Goals of Care Alberta: How the GCD System Directs Your Parent's Treatment

What a Goals of Care Designation Is

A Goals of Care Designation (GCD) is a medical order — not a wish list, not a guideline, not a conversation summary. It is signed by a physician or nurse practitioner and directs the specific level of medical intervention a patient will receive during a health crisis.

Alberta Health Services developed the GCD system to replace ambiguous terms like "full code" or "DNR" with standardized categories that clinical staff across the province interpret the same way. Whether a paramedic picks up the call in Medicine Hat or an ICU nurse reads the chart in Edmonton, the GCD means the same thing.

The Three Designation Categories

R — Resuscitative Care

Full intervention. CPR, intubation, mechanical ventilation, ICU admission, emergency surgery if needed.

M — Medical Care

Active medical treatment focused on managing the condition and controlling symptoms. Includes hospital admission, IV medications, antibiotics, and non-invasive interventions. Excludes ICU-level critical care and resuscitation attempts. This is the most commonly chosen designation for aging parents with chronic conditions — it provides treatment without the physical trauma of CPR and intubation on a frail body.

C — Comfort Care

Priority shifts to comfort, dignity, and symptom management. Pain medication, nausea control, and anxiety management continue. Hospital transfer happens only if symptoms cannot be managed where the patient is. No resuscitation, no life-prolonging interventions. This designation is typically chosen when a parent has entered the final stage of a terminal illness or advanced dementia.

Each category also carries numeric subcodes that specify further details — the combination gives the clinical team a complete picture without ambiguity.

Who Signs the GCD

Only a physician or nurse practitioner can sign a GCD order. The patient's agent under a Personal Directive cannot sign it, and neither can a family member acting informally.

But here is the part families often miss: the GCD conversation is collaborative. The physician should discuss options with the patient (if capable) and with the appointed agent or family members. The agent under a Personal Directive does not need to formally activate the PD to participate in this conversation. The agent can advocate for the parent's known wishes, share context about the parent's values, and help the physician determine the appropriate designation.

The GCD reflects a joint understanding — but the clinical order itself is the physician's signature.

When to Update the GCD

A GCD is not a one-time decision carved in stone. It should be reviewed:

• After every hospital admission and discharge
• When moving from home care to a continuing care home or supportive living facility
• After a new major diagnosis (dementia, cancer, heart failure)
• When the patient's functional status declines significantly
• When the patient or their agent expresses a change in treatment preferences
• At the annual care conference in continuing care homes

The most common failure point is staleness. A parent enters a care home with an R1 designation (full resuscitation), their condition deteriorates over two years, and nobody revisits the GCD. The family assumed the care team would bring it up. The care team assumed the family was satisfied with the existing order. Then a crisis hits and the paramedics follow the outdated order.

The GCD and the Green Sleeve

The GCD order is the first document in the physical Green Sleeve — the bright green folder that Alberta paramedics check on every residential emergency call. The sleeve sits on or near the refrigerator in the parent's home.

If the parent is in a continuing care home, the GCD lives in the medical chart. If they are living independently, the Green Sleeve is the system that ensures the GCD order is actually accessible during a crisis.

A GCD without a Green Sleeve is a clinical order filed in a chart that nobody reads at 2 a.m. on a Saturday. A Green Sleeve without a current GCD is a green folder with outdated or missing instructions.

What a GCD Cannot Do

A GCD does not grant anyone legal authority. It does not replace a Personal Directive or an Enduring Power of Attorney. It cannot direct financial decisions, property management, or care home selection.

A GCD also cannot authorize or direct Medical Assistance in Dying (MAID). Under Alberta's clinical standards, MAID requires the patient's own active, contemporaneous consent — a substitute decision-maker cannot request it on someone else's behalf.

The Alberta Power of Attorney & Personal Directive Kit explains how the GCD fits into the broader decision-making framework — connecting the clinical order to the legal documents that determine who has authority to make decisions when your parent cannot.

See more Alberta guides →