Updating an Advance Directive PEI: When and How to Revoke or Change

A PEI Health Care Directive doesn't expire — there's no mandatory renewal date under the Consent to Treatment and Health Care Directives Act. But a directive written five years ago may name a proxy who's since moved to Alberta, reflect treatment preferences that pre-date a new diagnosis, or reference a family situation that no longer exists. The document is only useful if it matches your current reality.

When to Update

After a new diagnosis. A cancer diagnosis, dementia, heart disease, or any condition that changes your treatment trajectory should prompt a review. Your original directive might authorize aggressive treatment for a condition you now know is terminal, or it might refuse interventions that could meaningfully help with a new, separate condition.

After a relationship change. Divorce, a new marriage, or the death of a named proxy all require immediate updates. Unless the directive expressly says otherwise, PEI law automatically revokes a spouse's proxy appointment if that person ceases to be your spouse. The rest of the directive can still stand, so you need a new proxy appointment (and a new acceptance signature) if you want someone else in the role.

After a proxy move. If your primary proxy relocates out of province, they're still legally valid, but you may want to add a local alternate who can respond to a crisis at Queen Elizabeth Hospital or Prince County Hospital within hours rather than flying in from Ontario.

After a family conflict. If your directive names one child as proxy and that decision has created friction with other children, consider whether the family dynamic has changed enough to warrant a new choice — or whether a Family Conversation Guide discussion could prevent a dispute from escalating during a medical crisis.

Every two years as a routine practice. Even if nothing obvious has changed, a biennial review ensures you still agree with the treatment preferences you wrote. Values shift gradually, and a directive you were comfortable with at 65 may not reflect your priorities at 70.

How to Revoke an Existing Directive

PEI doesn't require you to file a formal revocation with any court or government office. The process is straightforward but requires follow-through on distribution:

Draft a new Health Care Directive with an explicit revocation clause. The new document should state clearly: "I revoke all previous Health Care Directives made by me." This ensures there's no ambiguity about which document is current.

Have your new proxy sign. If you're changing your proxy, the new proxy must physically sign the updated directive to accept the appointment — the same mandatory acceptance rule applies to every version of the document.

Physically destroy all old copies. This includes copies held by your previous proxy, your family doctor, family members, and any version taped to your refrigerator. Leaving old copies in circulation creates the risk that a clinical team follows an outdated directive during an emergency.

Deliver written revocation notice to former representatives. Under the Powers of Attorney and Personal Directives Act, if you're also revoking a Personal Directive or Power of Attorney, the revocation is legally ineffective until the previously appointed representatives receive written notice. While this requirement is technically for the personal directive side rather than the healthcare side, treating the notification step as mandatory for all representatives is the safer practice.

Update clinical records. Deliver the new directive to your family physician and request that it replace the previous version in your clinical EMR file. If a Goals of Care Designation was based on the old directive, schedule a new Goals of Care conversation to update the GCD medical order.

What Not to Do

Don't just cross out sections of the old directive. Handwritten amendments on an existing document create ambiguity about what the maker actually intended. A clinical team presented with a directive that has scratched-out paragraphs and marginal notes will question the document's reliability. Draft a clean new version.

Don't assume verbal revocation is enough. Telling your doctor or family "I've changed my mind about resuscitation" doesn't revoke a written directive. While you have capacity, PEI law lets you revoke by a later directive, by a later writing that declares the revocation (signed the same way as a directive), or by destroying every original executed copy with the intent to revoke.

Don't update only the directive without updating the GCD. If your physician wrote a Goals of Care Designation based on your previous preferences (say, Designation R for full resuscitation) and your new directive specifies Designation C (comfort care), the mismatch between the active GCD order in the EMR and your updated written directive can cause confusion during a crisis. Both need to change.

Keeping the Chain Intact

The update process mirrors the original creation process: sign, get the proxy's acceptance signature, distribute copies to the proxy, doctor, and family, update the GCD, and complete a new wallet card. The only addition is the revocation and destruction steps for the old version.

The Prince Edward Island Advance Directive & Living Will Kit includes a Revocation and Update Checklist that walks through each step, with a distribution log to track who holds current copies and confirm that all old versions have been replaced.

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