Right to Refuse Treatment in Prince Edward Island

The Legal Foundation for Refusing Treatment in PEI

Every adult in Prince Edward Island has the legal right to refuse medical treatment — including treatments that would sustain their life. This right is grounded in the Consent to Treatment and Health Care Directives Act, which establishes that no medical intervention can proceed without the informed consent of the patient or their authorized substitute decision-maker.

The law presumes that every adult has mental capacity unless a clinical assessment proves otherwise. As long as you can understand the nature of a proposed treatment and appreciate the consequences of accepting or refusing it, the decision is yours alone. A doctor cannot override your refusal, even if they believe the treatment would save your life.

This applies to specific interventions — you can refuse CPR, mechanical ventilation, dialysis, blood transfusions, surgery, antibiotics, artificial nutrition, or any combination of treatments. You can also set conditions: accepting certain treatments under some circumstances while refusing them under others.

How to Refuse Treatment in Advance

The challenge comes when you can't communicate your wishes at the moment a treatment decision needs to be made. A car accident, a stroke, late-stage dementia — any of these can remove your ability to speak for yourself. Without written documentation, your medical team has to rely on family members who may disagree about what you would have wanted.

PEI law provides two mechanisms for refusing treatment in advance.

A Health Care Directive lets you specify exactly which treatments you accept and which you refuse. Under the Consent to Treatment and Health Care Directives Act, any person aged 16 or older with mental capacity can create a Health Care Directive. The document is legally binding on medical practitioners — if your directive clearly refuses a treatment, a doctor cannot administer it even if your family requests it.

The key word is "clearly." Vague language undermines the entire purpose. Writing "no heroic measures" or "no extraordinary treatment" leaves clinicians guessing about what you consider heroic or extraordinary. The more specific your directive, the more reliably it will be followed.

A Goals of Care Designation translates your written preferences into a clinical order. Your family doctor or nurse practitioner discusses your directive with you and records one of three treatment levels in your Health PEI electronic medical record: Designation R (full resuscitation and all interventions), Designation M (active medical treatment but no resuscitation), or Designation C (comfort care only — pain management and symptom relief with no curative treatment).

A Goals of Care Designation is not the same as a Health Care Directive. The directive is a legal document you create. The GCD is a medical order your doctor creates based on your directive. Both matter, and one without the other leaves gaps.

Refusing Life Support Specifically

Life support typically refers to mechanical ventilation (breathing machines), cardiac life support (chest compressions, defibrillation), dialysis, vasopressors (medications to maintain blood pressure), and artificial nutrition and hydration through feeding tubes or IV lines.

In PEI, you can refuse any or all of these interventions through your Health Care Directive. You don't have to refuse everything — many people choose Designation M, which means they want active medical treatment (antibiotics, surgery, diagnostic tests) but refuse CPR and mechanical ventilation if their heart or breathing stops.

Others choose Designation C, which limits all interventions to comfort measures. Under this designation, pain medication and symptom management continue, but the medical team does not pursue treatments aimed at curing or controlling the underlying illness.

If you're already on life support and regain capacity, you can refuse to continue treatment at any time. If you're on life support and lack capacity, your designated proxy makes the decision based on your directive's instructions or, if the directive doesn't address the specific situation, based on what they reasonably believe you would have wanted.

What Your Proxy Can and Cannot Do

When you appoint a proxy in your Health Care Directive, you're naming someone to make medical decisions if you lose capacity. But the proxy's authority has boundaries.

A proxy must follow the instructions in your directive. If your Health Care Directive explicitly refuses mechanical ventilation, your proxy cannot consent to it — even if they personally believe you should be on a ventilator. The proxy's job is to implement your wishes, not substitute their own judgment.

When your directive doesn't address a specific situation, the proxy makes decisions based on what they reasonably believe you would have wanted. If even that isn't clear, the proxy must act in your best interests.

There's a critical procedural requirement in PEI: the proxy must sign the Health Care Directive to accept the appointment. If they don't sign, the appointment is legally invalid regardless of what the directive says. This catches many families off guard — they name a proxy, file the directive, and only discover the gap during a medical crisis when the hospital asks for the proxy's signature page.

When Refusal Becomes Complicated

Two situations create real friction around treatment refusal in PEI.

Family disagreement. If you lose capacity without a Health Care Directive, the Consent to Treatment and Health Care Directives Act activates a statutory hierarchy of substitute decision-makers: a guardian with treatment authority, then the spouse, then a child or a parent (same class), then a brother or sister, then a trusted friend, then any other relative. When two people at the same level disagree — and this happens regularly with adult siblings — the medical team cannot proceed until the dispute is resolved, often by involving the Public Guardian and Trustee.

Ambiguous directives. Clinicians are trained to err on the side of preserving life when instructions are unclear. If your directive says "no extraordinary measures" without defining what that means to you, the medical team may continue treatment while they try to clarify your intent through family members or the PGT. By the time the ambiguity is resolved, treatments you might have refused are already underway.

Both problems have the same solution: a clearly written Health Care Directive with specific treatment instructions, a named proxy who has accepted the role in writing, and a Goals of Care Designation recorded in your medical file.

How to Document Your Wishes

Start by listing every treatment category and deciding whether you accept or refuse it: CPR, mechanical ventilation, dialysis, feeding tubes, IV hydration, antibiotics in terminal illness, blood transfusions, surgery. For each one, note any conditions — you might accept antibiotics for a curable infection but refuse them for a terminal condition.

Then decide on your Goals of Care level. R means you want everything possible to extend your life. M means you want active medical care but not resuscitation. C means comfort measures only. Most people fall somewhere in this framework, though the conversation with your doctor will help you think through scenarios you might not have considered.

Finally, appoint a proxy and make sure they sign the directive. Discuss your wishes with them in detail so they understand not just what you've written but why you've made these choices.

The PEI Advance Directive & Living Will Kit includes worksheets for documenting treatment preferences in the specific clinical language PEI hospitals use, plus a Goals of Care translation worksheet that maps your values to the R/M/C framework.

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