Right to Refuse Medical Treatment in Manitoba

The right to refuse medical treatment is a fundamental principle in Canadian healthcare, and Manitoba law gives it teeth. Under The Health Care Directives Act, your written instructions carry legal weight — including instructions to refuse or withdraw specific treatments, even life-sustaining ones. But the right to refuse while you have capacity works differently from the right to refuse in advance through a directive, and understanding the distinction matters.

While You Have Capacity

If you're conscious and competent, you can refuse any medical treatment at any time. This includes refusing surgery, chemotherapy, blood transfusions, dialysis, ventilation, CPR, or any other intervention. A competent adult's refusal is legally binding, full stop.

Physicians can explain the risks and consequences of your refusal. They can document that you've been informed. They can strongly recommend against it. But they cannot override your decision. Consent is the foundation of medical care in Manitoba, and consent includes the right to say no.

This right extends to withdrawing consent for treatment that's already underway. If you're receiving dialysis and decide to stop, or if you're on a ventilator and want it withdrawn, your physician must honour that decision as long as you have the capacity to make it.

When You Lose Capacity: The Health Care Directive

The harder question is what happens when you can't communicate your refusal in person. This is where the health care directive becomes essential.

The Health Care Directives Act allows you to document treatment refusals in advance. If you write in your directive that you do not want CPR, mechanical ventilation, or artificial nutrition under certain conditions, your healthcare team is legally bound to follow those instructions once you've lost the capacity to decide for yourself. Your proxy is also bound to respect the refusals you've documented.

The key is specificity. A directive that says "I refuse all treatment" is technically valid but clinically awkward — it could be interpreted to include comfort measures like pain management, which is unlikely to be what anyone actually means. Instead, specify which treatments you're refusing and under what circumstances:

• "I refuse CPR if I have a terminal diagnosis or advanced dementia"
• "I do not want a feeding tube if I permanently lose the ability to swallow"
• "I refuse hospital transfer from a personal care home except for the management of acute pain or distress"

These specific refusals map onto Manitoba's Goals of Care framework. A directive that refuses CPR and life-prolonging measures aligns with Level C (Comfort Care). One that accepts medical treatment but refuses resuscitation aligns with Level M (Medical Care). Using this clinical vocabulary in your directive helps ensure your refusals are translated accurately into active medical orders.

Treatment Refusal and MAID

Refusing treatment is legally and ethically distinct from Medical Assistance in Dying (MAID). Refusing a ventilator or CPR allows a natural disease process to continue without intervention. MAID is the active administration of medication to cause death.

Under Canadian federal law, you cannot request MAID through an advance directive — a MAID request currently requires the person to have decision-making capacity at the time of the request (with narrow exceptions for those whose natural death is reasonably foreseeable). So while you can refuse any treatment in advance through your Manitoba health care directive, you cannot pre-authorize MAID for a future scenario where you've lost capacity.

If MAID is something you want to explore while you have capacity, that's a separate process with its own eligibility criteria, clinical assessments, and legal requirements. The MAID and advance directive relationship deserves its own consideration.

What Happens When There's No Directive

If you lose capacity without a health care directive, your medical team turns to substitute decision-makers using the next-of-kin priority hierarchy. Your spouse or common-law partner decides first, then adult children, then parents, then siblings, and so on.

The problem is that substitute decision-makers are supposed to decide based on what they believe you would have wanted — but without a directive, they're guessing. And if multiple family members of equal priority disagree, the clinical team faces a deadlock that may require a court application to resolve.

A treatment refusal documented in a directive removes the guesswork. Your proxy doesn't need to agonize over whether to authorize CPR because you've already told them — in writing, with legal force — that you don't want it under the specified circumstances.

Documenting Your Refusals

When writing treatment refusals into your directive, cover the interventions most commonly encountered in emergency and end-of-life care:

• Cardiopulmonary resuscitation (CPR)
• Mechanical ventilation (intubation and ventilator)
• Artificial nutrition and hydration (feeding tubes, IV fluids)
• Dialysis
• Blood transfusions
• Hospital transfer from a care facility
• Antibiotics for life-threatening infections in the context of terminal illness

For each, specify the circumstances under which you'd refuse — blanket refusals without context are harder for clinical teams to apply than conditional ones tied to your diagnosis or prognosis.

The Manitoba Advance Directive & Living Will Kit includes a Health Care Directive Worksheet with structured treatment-refusal options that map directly to Manitoba's clinical framework, making it straightforward to document your refusals in language your medical team can act on without ambiguity.

See more Manitoba guides →