A 70 year old man with an elevated blood alcohol level was taken into the Jackson Memorial Hospital emergency room in Miami when doctors found something that led them from trying to save him as quickly as possible to buying time.
The man had a chest tattoo that said “Do Not Resuscitate.” The word “Not” was underlined. A signature was also tattooed on his chest.
This left the doctors wondering what they should do. Was it an accurate representation of what the patient wanted? Was it legally sound? Should they honor it?
Since the patient had no identification or known family members, the social work department was called in to contact friends. Meanwhile, doctors tried their best to get the 70 year old man back to the point of consciousness where he could discuss his goals. They failed..
“We had a man I couldn’t talk to,” Holt told The Washington Post, “and I really wanted to talk to him to see whether that tattoo truly reflected what he wanted for his end of life wishes.”
Fearing that if they did not act now his situation would be irreversible, the doctors decided not to honor the tattoo. However, they felt that this was wrong. They called ethics consultation and the man was placed on antibiotics.
In the end, the ethics consultation decided that the tattoo most likely reflected the patient’s intentions, and a DNR (Do Not Resuscitate) order was written. DNR Reports are written by the doctor. They order health care providers to not do CPR if a patient’s breathing or heart stops.
The patient’s tattooed DNR request had created more confusion than clarity. There were many questions as to the tattoo’s legality. Adding on to the confusion was the belief that the tattoo might be a mistake the patient made when he was intoxicated.
The doctors at Jackson Memorial Hospital had also known of a “cautionary tale” published in 2012 in the Journal of General Internal Medicine, in which a 59-year-old patient had had a “D.N.R.” tattoo across his chest. However, he said he wanted lifesaving measures to be taken, in the event that he needed them.
When the doctors asked why he had the tattoo, the patient told them he had “lost a bet playing poker.”
Despite the well-known difficulties that patients have in making their end-of-life wishes known, the case neither supported nor opposed the use of tattoos to express end-of-life wishes when a person is incapacitated.
For more information, click here.
For the case report from the doctors, click here.
Editor: Maria ‘Stefi’ Ticsa