DNR/DNI: What Age Would You Choose to No Longer Be Full Code? - page 4

At 16, I graduated high school. At 20 years of age, I graduated with my BSN and successfully landed my first nursing job in a progressive care unit, where I worked for only 6 months before I was... Read More

  1. by   KelRN215
    There are situations in which I can imagine signing a DNR tomorrow. I am 33 but have been ill for 15 years, diagnosed with a large brain tumor on the eve of my 18th birthday. My biggest fear when I had my brain surgery was not dying but suffering a complication that left me unable to be a normal college student again. I was clear with my mother then, at 19, that there were to be no trachs or feeding tubes if anything went wrong. A few years ago my Neuro-Oncologist pointed out that I was "pretty lucky" that my surgeon hadn't made any errors since my resection was so close to my right MCA. A couple years ago, a routine MRI noted a new lesion on my left side, millimeters from my left MCA. I had extensive testing prior to having brain surgery 14 years ago that concluded that my verbal memory is controlled by the left side of my brain. I would be VERY hesitant to have surgery on the left side of my brain, were it ever to be recommended. (It hasn't been as right now this lesion isn't causing me any symptoms and it was a little smaller on my last MRI, leading my Neuro-Oncologist to conclude that it may be the evolution of some kind of process that we would have never known about if I weren't someone having regular MRIs anyway.) But when this lesion was first found, I did start to think about what situations I would want to live under, what I would treat and what I wouldn't, etc.
  2. by   Penholder
    I work in LTC. I have had 2 codes recently. Neither should have been a full code. I've also seen patients that were compressions only. To me a full code in an LTC (barring the patient being adamant about living) is a failure of nursing. We need to teach this process. The MDs sure don't.

    Thanks for reminding me to so an advance directive. 38 and DNR please.
  3. by   mslove717
    Depends on your quality of life. I'm 32, having my babies and in my prime. So I don't want to die, and it's hard to imagine being old and in poor health. It will just depend how I am as I age
  4. by   erniefu
    I think that people have a problem with recognizing how do we quantify qualify of life such that we would make ourselves a DNR. For me, if my palliative performance scale was 40% or lower, I would make myself a DNR. I like this scale because it does not depend on the age, just how one can go about life. Of course no scale is perfect and is subject to human interpretation.

    The Palliative performance scale, from Victoria, BC, Canada.
    https://www.cancercare.on.ca/common/...x?fileId=13380
  5. by   db2xs
    I have been a DNR since my 30s and I'm in my 40s now. I don't have any serious health problems and never had. I have a 19-page advance directive because the vague and flimsy traditional 3-page AD available to people does not cover enough of the "What ifs" that could happen. I see confusion of vague wording in the hospital and don't need that to happen to me.

    Making oneself DNR is a personal choice. Just remember to live every day like it's your best day.

    I would like to remind people that DNR does equate to "Do not treat at all," which is the misunderstanding many people have (not just laypersons, but nurses too)l
  6. by   retirednotdead
    LollaPaupRN, BSN, RN Early in my career, I worked "General Medicine" when we didn't have all of the bells and whistles we take for granted today and patients stayed for long times as needed. Bed rails had to be put up on all patients over 65 to "prevent falls"; many were highly insulted. Putting an age requirement on requiring DNR/DNI is also insulting. I have seen many deaths,but I have also seen many miraculous recoveries with and without DNRs. I hope you are able to let time help you find your answer.
  7. by   hppygr8ful
    Quote from LollaPaupRN
    At 16, I graduated high school. At 20 years of age, I graduated with my BSN and successfully landed my first nursing job in a progressive care unit, where I worked for only 6 months before I was promoted to the corresponding ICU. I have worked there the last 8 years and as you can imagine, I've seen a lot of miracles, but also a lot of deaths. Some of the deaths were probably for the best, some were untimely (such as the new babies our unit sees) and some were prolonged for far too long, and really, only promoted more suffering. The prolonged deaths tended to be 80 and 90 year olds who, were unwilling themselves to let go, or who had family members in denial about their condition. Although I am not sure of the "right" age to become a DNR/DNI, I sometimes think to myself there's no way I want to be full code when I become their age. However, I really don't know when I would want to change my status; I am not even 30 years old, so I feel there are many more years for me to accomplish things. At the same time, I know I won't be full code forever. What is your opinion?
    For me it's not so much about age as it is about quality of life. One can be relatively young and have a devastating accident or illness that places one on a vent or other machines for life. My advanced directive addresses what measured can be done on a Trial basis of not more than two months and that after such time if there is no meaningful recovery of return to function all life sustaining measures are to be stopped. My entire family is aware of this advanced directive.

    Hppy
  8. by   djh123
    I'm going to comment before reading anyone else's responses. I think age doesn't have all that much to do with it. Should my aunt, who was in unbelievably good shape at 95, have automatically been DNR? She lived far away, so I didn't see her again until she was 100, at which time yeah, maybe, she should've been DNR.

    But compare her with say, maybe a patient I have or have had who had a stroke in his 50's and has little quality of life. Should he be DNR? It's not really up to me to say - it's he and his family's decision - but my point is, it's got a lot more to do with someone's individual physical and mental condition than their numeric age.
  9. by   ~♪♫ in my ♥~
    As I see it, the tenacity with which some people maintain 'full-code' status is analogous to playing the lottery...
  10. by   Jory
    To attach an age to it is ridiculous. You look at quality of life and what the patient wants, not their age.

    At what age do you think you would have lived long enough? Do you have the right to decide that for someone else?

    I saw a 91 year old in the hospital, full code. She was living by herself, doing all of her own gardening, cooking her meals, even doing her own yard with a push mower. She had got out of bed and passed out and was a little slow to recover, but she was fine. Her mind was sharp as a tack. She had a lot of living to do!
  11. by   wernicke
    I wouldn't go by age. I have a close family friend who is 78, will be 79 in January. He's fitter and more active than the average 45 year old, no exaggeration. His doctors agree. He had a single lung transplant for ILD (genetic in his case, no smoking nor chemical exposure) at 75. Oldest patient that hospital had ever done, because he was so fit that they made an exception for him. He's now got 85% FEV1 on that single lung, still works full time, is still athletic, just did his second inter-state move in the same number of years, and once more had his new medical team be stunned by how fit he is. He enjoys excellent quality of life, and thanks to his history with the transplant alongside new advances involving Zithromax and FEF25-75 monitoring, he is extremely low risk for CLAD. He has no reason to be a DNR/DNI, and is thus full code.

    I'm 23 and already have a "complex medical history" but am finally doing well now. Had I plateaued at the level I was at when I was 17, I would have made myself a DNR/DNI. (I'm a "conditional" full code now. I've written into my proxy form certain situations where I'd want nature to take its course.) So, there are situations when it makes perfect sense for a 75 year old to have a lung transplant, and perfect sense for a 17 year old to be a DNR/DNI. It all comes down to overall health, likelihood of treatment success, and quality of life.
    Last edit by wernicke on Sep 30 : Reason: Me no grammar goodly
  12. by   LadysSolo
    I have been a DNRCCA since age 18 (with the caveat to my family that if it's from a car accident and they want to try life support for a day or two to see if I recover, okay but otherwise withdraw life support and let me go.) I made the decision at that time that I do not want to be dependent on a ventilator or "live" in a permanent vegetative state. Let me go.
  13. by   CardiacUnderground
    I do not think there is a set age, although I think it's based on condition. I see patients who are in their 70s who are in better condition than myself and are vibrant and full of life. Perhaps they have another 30 years ahead of them. My grandfather was a full code until he had a short stay in the ICU being put on and off a vent, he had COPD so once he was extubated although he was breathing on his own okay he just couldn't maintain life and we changed him to DNR at 71 and let him pass a few days later peacefully at home. I think once you know there is no functional quality of life that is normal for that patient then they should be a DNR. It breaks my heart to see people prolonging life just to add years and not happiness. So very sad. There can be dignity and autonomy in being allowed to die.

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