End of Life Treatment Refusal Rights in Saskatchewan

Saskatchewan law gives you an absolute right to refuse medical treatment — including life-sustaining treatment — as long as you have capacity to make the decision or have documented the refusal in a valid health care directive. That right doesn't come with exceptions for "but the treatment would save your life" or "but your family disagrees."

Understanding how to exercise that right effectively, and where it reaches its limits, is what separates a directive that actually works from one that gets argued over in a hospital hallway.

The Legal Foundation

Under The Health Care Directives and Substitute Health Care Decision Makers Act, 2015, a competent adult (aged 16 or older in Saskatchewan) can refuse any medical treatment through a written health care directive. Healthcare providers who follow that refusal in good faith are protected from civil and criminal liability.

This applies to:

• Mechanical ventilation and intubation — being placed on a breathing machine
• CPR and defibrillation — chest compressions and electric shocks to restart the heart
• Artificial nutrition and hydration — feeding tubes and IV fluids
• Dialysis — kidney filtration when the kidneys fail
• Blood transfusions — whether for religious reasons or personal preference
• Antibiotics for life-threatening infections — choosing comfort care over curative treatment
• Surgery — declining a procedure even if it's recommended as life-saving

The refusal stands whether you make it while you have capacity or document it in advance through your directive. There's no category of treatment that can't be refused.

How to Document a Treatment Refusal

Vague language is the enemy. "No extraordinary measures" means different things to different clinicians, and it gives medical teams room to interpret — which is the opposite of what you want.

Instead, name the specific interventions you refuse and the conditions under which you refuse them:

Too vague: "I don't want to be kept alive artificially."

Specific enough to be actionable: "I refuse mechanical ventilation, including intubation, tracheostomy, and BiPAP, if I have an irreversible neurological condition with no reasonable prospect of recovering the ability to communicate. I refuse artificial nutrition and hydration, including nasogastric tubes and PEG feeding, under the same conditions. I accept all comfort care measures including pain management."

The more precise your language, the harder it is for anyone — family members, medical staff, or a court — to argue that the directive didn't really mean what it says.

Your Proxy's Role in Treatment Refusal

If your directive names a proxy and you lose capacity, the proxy can refuse treatment on your behalf. They should be guided by your documented wishes first, and by their understanding of your values where the directive is silent.

A proxy's refusal carries the same legal weight as yours. Healthcare providers are required to follow the proxy's direction when it's consistent with the directive. If the proxy refuses ventilation for you and the medical team believes ventilation would be beneficial, the proxy's decision still controls.

The limit: a proxy cannot authorize MAID on your behalf. Federal law requires a conscious, voluntary request from the patient at the time of administration. No amount of directive language or proxy authority can circumvent this requirement.

What Happens When Family Disagrees

Your directive overrides family opposition. If your directive says you refuse CPR and your adult children want everything done, the directive wins. The children don't have standing to override a valid, written refusal — even if they're next of kin.

If no directive exists and your proxy makes a refusal decision that family members dispute, the disagreeing family member can apply to the Court of King's Bench for judicial direction. But court intervention during an active medical crisis is exceptionally rare and slow — which is why having a clear written directive is so much more effective than relying on your proxy to fight for your wishes in real time.

The Limits of Treatment Refusal

Your right to refuse treatment is absolute. But two related rights are not:

You can't demand treatment that's clinically futile. Just as doctors must honour your refusal, they're not required to provide interventions they consider clinically inappropriate. A directive that says "do everything to keep me alive no matter what" doesn't obligate a physician to perform CPR on a patient whose body cannot survive it.

You can't pre-authorize MAID. This is the hardest limit for many people. You can refuse every life-sustaining intervention, which may result in death — but you cannot direct a physician to actively end your life through medical assistance in dying when you lack capacity. MAID requires a contemporaneous, voluntary request.

Making Your Refusal Stick

Document it in your directive with specific language. Then follow through:

• Discuss it with your physician and ask for a Goals of Care Designation that matches your refusals
• Upload your directive to MySaskHealthRecord and enable eHR Viewer sharing
• Place a copy in your Yellow Sleeve on the fridge for EMS access
• Brief your proxy so they can advocate for your refusal if the medical team or family members push back

The Saskatchewan Advance Directive & Living Will Kit includes treatment-refusal templates with specific language for each common intervention, so your preferences are documented in terms that medical teams can follow without interpretation.

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