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?
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!
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.
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.
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.
Jory, MSN, APRN, CNM
1,486 Posts
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!