Unrecognizable teenage girl with grandmother at home, holding hands.

Other end-of-life options

Make an informed choice based on your wishes and values.

Home / End of Life Support / Other end-of-life options

When making end-of-life decisions, we encourage you to consult with your health care provider. Please note that the content below is provided for informational purposes and should not be interpreted as medical or legal advice.

Voluntary Stopping of Eating and Drinking (VSED)

In Canada, nutrition and hydration by tube are considered medical treatments. You have the right to refuse them in the first place, or to stop them after they have started.

You also have the right to refuse nourishment by mouth. Individuals with capacity for health care decisions are legally permitted to refuse oral nutrition and hydration in all provinces and territories across Canada. This is referred to as Voluntary Stopping of Eating and Drinking (VSED).

VSED is not a process that should be undertaken without careful consideration. It is a very difficult process that requires medication, support, and supervision by a health care provider. If this is something you are considering, please discuss with your primary care provider before taking any action. A health care provider will be able to speak to the risks and benefits of all options.

a senior woman holding a bouquet of small yellow flowers

Voluntary Stopping of Care (VSC)

People who wish to allow their life to end naturally sometimes refuse or discontinue care which includes health care to prevent or cure illness. This may be referred to as Voluntary Stopping of Care (VSC). 

VSC commonly involves stopping or refusing the following (although not everyone refuses all of these): 

  • Oral food and drink (see VSED) 
  • Respiratory support (oxygen, BiPap, C-Pap, ventilator) 
  • Regular changing of position 
  • Any other procedures that might prolong life 

Switzerland

Switzerland is the only country in the world that permits assisted dying for non-residents. If you are considering an assisted death in Switzerland, it is recommended that you have an assessment by a local nurse practitioner or doctor to see if you are eligible for MAID in Canada first. Please visit our Navigating a Request for MAID page or contact support@dyingwithdignity.ca if you require assistance in finding a local assessor. Dying With Dignity Canada is not affiliated with any of the death clinics in Switzerland.

Cardiopulmonary resuscitation and do-not-resuscitate orders

Cardiopulmonary Resuscitation (CPR) is a medical procedure designed to maintain blood circulation if your heart suddenly stops beating. It can involve manual chest compressions or electric shock paddles. CPR can save your life in an emergency, but the success rate of CPR for seriously ill or frail people is very low.

It is important to think ahead about CPR and to make your wishes known to your loved one(s) and your health care provider(s) as you will not be in a position to speak for yourself when such intervention is required. 

If you decide against CPR, you can help avoid it by getting a Do Not Resuscitate Order (DNR) or No CPR order, whether you are in a hospital or living at home. A formal DNR order must be obtained through your health care provider. It instructs other health care providers to withhold CPR if your heart stops beating. Let your caregivers and loved ones know about a DNR order and display it somewhere obvious (e.g., on your fridge, in your wallet) to inform others of your wishes. 

Your health care provider must make sure that you are capable of making an informed decision about a DNR order after discussing the risks and benefits involved. Each province and territory has different rules and requirements concerning DNR orders. Talk to your health care provider to ensure you have the right information and the correct form. 

Note: In an emergency situation, if you do not have the capacity to make health care decisions and a valid DNR is not easily available, Emergency Medical Responders have a legal and ethical duty to do whatever is immediately necessary to keep you alive, including CPR. If you feel strongly that you do not want life‐saving treatment even in an emergency, make sure to obtain a formal DNR order in accordance with the requirements of your location. Carry it with you or place it somewhere in plain sight (e.g., the fridge) so emergency responders can be aware of your request; however, there can be no guarantee that it will be followed, if it isn’t easily accessible.

Palliative sedation

In terminal situations where pain or other intolerable symptoms are constant and all other options have failed, with your consent, your medical team may suggest palliative sedation in accordance with medical protocols. 

There are many medications that can control pain and reduce discomfort; however, suffering such as nausea, coughing, shortness of breath, and other difficult symptoms can persist in addition to pain. This can cause continued anguish and distress for you.  

Palliative sedation drugs lower your level of consciousness to relieve intolerable symptoms. Palliative sedation can be intermittent to permit occasional periods of wakefulness and lucidity, in which case food and water may continue to be given if you want them. Or it can be continuous, where food and fluids are withheld (although, very rarely, intravenous fluids may be administered). Continuous palliative sedation is only used in situations where suffering is so intractable that nothing else can relieve the pain, and where death is anticipated soon – usually within two weeks. Palliative sedation can only be used after consent from you or your SDM, although it is your health care provider who determines eligibility for palliative sedation. 

Palliative sedation can never be implemented against your will. Its intent is not to hasten your death, but to provide comfort in the final stages of your life.

Download a Patient Rights Guide

This guide is a source of information for individuals who are eligible for publicly-funded health services in Canada – including Canadian citizens and permanent residents.

Empower. Inform. Protect your rights.