New Brunswick DNR: How Do-Not-Resuscitate Orders Work in the Province

What a DNR Order Actually Does in New Brunswick

A Do-Not-Resuscitate order instructs medical staff not to perform cardiopulmonary resuscitation if your heart stops or you stop breathing. In New Brunswick, a DNR is a medical order — meaning a physician or nurse practitioner must sign it before it takes effect on your clinical chart. You cannot simply write "no CPR" in a personal document and expect paramedics to honour it at the scene.

The distinction matters because many families assume that writing resuscitation wishes into an advance directive is enough for every setting. A Health Care Directive under New Brunswick's Enduring Powers of Attorney Act records your preferences, and the clinical team must review clear instructions; a clinician may also need to translate them into a formal DNR or other medical order on your chart.

The Clinical Levels You Need to Know

New Brunswick hospitals — both the Horizon Health Network and the Vitalité Health Network — use a tiered resuscitation status system. The most common classification runs from Level 1 (full resuscitation, all interventions) through to Level C/4 (comfort measures only, no CPR, no life-sustaining interventions). The specific level matters beyond the hospital walls: residential hospices in New Brunswick, such as Maison Albert House in the southeast, require a formal DNR Level C/4 on the medical chart as a mandatory admission prerequisite.

If your goal is to enter a residential hospice program, your attending physician or nurse practitioner must chart this specific level. An instructional Health Care Directive alone will not satisfy the hospice intake criteria.

How to Get a DNR Placed on Your Chart

The process starts with a conversation between the patient (or their Attorney for Personal Care, if the patient lacks capacity) and the attending physician. In practical terms:

1. State your wishes clearly. Tell your physician: "If my heart or breathing stops and I am in a state of irreversible decline, I refuse CPR. I want a clinical Do-Not-Resuscitate order placed on my chart."
2. Specify the level. If you want comfort-only care, request Level C/4 specifically. If you want some interventions (antibiotics, IV fluids) but not CPR, discuss where you fall on the scale.
3. The physician signs the order. Once signed, the DNR becomes active immediately — there is no waiting period.
4. The order is recorded in the electronic medical record. Both Horizon and Vitalité maintain EMR systems. Request confirmation that the order has been entered.

If you are acting as someone's Attorney for Personal Care under an Enduring Power of Attorney, you have the legal authority to request and consent to this order on the patient's behalf, provided the health-care provider determines that the patient lacks capacity to make that decision.

Out-of-Hospital DNR: The Gap That Catches Families

The most significant practical gap is what happens outside the hospital. A DNR entered in a hospital chart may not be available to paramedics responding at home or in a care facility. Do not assume that a hospital order alone will be recognized outside that setting; ask the attending clinician or local ambulance service what portable documentation or process they recognize.

Families can take several steps to bridge this gap:

• Document the DNR preference inside the Health Care Directive and ensure the directive is immediately accessible — posted on the refrigerator in a bright envelope marked "EMERGENCY MEDICAL DIRECTIVE," or carried behind the Medicare card in the wallet.
• Ask the attending physician what portable documentation or process local paramedics will recognise.

When the Attorney for Personal Care Steps In

If the patient cannot communicate — due to sudden unconsciousness, advanced dementia, or a catastrophic medical event — the Attorney for Personal Care appointed under the Enduring Power of Attorney becomes the decision-maker. The attorney carries a statutory duty to make decisions that align with the patient's documented wishes, values, and beliefs.

This is where having both documents matters. The Health Care Directive tells the attorney what the patient wanted. The Enduring Power of Attorney gives the attorney the legal standing to translate those wishes into binding medical orders, including a DNR.

Without an EPA, no family member has automatic authority to make the decision on the patient's behalf. The clinical team must still review any clear Health Care Directive instructions, but other decisions may require an application under the Supported Decision-Making and Representation Act.

What Cannot Be Requested Through a DNR

A DNR order covers one specific scenario: cardiac or respiratory arrest. It does not address other end-of-life decisions, such as withdrawal of ventilation, refusal of feeding tubes, palliative sedation, or transfer to hospice. Those preferences belong in the broader Health Care Directive.

It also cannot be used to request 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, and the assessment and administration process follows a separate legislative pathway.

Next Steps

If you are planning your care preferences in New Brunswick and want to ensure a DNR order is properly documented and accessible, having both a Health Care Directive and an Enduring Power of Attorney for Personal Care is essential. The New Brunswick Advance Directive & Living Will Kit walks you through the dual-document system, includes clinician-ready templates for requesting specific resuscitation levels, and provides a storage and distribution plan to ensure your DNR preferences are accessible during an emergency.

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