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

[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?

[Coffee Nurse, BSN, RN]

Agree with PPs that quality of life is much more important than age, although I'm surprised that so many are choosing 70 as a cutoff. IIRC that's not even considered "extreme old" or whatever anymore. Three of my grandparents lived/have lived into their mid 90s and up until recently were doing well, living independently, etc.

OT: OP, you have an ICU with babies and 90 year olds? What kind of place is that?

[RNperdiem, RN]

I would take it on an individual basis rather than on age.

A DNR without a strong patient advocate is another problem. Yes you can have a DNR and still end up in ICU with tubes everywhere like the patient I had recently. She had metastatic lung cancer, requiring higher and higher vent settings. She had to be restrained and is tube fed. She is just like any other ICU patient. If her heart stops, we won't try CPR. This patient probably would not have ended up in ICU if she was not socially isolated. If there had been a spouse or parent who was there to step in and withdraw treatment, make her comfort care, take her home with hospice care, anything, her story would have been different. The DNR did not make much of a difference.

I see this from time to time. Socially isolated people whose next of kin is a nephew who lives 3 states away have a weaker advocate than people with a devoted spouse, community involvement and strong family ties.

A DNR is good, but you need involved people who will make your wishes known when you cannot.

[traumaRUs, MSN, APRN]

Its all about quality of life.

[FolksBtrippin, BSN, RN]

Age is not the deciding factor. If at some point I was terminally ill I would do a POLST. That could happen at any age. The POLST would lay out my wishes.

[Nurse SMS, MSN, RN]

Age has nothing to do with it. My directive for whether to code me or not has a very blunt, short series of yes or no questions to be answered that speak to quality of life and things that are important to me. If the answers to them are negative my loved ones know I am not to be resuscitated, regardless of how old I am.

I also have very specific yes or no questions related to whether to intubate. There are very few scenarios in which I would be okay with being intubated at all, period.

[missmollie, ADN, BSN, RN]

I agree with the posters stating that it depends on the condition, not the age. My husband has to ask this one question to the physician: Will she still be a PRODUCTIVE member of society? If the answer is no, then I am a DNR/DNI, regardless of age.

[nursemike, ASN, RN]

If I hadn't procrastinated about filling out advanced directives, I might not be writing this. (Might not, because a secret about DNR is that it depends a bit on how hard your family fusses about it) The last three times I've participated in a code, I was the "guest of honor." Except for some bizarre dreams, I have total amnesia about my time on life support, although I've been told I was found once sitting on the side of my bed while on a vent and ECMO. In one dream, I was looking at lighted characters on a monitor of some sort that read "400J" and wondering is that meant those bastards were getting ready to shock me again. But I felt pretty sure 360 Joules was the max ever used. Does that vary between facilities? Then I felt a pain rather like a heart attack, but kinda worse, and when it stopped I told the doctor, "Maybe we need to rethink my advanced directives." At which point he stopped my code and explained that of course I had the right to refuse, and if I was sure that was what I wanted, my wishes would be respected. So I assured him I was only joking and he should do whatever he needed to do, then braced myself for another shock. Like I said, it was a bizarre dream. But it does summarize my current view on my own advanced directives: do whatever you need to do, and if it doesn't work, that's okay, too.

[VioletKaliLPN, LPN]

I am 35 and a DNR. I am a cancer patient/survivor. Quality of life is more vital to me than quantity, and when it is my time to die I do not want people pumping on my chest in a futile attempt to save my life. I am not jaded, but I have not personally seen any codes end with positive outcomes aside from children. I would not want to live on a vent, feeding tube, etc, so being a vegetable or partial vegetable does not appeal to me in the least.

I believe the choice to be a DNR is very personal, there is not an age that makes it appropriate.

[Irish_Mist, BSN, RN]

I agree with the overall consensus of this thread that quality of life rather than age is the major factor. I have taken care of people in their 60s that are total cares and look like they're in their 90s. I've taken care of 90 year olds that look like they're in their late 60s or early 70s. Active 90 year olds that still drive and take care of themselves and are able to get up and walk around. Age is just a number, really.

[MrNurse(x2), ADN]

Age is not the be all and end all of this question. In three decades I have seen 60 yr olds who have lived their lives, I have seen 90 yr old individuals who would have run circles around those 60 yr olds. Many factors are taken into account and I have heard many a nurse say they will always be no code, even though they were 30. I hate these discussions at the station because, you know what? They aren't our decisions to make. A patient who refuses to accept their own demise may be holding out for an event, a person or their own fear, but how pompous to put your own values on the view of another's life? Every person is given their time here and to say that their life has no worth because they may be suffering (which impacts your life the grand sum of zero) puts each and everyone of us in jeopardy. Not much further down that slope is justified homicide. Just how close will you come to that cut off for worthiness? The cost argument does not make this more palatable at all. It is still quantifying someone's worth.

[mmc51264, BSN, MSN, RN]

I am 53. I am relatively healthy. I see patients younger than I am that are DNAR. I'm not sure you can just pick an age. So much depends on that decision. I don't want my ribs broken d/t CPR @ 90 but where I work it is all or nothing: all in or nothing (hence the DNAR-do not attempt resuscitation) I worked at a LTC and they had all these caveats: CPR but no intubation, it is difficult to keep them all straight. My husband and I have had frank discussions about this and are each other's HCPOA.

I hate seeing some of these frail older people whose families want the whole 9 yards, not realizing how brutal it can be.

[Zyprexa]

I've already decided I want to be DNR at this point (let's just say I'm