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

Nurses General Nursing

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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?

I'm 37 and I have an advance directive. But DNR? Honestly, some days after work I would be totally willing to sign a DNR.

So I have no clue what actual age I think I'll be when I put pen to paper!

Specializes in Family Nurse Practitioner.

I've had an advanced directive, used to be called living will, since my 20s and at 40yo I went to full DNR/DNI I'm in early 50s now and there is very little I'd even consider treating cancer wise etc. We are all going to die and like most everyone I hope its later rather than sooner provided I'm in good health but I also think there is something to be said for accepting our mortality gracefully. When I encounter people in their 70s and 80s struggling to accept that their bodies are failing I have to wonder what they expected.

Nothing to do with age, it is about quality of life.

I have seen 40 year olds that need to be let go but family will not, and 90 year olds that run laps around me.

I have a living will, no excessive measures to be taken. Intubation, sure, if I am at the point of needing a trach and I can't tell you yes or no, then the answer is no. Let me go.

I do not want to be in a vegetative state and "kept alive". My wife and kids know this. I am also the medical power of attorney for several family members because we have discussed things like this and I know where they stand and know I will have no problem "pulling the plug" when the time comes.

Specializes in Pedi.

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.

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.

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

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/pages/UserFile.aspx?fileId=13380

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

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.
Specializes in Psych, Addictions, SOL (Student of Life).
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

Specializes in LTC, Rehab.

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.

Specializes in Med-Tele; ED; ICU.

As I see it, the tenacity with which some people maintain 'full-code' status is analogous to playing the lottery...

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