Treatment Refusal in a Yukon Advance Directive

One of the core purposes of a Yukon advance directive is to document treatments you don't want. The Care Consent Act (2003) gives capable adults the right to refuse any medical intervention in advance — including life-sustaining treatment. But the way you document those refusals matters. Vague language gets interpreted. Specific language gets followed.

What You Can Legally Refuse

Under Yukon law, you can refuse any health care treatment through your advance directive. There's no category of treatment that's off-limits for refusal. Common refusals include:

• Cardiopulmonary resuscitation (CPR) — This is also addressed through the separate Resuscitation and Care Form, which is a clinical document that paramedics check on scene.
• Mechanical ventilation — Being placed on a breathing machine.
• Artificial nutrition and hydration — Tube feeding or intravenous fluids when you can no longer eat or drink.
• Dialysis — Kidney replacement therapy.
• Blood transfusions — Whether for medical or personal/religious reasons.
• Antibiotics for life-threatening infections — Choosing comfort care over curative treatment in terminal situations.
• Surgery — Refusing surgical intervention for conditions you've decided not to treat.

The refusal can be absolute ("I refuse mechanical ventilation under all circumstances") or conditional ("I refuse mechanical ventilation if my attending physician determines there is no reasonable prospect of recovery"). Conditional refusals give your proxy and medical team more flexibility while still honouring your core intent.

How to Write Refusals That Hold Up

Generic language like "no heroic measures" or "no extraordinary treatment" creates problems. These aren't medical or legal terms — they mean different things to different clinicians, and they give family members grounds to dispute what you intended.

Instead, be specific about:

The intervention. Name the exact treatment. "I refuse cardiopulmonary resuscitation" is clear. "I refuse aggressive measures" is not.

The circumstances. State when the refusal applies. "If I have an irreversible, terminal condition and my attending physician determines there is no reasonable prospect of meaningful recovery" sets a clear trigger. A refusal with no conditions applies in all situations, which may be broader than you intend.

What you do want. Refusal directives work best alongside positive instructions. "I refuse mechanical ventilation but I want all available comfort care, pain management, and palliative sedation" tells the medical team what to do, not just what to stop.

The Proxy's Role in Treatment Refusal

Your proxy is bound by your documented wishes. Under the Care Consent Act, when a primary healthcare provider determines you lack capacity, the proxy steps in and must follow your last known capable wishes. If your directive says you refuse ventilation in a terminal situation, your proxy cannot override that and consent to ventilation.

If the directive doesn't address a specific situation, the proxy makes decisions based on your known values and beliefs. As a last resort, they act in your best interests. This is why documenting your values alongside your specific refusals matters — it gives the proxy a framework for the scenarios you didn't anticipate.

Family members who disagree with your refusal cannot simply override your proxy. If there's a dispute, the matter can be brought before the Capability and Consent Board, but the starting point is always your documented wishes.

The Resuscitation and Care Form: A Separate Tool

If CPR refusal is part of your plan, you should know that the advance directive and the Resuscitation and Care Form serve different purposes:

Your advance directive is a legal document that appoints a proxy and records your healthcare preferences. It's filed with Insured Health Services and stored with your physician.

The Resuscitation and Care Form is a clinical order that tells paramedics and emergency responders whether to perform CPR. In a planned home death scenario, this form must be physically present — paramedics who arrive without seeing it are legally obligated to attempt resuscitation.

These complement each other. The advance directive covers the full scope of your treatment preferences. The Resuscitation and Care Form covers the specific emergency scenario where seconds matter and there's no time to consult a longer document.

Section 30: When Refusal Gets Complicated

There's a tension in advance care planning that the Care Consent Act addresses directly. What happens if you lose capacity and then resist treatment that you previously consented to?

Section 30 allows you to grant your proxy "special authority" — including the authority to consent to treatment despite your objections at the time, or to authorize physical or chemical restraint during a medical crisis. This provision exists specifically for conditions like dementia, where a person might fight medical care they rationally wanted when capable.

Including Section 30 authority requires a Certificate of Legal Consultation (Form 1) signed by a practising Yukon lawyer. It's not something you can add informally — the legal consultation requirement exists because you're authorizing your proxy to override your future expressed wishes.

This cuts both ways. If your advance directive refuses ventilation and you haven't granted Section 30 special authority, your proxy cannot consent to ventilation even if you're not resisting — they're bound by your refusal. If you have granted Section 30 authority for specific treatments, your proxy has more discretion.

Putting It Together

The strongest treatment refusal in a Yukon advance directive combines three elements: specific interventions named clearly, defined circumstances for when the refusal applies, and positive instructions for the care you do want.

The Yukon Advance Directive & Living Will Kit includes template treatment refusal clauses covering the most common scenarios, a values documentation framework, and the signing and witnessing checklists to make sure your directive is legally valid when it matters.

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