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?

[lindsayCalifornia]

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?

Well you achieved a BSN before reaching the legal age to drink.. you are obviously immortal and shouldn't be worried about death. I kid I kid, I'm 25 and struggling to get into a nursing program so I admire your impressive achievement. I'm currently working as a CNA in LTC and I find myself wondering the same thing, as some patients who seem "better off" than others are DNR while the ones with more progressive ailments are FULL CODE. I personally wouldn't want to live in a progressively demented state, where I have lost all control of bodily function, along with cognitive thinking and memories.

[Jedrnurse, BSN, RN]

My personal philosophy is counter to a lot of what nursing entails.

When a body can't carry on it's processes without a MINIMUM amount of outside assistance, I believe that nature should take it's course. Hence, I'm a DNR/DNI irrespective of my age...

[Neats, BSN]

I really like the comments found in this thred and know if I really get sick I am in good hands with the decision I make for my healthcare delivery.

I am over age 50 and have a DNR for a variety of reasons, the main reason is quality of life. I know myself and know I would not be happy confined to a bed, I would not be happy if another person had to clean me after I go to the bathroom, and I would not be happy if my children had to take time from their families to take care of me in such a way that it takes longer than 5 hours per MONTH. These are my baselines for making hard decisions about how I want my life to be as I age. As a LNHA, as a RN, as a breast cancer survivor, and as a German Jew, and spouse of an older man (in great shape and active and working full time).

I do not want to be a burden not only on my children but society. To me it makes no sense attempting to give me another 2 years to be alive stuck to some chemotherapy regime verses the 6 months I will have to be free and say goodbye in my own way, to travel, or to get items off my bucket list.

I think each person has their own path to take however I see again and again we spend more monies in a person last 2 years of life then the person did before they became ill. I do not want that for me.

If you see me in a hospital bed intubated, having to clean me up after a BM, know I will never be the same and will always need ADL assistance (with bathroom clean up), if you know I am NEATS from allnurses... be an advocate for me...please. If I have Alzheimer's and in a locked unit and know it is me from allnurses then well....give me a medical bag for I will probably try to get out of the building to go to work... I have things to do, people to see, and travel in my own locked mind!

Life decisions are difficult and best left up to the individual. We do need to be more proactive and have life discussions maybe then it will not be treated much like mental health...taboo, and stigmas. Remember to be an advocate for your patient and their wishes.

[txmurse69]

I don't think it has anything to do with age. I have had a living will since 25. By then after 5 years as a paramedic I had seen enough to k ow there were certain situations I wouldn't want to survive

My living will gives parameters like how long on the vent if I can't breath on my own, no tube feedings if not going to regain consciousness, etc. Also need an MPOA that you know will unplug you, I have 2, my wife who may struggle with it and my sister who would do it with no issues.

[kbrn2002, ADN, RN]

I don't think it's age so much as health. A healthy person can and often does stay a full code well past the age one would expect. I have a few that are 80+ years old at my LTC that remain full code. On the flip side I've seen several relatively young people that choose to be DNR due to chronic health issues. I work with two CNA's with chronic heart conditions that have opted for DNR and I've sadly seen several younger people with terminal disease processes that choose to be a DNR.

[Ruby Vee, BSN]

I don't think age is an appropriate criterion for making this decision. If I'm 95 and perfectly healthy, still able to sail my boat, hike into town and carry groceries back for dinner I'm clearly not ready for a DNR. Unless I've tripped over my lifelines, hit my head on a winch and am brain dead . . . but that's a different issue.

My best friend from high school has a form of arthritis that has robbed him of mobility and of a pain-free existence. He has asthma, COPD, diabetes, renal failure, is going blind and is contemplating is fifth or six hip replacement and yet another eye surgery. He says he's done now. He's done struggling, he's ready to die. He might be an appropriate candidate for a DNR.

[Kooky Korky, 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?

They're choosing 70 because they're nowhere it, LOL.

OP - it's not the age, it's a person's condition/health status. I recall a pt who was only 16 or 17. She had attempted suicide but someone found her in time to call 911 and she was saved. Saved to a persistent vegetative state. to a lifetime of 24/7 care in a nursing home. Colostomy, trach, feeding tube,

total care. Was she in pain? Was she aware of her surroundings? In some ways, it seemed she was - she seemed to enjoy it when pets, dogs visited and she seemed to know her Mom's voice. It was hell on

me because I thought Mom was being unrealistic to keep her a full code, but realized how hard it would

be on a parent to decide otherwise, especially if she felt guilty about the daughter's actions and status.

All I could do was pray privately for this family and give good care.

It's a mess, that's for sure.

But to answer your question - it's not the age, it's the condition. Of course, I believe in Heaven, so death

isn't as scary as it might be if I didn't.

[Kooky Korky, BSN, RN]

I really like the comments found in this thred and know if I really get sick I am in good hands with the decision I make for my healthcare delivery.

I am over age 50 and have a DNR for a variety of reasons, the main reason is quality of life. I know myself and know I would not be happy confined to a bed, I would not be happy if another person had to clean me after I go to the bathroom, and I would not be happy if my children had to take time from their families to take care of me in such a way that it takes longer than 5 hours per MONTH. These are my baselines for making hard decisions about how I want my life to be as I age. As a LNHA, as a RN, as a breast cancer survivor, and as a German Jew, and spouse of an older man (in great shape and active and working full time).

I do not want to be a burden not only on my children but society. To me it makes no sense attempting to give me another 2 years to be alive stuck to some chemotherapy regime verses the 6 months I will have to be free and say goodbye in my own way, to travel, or to get items off my bucket list.

I think each person has their own path to take however I see again and again we spend more monies in a person last 2 years of life then the person did before they became ill. I do not want that for me.

If you see me in a hospital bed intubated, having to clean me up after a BM, know I will never be the same and will always need ADL assistance (with bathroom clean up), if you know I am NEATS from allnurses... be an advocate for me...please. If I have Alzheimer's and in a locked unit and know it is me from allnurses then well....give me a medical bag for I will probably try to get out of the building to go to work... I have things to do, people to see, and travel in my own locked mind!

Life decisions are difficult and best left up to the individual. We do need to be more proactive and have life discussions maybe then it will not be treated much like mental health...taboo, and stigmas. Remember to be an advocate for your patient and their wishes.

Just curious - what is an LNHA and why does being a German Jew influence your view?

Yes, I will advocate for your wishes if we ever meet, NEATS. God bless you.

[aprilmoss]

End of life issues aren't a simple YES/NO decision. I recommend people sit down with an elder law attorney who can work out the advance medical directives that have the proper aspects to match your wishes. You can also at the same time set up medical and general powers of attorneys and work on your will, trusts, etc...

We were fortunate to get all this done with my Alzheimer's diagnosed mother before she lost competency to make these elections. I didn't wait long before getting me and my hubby to the lawyer as well to get ours drawn up. Hopefully we won't need it for a long time, but I don't want to be caught by surprise nor cause an undue burden on my surviving family.

[lakepapa]

I'm not sure. But I know it when I see it..

[SopranoKris, MSN, RN, NP]

Even before I became a nurse, I always put my code status as DNR when I had surgeries. I am adamant that I do not want chest compressions, mechanical ventilation, feeding tubes, etc. If it's my time to go, it's my time to go. The outcomes for pts that go through full code situations don't lead to a good quality of life. At least, not the quality of life that I would want to have. I don't want to be a burden on my family. I don't want to have an anoxic brain injury. I don't want to live through all of that. Sure, there are people that come through it, but they're far and few between. I'm in my late 40s, but I've felt this way since my first surgery when I was 18. My parents were very upset that I opted to be a DNR. I remember the doctor trying to talk me out of it, saying "that's really only for people at the end of their lives". I told him how I felt about what life could possibly be AFTER going through it. Not something I ever want to experience. As I said before, if it's my time to go, it's my time.

I had hospital staff ask why I was a DNR at such a young age. Did I have cancer? (No) Did I have a life threatening disease? (No). I think some people just can't handle the fact that it's OK to be accepting of your inevitable death. We are all going to die at some point in our lives. Yes, we'd all love to be in our 90s and die peacefully in our sleep. But it doesn't always happen that way.

Now that I work in the ICU, I see the medical profession almost going over-board with life-prolonging procedures that, in the long run, do little to improve the quality of life. In fact, it can actually make it worse. There was an interesting article written by an ER doctor that we have taken the "do everything you can to save them" mentality to an extreme. If it ever came to the point where I had a terminal illness or life threatening condition, I would rather be made comfortable and spend my last days with my family and friends and be at peace. I don't want to be in a hospital room, alarms blaring, bright lights, a view of the wall clock and visitors on a scheduled basis. I want to be at home with my loved ones. I think palliative care and hospice care are wonderful and sadly, under utilized.

Just my 2 cents :)

[cyc0sys]

I must say that I'm a bit surprised at some of these answers. As a former medic, I can tell you that your chances for surviving a code, even for the young and fit, is pretty low unless you're in/very near a hospital when it happens perferrably with a competent surgical team on standby. Even then, coming out of a code unscathed is extremely rare.