a medical professional to translate your preferences into clinical terms and document them as medical orders.

The process:

1. Have your health care directive completed first — this gives the physician your documented preferences as a starting point
2. Schedule an advance care planning appointment with your family doctor
3. Discuss your treatment preferences in clinical terms: CPR, ventilation, ICU admission, dialysis, artificial nutrition, antibiotics for life-threatening infections
4. Your physician documents the GCD in your permanent medical chart
5. The GCD is covered under provincial health insurance — there's no out-of-pocket cost

How the GCD Interacts With Your Directive

The GCD should reflect your directive's wishes, not override them. If your directive says you refuse mechanical ventilation, the GCD should designate a level of intervention that excludes intubation. If there's a conflict — your directive says one thing and the GCD says another — the situation gets complicated. The directive is the legal document that represents your autonomous wishes; the GCD is a medical order that should flow from those wishes.

In practice, conflicts usually arise because the directive was written years ago and the patient's condition has changed. This is why physicians often want to revisit the GCD conversation after a new diagnosis, a hospitalization, or a significant decline in health.

The Emergency Scenario

Here's where the two documents work together. You're at home. You have a cardiac arrest. EMS arrives.

• They check your fridge for the Yellow Sleeve — inside they find your health care directive and (ideally) your GCD
• The GCD tells them immediately: this patient is designated for comfort care only, no CPR
• They follow the medical order

Without the GCD, the paramedics would need to read your directive under emergency conditions and interpret legal language in real time. That takes time they may not have, and it puts them in a position of making clinical judgments about legal documents — which is not what they're trained to do.

When to Request a GCD Review

Request a review of your GCD when:

• You receive a new serious diagnosis
• You've been hospitalized
• Your health has significantly declined
• You've updated your health care directive
• Your proxy or physician has changed
• You're being admitted to a special-care home

The GCD is not static. It should evolve with your medical reality, just as your directive should be updated when your circumstances change.

Getting Both Documents Right

A directive without a GCD relies on real-time medical interpretation of legal language. A GCD without a directive has no legal backing if family members or alternate providers disagree with the physician's documented orders. Both documents together create a complete advance care plan — your legal wishes and their clinical implementation.

The Saskatchewan Advance Directive & Living Will Kit includes a goals-of-care conversation card that helps you prepare for the GCD discussion with your physician, covering the clinical decision points you'll need to address.

See more Saskatchewan guides →