What Happens If No Health Care Directive PEI

If you become incapable of making medical decisions in Prince Edward Island and you don't have a Health Care Directive naming a proxy, the province's Consent to Treatment and Health Care Directives Act activates a default hierarchy to determine who decides for you. The result can range from your spouse stepping in smoothly to the Public Guardian and Trustee intervening at your family's expense.

The Default Substitute Decision-Maker Hierarchy

When no proxy has been validly appointed, PEI law assigns decision-making authority in this order:

1. Guardian — if they have authority to give or refuse consent to treatment
2. Spouse — not including a person living separate and apart under the Divorce Act
3. A child or a parent (or a person who has assumed parental authority) — these sit in the same class
4. A brother or sister
5. A trusted friend with close knowledge of the patient's wishes
6. Any other relative

The medical team must work through this hierarchy in order. A later class is used only if the higher-ranking person is unavailable, unwilling to decide, or themselves incapable of the treatment decision. If no one on the list is available, willing, and capable — or if people in the same class disagree — the Public Guardian and Trustee may decide.

This system works adequately when there's a single, clear person at the top of the hierarchy — a present spouse with no disagreements about treatment. It falls apart in more common scenarios: separated spouses, estranged family members, a child and a parent who disagree, multiple children who disagree, or situations where the highest-ranking relative lives out of province.

When Equal-Ranking Relatives Disagree

This is where the lack of a directive becomes genuinely costly. If two or three children have different opinions about whether their parent should receive resuscitation, palliative sedation, or aggressive treatment, the clinical team at Queen Elizabeth Hospital or Prince County Hospital cannot simply pick one child's view and proceed.

The disagreement must be escalated. The medical team involves the Public Guardian and Trustee (PGT) to resolve the dispute, which introduces delays in treatment decisions and pulls a government office into the most personal decisions a family can face.

Public Guardian and Trustee Involvement

The PGT was established under PEI's Adult Guardianship and Trusteeship Act (in force since March 30, 2026) as a protective service and decision-maker of last resort for vulnerable adults. When the PGT gets involved in healthcare disputes, the office carries the authority to make binding decisions — but it also charges fees.

The PGT fee schedule under the regulations includes:

• Annual management fees ranging from $100 (for assets under $10,000) to $10,000 (for assets over $1 million) per fiscal year
• Tax return filing: $100 per estate return, $30 per individual return
• Physical inspection of assets: $60 per hour
• Travel time: $40 per hour plus provincial mileage rates
• File closing fee: $100

The PGT can also register a statutory lien against the individual's real and personal property to recover costs. For a family whose parent has a modest home and limited savings, these fees can consume a meaningful share of the estate.

The Practical Problem: Speed

Healthcare decisions during a crisis don't wait for family negotiations. A stroke, cardiac event, or sudden decline can require an immediate resuscitation decision — and if the clinical team can't identify a clear decision-maker, they default to providing full treatment until the hierarchy sorts itself out.

That might be exactly what you'd want. Or it might mean receiving aggressive interventions you would have refused, including ICU admission, intubation, and CPR, because no one with legal authority was available to communicate your preferences.

Without a directive, there's also no written record of your treatment preferences. Even when a single substitute decision-maker is identified, they're making choices based on what they believe you would have wanted — not on documented instructions. The gap between a daughter's interpretation of her father's wishes and what he actually would have chosen can be significant.

What a Directive Prevents

A valid Health Care Directive with a properly appointed proxy (one who has physically signed the document to accept the role, as PEI law requires) cuts through all of this:

• The hierarchy never activates. Your named proxy has sole decision-making authority.
• Family disagreements become irrelevant. Siblings can disagree all they want — the proxy's decision has legal force.
• The PGT stays out of it. No government intervention, no fees, no liens on property.
• Your treatment preferences are documented. Instead of guessing, the medical team has specific instructions about resuscitation, ventilation, artificial nutrition, and comfort care.
• Hospital staff can act immediately. A Goals of Care Designation based on your written directive gives the clinical team a clear medical order from the moment you're admitted.

The cost of not having a directive isn't abstract. It's the difference between your chosen proxy making a quick, informed decision aligned with your values and a conference room full of disagreeing relatives, a PGT case manager, and a medical team waiting for authorization.

The Prince Edward Island Advance Directive & Living Will Kit walks you through both the proxy appointment process and the treatment instruction framework so the statutory hierarchy never comes into play.

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