DNRs, VSED, and the cessation of treatment

You have a right to refuse life-extending care measures, from emergency resuscitation to food and drink.

In Canada, a person has the right to withdraw from or refuse life-extending treatment. But even though this right was recognized decades ago, many of us are unaware of it and the different ways in which it can be exercised.  

Understanding and defending your rights is an integral part of our work at Dying With Dignity Canada. That includes rights and options that aren’t as well-known or well-understood. We believe that by informing you of all of your rights — and protecting access to them — we can help Canadians plan for the care they want and ensure their wishes are respected.

Do-Not-Resuscitate orders

One way a person can refuse life-saving treatment is through what is known as a Do-Not-Resuscitate order, or a DNR. By filling out a DNR order, a person is communicating that they do not want to receive emergency life-saving measures, such as cardiopulmonary resuscitation (CPR), in the event that they become critically ill or suffer a catastrophic injury.

Most provinces and territories have their own DNR forms for residents to use. However, the names of these forms, and the range of situations in which they can be enforced, may differ from one jurisdiction to the next.

Because a DNR order is usually written on a government-issued form, people expect that their wishes will be understood and respected. Unfortunately, this isn’t always the case. Paramedics or firefighters responding to a 911 call don’t have time to search a person’s residence for a DNR form. In addition, according to a 2017 CBC News investigation, almost none of Canada’s provinces and territories have a central electronic database tracking residents’ DNR orders. As a result, many people receive invasive, often painful, life-saving interventions despite having refused those options via a DNR order.

Voluntary Stopping of Eating and Drinking (VSED)

The right of Canadians to forego life-sustaining measures extends to food and hydration. In this country, a suffering person may hasten their own death by refusing to eat or drink. This is known as Voluntary Stopping of Eating or Drinking, or VSED.

When attempted by a person who is terminally ill or very frail, VSED usually leads to death within 10 to 14 days. However, VSED can take longer for suffering people who are younger and more physically robust.

Although VSED is allowed in Canada, confusion remains surrounding the legal role a clinician can play in supporting or observing a person who has chosen to starve and dehydrate themselves. We also need to learn more about the legal and ethical implications of patients using VSED as a path to qualifying for an assisted death: in other words, when a person who starves and dehydrates themselves in order to be deemed eligible for medical assistance in dying (MAID) under the rules laid out in the federal Criminal Code.

For our part, DWDC continues to work with legal experts in the field of end-of-life decision-making to better understand what the rules are and what they mean for your rights.