End-of-Life Treatment Refusal in New Brunswick: What You Can Legally Refuse and How

The Right to Refuse Is Absolute

Under Canadian common law and New Brunswick's Enduring Powers of Attorney Act, a competent adult has an absolute right to refuse any medical treatment — including treatment that would sustain their life. This right does not depend on having a terminal diagnosis, being in pain, or meeting any clinical threshold. It is a fundamental principle of bodily autonomy, upheld in landmark cases like Malette v. Shulman and Fleming v. Reid.

The advance directive system extends this right forward in time. Through a Health Care Directive, you can document specific treatment refusals that take effect when you can no longer communicate — whether from advanced dementia, unconsciousness after a stroke, or the final stages of a terminal illness.

What Treatments Can Be Refused

You can refuse any medical intervention. The most common refusals documented in advance directives include:

Cardiopulmonary resuscitation (CPR) — refusing CPR means that if your heart stops or you stop breathing, medical staff will not attempt to restart them. This refusal is implemented through a Do-Not-Resuscitate order on your medical chart, signed by a physician or nurse practitioner.

Mechanical ventilation — refusing a ventilator means you will not be placed on a breathing machine. If you are already on one and specified refusal in your directive, your Attorney for Personal Care can authorize withdrawal.

Artificial nutrition and hydration — refusing feeding tubes (nasogastric or PEG tubes) and IV hydration. This is one of the most emotionally charged refusals for families, but it is legally straightforward. A clear directive refusal is binding.

Dialysis — refusing kidney dialysis in the context of irreversible organ failure.

Antibiotics and other treatments — you can refuse any class of treatment, including antibiotics for infections that would otherwise be treatable.

The key to enforceability is specificity. Writing "no extraordinary measures" gives clinicians no actionable guidance — the phrase has no clinical definition. Writing "I refuse cardiopulmonary resuscitation, mechanical ventilation, and artificial nutrition via feeding tube in any circumstance where my attending physician determines that my condition is irreversible" gives them a clear instruction and a clinical trigger.

Palliative Sedation: The Legal Alternative to Suffering

When a person is dying and experiencing intractable pain that cannot be managed with standard palliative care, continuous palliative sedation is a legal option in New Brunswick. This involves administering medication to render the patient unconscious until death, eliminating the experience of suffering.

Palliative sedation is not euthanasia or MAiD. It does not hasten death — it manages symptoms during the dying process. You can request it in your Health Care Directive, and your Attorney for Personal Care can authorize it on your behalf when you can no longer communicate.

A useful phrase for your directive: "If my clinical pain becomes intractable near the end of my life and cannot be managed through standard palliative measures, I authorize continuous palliative sedation to manage my symptoms."

Voluntarily Stopping Eating and Drinking (VSED)

VSED — voluntarily refusing all oral food and fluids — is a legal end-of-life choice in Canada. A person with capacity can choose to stop eating and drinking, and clinicians must respect that decision. The process typically takes one to three weeks, with comfort care (mouth moisture, symptom management) provided throughout.

The advance directive angle: you can include instructions about VSED for scenarios where you can no longer make decisions. For example, if you enter an advanced stage of dementia where you can no longer swallow safely, your directive can state that you refuse oral feeding assistance and artificial nutrition. Your Attorney for Personal Care would then work with the clinical team to ensure comfort measures are in place.

This is one of the areas where having a conversation with your physician before documenting the preference is valuable. The clinical team needs to understand what you are asking for, and the attending physician can confirm that the instruction is clear and consistent with how they would implement it.

What You Cannot Refuse or Request Through a Directive

Medical Assistance in Dying (MAiD): Canadian federal law currently prevents anyone from requesting MAiD through an advance directive. The patient must make the request themselves while they have capacity, undergo two independent assessments, and be present for the administration. This means MAiD is unavailable for people who have already lost capacity — regardless of what their directive says. Legislative discussions about advance MAiD requests are ongoing, but as of 2026, the prohibition stands.

Demanding specific treatments: A directive can refuse treatment, but it cannot compel a physician to provide treatment that is not medically indicated. If your directive says "I want all possible interventions to keep me alive," the clinical team is not obligated to provide interventions they consider futile — though they would need to discuss the situation with your Attorney for Personal Care.

How Your Attorney for Personal Care Implements Refusals

When you lose capacity, your Attorney for Personal Care becomes the person who communicates your refusals to the clinical team and authorizes their implementation. The conversation might sound like:

"My mother's Health Care Directive explicitly refuses CPR and mechanical ventilation. Her directive has been filed with this hospital. I am her appointed Attorney for Personal Care under the Enduring Powers of Attorney Act. Please ensure a Do-Not-Resuscitate order is placed on her chart at Level C/4 — comfort measures only."

The attorney does not need to justify the refusal to the clinical team, argue its merits, or seek permission from other family members. The directive governs. The attorney's job is to ensure it is followed.

Without an appointed attorney, these refusals remain on paper. No family member has automatic authority to enforce them — which is why the Enduring Power of Attorney for Personal Care is as important as the Health Care Directive itself.

Documenting Your Refusals Properly

The New Brunswick Advance Directive & Living Will Kit includes treatment-specific templates with precise clinical language for each type of refusal — CPR, ventilation, nutrition, hydration, dialysis, and comfort-only care. The templates are written to be clear enough for clinicians to act on directly, reducing the risk of ambiguity that can delay or undermine your wishes.

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