You don’t sit on the tractor while you’re augering grain thinking about your odds of getting a debilitating illness or calculating your chances of suffering life-threatening injuries. But that doesn’t change your risks.
Farming is an inherently dangerous occupation. The latest data from Farm Credit Canada show that 72 per cent of producers have had an injury or close call in their operations during their lifetime. Almost a quarter of the surveyed farmers reported an injury or close call in the past year, so it’s essential to be prepared in case the unthinkable happens.
“Advance care planning is part of life planning,” says Cari Borenko, regional lead for advance care planning for the Fraser Health Authority in British Columbia and appointed task member for Advance Care Planning Canada.
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Farmers do financial planning and estate planning, says Borenko. “We want to place advance care planning in that same framework.”
At its most basic, an advance care plan outlines the kinds of health care you would want based on your personal values, beliefs and goals and who can make those decisions on your behalf if you’re unable to advocate for yourself due to illness, injuries or emergency care.
Not only does an advance care plan ensure that you’ll receive the kind of health care you want, it also reduces distress and anxiety during health crises and improves overall satisfaction with medical care, according to an Advance Care Planning Canada report.
Despite the importance of planning ahead for health care, ACPC found that only 17 per cent of Canadians have created advance care plans, and often they have only created their plans after personal experiences making health care decisions for loved ones or after being prompted by a family member or estate planning professional. Of course, though, it also works to simply think ahead for yourself.
Follow these five steps to create an advance care plan:
1. Consider the options
Your advance care plan should include specific details about the kinds of medical care you wish to receive in the event of illnesses or injuries, including the use of CPR, ventilators/breathing machines, surgeries, blood transfusions, kidney dialysis and tube feeding.
It’s not just important to consider whether you would want these treatments. Your decisions should be based on your values, beliefs and goals. You might, for instance, want health care professionals to try any medical treatments that could improve your condition or prolong your life, or you might want medical interventions only if a cure or full recovery is possible, or you might want to decline all lifesaving measures.
Although these are difficult scenarios to consider, it’s important to think about care planning in advance, advises Karine Diedrich, director of Advance Care Planning Canada and the Canadian Hospice Palliative Care Association.
“One of the most common mistakes (in advance care planning) is waiting until there is a health or personal emergency to begin,” she says. “We may not know ourselves until we really stop to think about it and there may be nuances we haven’t considered or discussed before.”
Without an advance care plan, you may be forced to make decisions on the fly.
“When you (go to the) hospital for a procedure, you’ll be asked to fill out forms asking what kind of treatment do you want if something happens like your heart stops beating,” Muma says.
“You don’t get a chance to think about what you’d like. Rather, somebody provides you with a several-page document, gives you instructions to take a look and check the boxes that you think apply, so there’s no consultation, no forethought, no discussion with family and loved ones and … no legal help.”
2. Share the details
Your loved ones should know about your wishes.
Telling your spouse, children and other family members about the kinds of medical care you want (and don’t want) to receive and outlining the reasons for your choices can provide them with valuable information in the event of an emergency.
“Another common mistake is assuming your family, friends or health professional would know what you would want if something were to happen,” says Diedrich. “Talk about your values, wishes and beliefs with your substitute decision-maker, family (and) friends. (Their support) to encourage these discussions can go a long way to breaking down those barriers.”
Although talking to your loved ones about the kinds of treatments you want in the event of a critical illness or injury can feel uncomfortable, more Canadians are talking to their families about medical decisions. In fact, between 2019 and 2021, an ACPC survey found that the number of Canadians who talked about the kind of medical care they wanted to receive jumped from 36 per cent to 59 per cent.
Such willingness to engage in uncomfortable conversations is a good sign, according to Borenko, who says an advance care plan reduces stress and uncertainty and provides clarity during an emotional time, preventing families from being put in precarious situations that can exact an emotional toll.
Without a plan, she says “it leaves people guessing, ‘What should I do? … If we don’t want to be a burden to our families, we need to equip them to know what decisions you would make for yourself and give them something to go on.”
You’ll also need to appoint a “substitute decision-maker” or health care proxy who has the authority to authorize or decline medical treatments on your behalf. Your health care proxy should be someone you trust to honour your wishes and make health care decisions on your behalf.
3. Consult with medical professionals
In considering your health care directives, Muma suggests talking to your health care professionals about what kinds of medical treatments might be offered in an effort to save or prolong your life. Also be ready to ask whether those would increase the odds of recovery or survival.
“To understand the options you might have, it’s good to consult with a medical practitioner,” Muma says.
This step is especially important if you’ve been diagnosed with a progressive illness such as Alzheimer’s disease or cancer that may eventually leave you without the ability to make and communicate your own health care decisions.
Even so, the latest ACPC survey found that a mere seven per cent of Canadians have talked to their health care providers about the kind of care they want to receive.
Ask general questions about the risks and benefits associated with treatments like CPR, life-support and feeding tubes to help you make educated decisions about whether you would want to receive these interventions, Muma adds.
“The decisions are very personal (and) you have the right to make those decisions on your own,” he explains. “(A doctor) can’t tell you what to do but can help you to start thinking about it.”
Your health care providers should have copies of your advance care plan and it should be included in your medical records.
4. Record your wishes
Once you’ve thought about your health care decisions, communicated those wishes to loved ones and designated a health care proxy, get it in writing.
“[An advance care plan is] not valid unless it’s written, dated and signed,” Muma says. “It could be written on the fender of a tractor, as long as it’s written, dated and signed.”
Borenko stresses that an advance care plan doesn’t need to be a legal document, explaining, “There are different ways to record (your advance care plan) than just going to a lawyer. It could be a video or audio recording, written on a piece of paper or turned into a poem.”
ACPC also has a downloadable workbook, My Speak Up Plan, that guides you through the steps of creating an advance care plan. Provincial health authorities have similar resources: The Saskatchewan Health Authority created the My Voice planning document and Health PEI released an Advance Care Planning Workbook to help residents work through the decision-making process.
Although advance care planning isn’t about completing legal documents and forms, Muma believes there are good reasons to call in a lawyer.
“You can do this on your own … but would I recommend it? No?” he says. “You may put in things that are irrelevant or confusing. Bring it to your lawyer so it can be expressed clearly.”
Your advance care plan remains in effect until you recover the capacity to make your own medical decisions or die. You can also revoke your advance care plan orally, in writing or by creating a new directive.
5. Keep it updated
An advance care plan is not a “one and done” document; Borenko calls it an evolving process. You’ll want to review your advance care plan annually (or anytime there’s a change in your health or life circumstances such as marriage or divorce) to ensure that it continues to reflect your goals and values.
The specifics of your health care decisions are deeply personal but the need to create an advance care plan is universal.
“Advance care planning is for any age or stage of life,” Diedrich says. “Talking with others about your wishes is a critical part of the process and so is revisiting these discussions as our preferences change over time.”
