End-of-Life Planning in New Brunswick: Palliative Care, Hospice, and MAiD
End-of-life planning in New Brunswick involves navigating three distinct systems — palliative care services, residential hospice access, and the federal MAiD framework — each with its own eligibility rules, capacity requirements, and documentation thresholds. An advance directive can influence two of these paths directly and the third only indirectly, and the distinction matters more than most families realize until they're standing at the intersection.
Palliative Care in New Brunswick
Palliative care in the province is delivered through both the Horizon Health Network and the Vitalité Health Network, with services spanning hospital-based palliative units, home-based care programs, and community partnerships. Access begins with a referral from the person's primary care provider or attending physician, and eligibility is based on clinical prognosis rather than age or diagnosis type.
The critical planning question for advance directives is what palliative care involves and what it excludes. Palliative care is comfort-focused — symptom management, pain control, emotional support — but it doesn't inherently exclude curative treatments. A person receiving palliative care for advanced cancer might still elect radiation to manage bone pain, or antibiotics for an acute infection. The directive should specify where the line falls: comfort measures only, or palliative care with selective interventions.
For individuals whose pain becomes intractable, continuous palliative sedation — using sedative medications to reduce consciousness and relieve refractory suffering — is a recognized clinical option in New Brunswick. This is distinct from MAiD in both mechanism and legal framework: palliative sedation manages symptoms while the underlying condition follows its natural course. An advance directive can explicitly authorize continuous palliative sedation if the clinical team determines that the person's suffering cannot be managed by other means, giving the attending physician a documented basis to proceed without the family having to make that call under crisis conditions.
Residential Hospice Admission
New Brunswick's residential hospice capacity is limited, and admission requires meeting specific clinical criteria. The central requirement that most families don't learn about until the application process is the DNR prerequisite: residential hospices require a formal Do Not Resuscitate order — specifically DNR Level C/4 — to be placed on the patient's medical chart before admission is approved.
A DNR order in New Brunswick is a clinical order signed by a physician or nurse practitioner. It cannot be placed by the patient or family unilaterally, but the patient's advance directive can explicitly instruct their attorney to request a DNR once the prognosis meets specified criteria. This converts the DNR from a bedside negotiation into an execution of documented wishes.
The Health Care Directive should address this directly: "If my attending physician determines that my condition is terminal and recovery is not expected, I direct my Attorney for Personal Care to request that a Do Not Resuscitate order be placed on my medical chart, including classification at Level C/4 for residential hospice eligibility."
Without this instruction, the attorney must make the DNR request on their own authority — which is legally permissible under the EPA's decision-making mandate, but practically more difficult in clinical settings where the medical team may be reluctant to place a DNR without clear evidence of the patient's own wishes.
Medical Assistance in Dying: What Advance Directives Can and Cannot Do
Federal law currently prevents anyone in Canada from making an advance request for MAiD through an advance directive. The person must complete the separate MAiD request and assessment process while they have capacity; in limited circumstances, a person whose natural death is reasonably foreseeable may arrange a waiver of final consent with a practitioner after being assessed and approved.
This creates a specific frustration for people with progressive conditions like Alzheimer's or ALS. A person diagnosed with early-stage dementia might clearly want the option of MAiD when the disease reaches an advanced stage, but by the time they reach that stage, they may no longer have the capacity to consent.
There have been extended discussions about expanding the federal framework to permit advance requests for MAiD, but as of 2026, no such amendment has been enacted.
What an advance directive can do on this topic:
Document the person's position on MAiD for the record. Even though the directive cannot trigger a MAiD request, explicitly stating the person's values — whether they support or oppose MAiD as an option — provides the attorney and family with clear guidance for future conversations. If the law changes, this documented position becomes immediately relevant.
Authorize alternative end-of-life interventions. Continuous palliative sedation, voluntary cessation of eating and drinking, and refusal of all life-sustaining treatment are all legally distinct from MAiD and can be addressed in an advance directive under existing New Brunswick law. A directive that authorizes palliative sedation for intractable suffering and refuses artificial nutrition and hydration in advanced dementia covers the clinical territory that MAiD would otherwise occupy — within the legal framework that actually exists.
Address the MAiD eligibility question while capacity remains. If the person wants to explore MAiD while they still have capacity, the advance directive can sit alongside the broader care plan documentation — though the formal MAiD request and assessment follow a separate statutory process.
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The Hospital Discharge Pipeline
End-of-life planning in New Brunswick intersects with a hospital system under intense pressure. When a patient is clinically stable but cannot return home and no nursing home bed is available, they are designated as Alternate Level of Care (ALC). ALC patients occupy up to forty percent of acute care beds in the province, and once designated, the hospital begins billing a daily residential rate.
Under Regulation 85-187, when hospital occupancy exceeds ninety-five percent with ALC patients at or above twenty-five percent of that total, fast-track placement protocols activate. The Department of Social Development can transfer the patient to any suitable nursing home within a 100-kilometre radius, provided the facility serves their preferred official language.
The advance directive's role here is documenting two things: the language preference for facility placement (exercising the statutory right to refuse linguistically incompatible facilities) and the level of care acceptable during the transition (whether the person wants aggressive treatment maintained during the ALC period, or whether comfort measures should be the focus while awaiting permanent placement).
An Enduring Power of Attorney for Personal Care gives the attorney the legal standing to navigate these placement decisions — something a standalone Health Care Directive cannot do, because a directive provides instructions without granting decision-making authority.
Building the Complete Plan
Effective end-of-life planning in New Brunswick isn't a single document — it's the directive (clinical instructions), the EPA (decision-making authority), the physician conversation (translating written wishes into medical orders), and the distribution strategy (ensuring the right people have copies when they need them).
The New Brunswick Advance Directive & Living Will Kit covers all four components: the dual-document system with clinical instruction frameworks for palliative care, DNR, and MAiD positioning; witnessing checklists and distribution logs; and conversation scripts for the physician review that converts a paper directive into actionable medical chart entries. The goal isn't just having documents — it's having documents that actually work when the moment arrives.
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