December 1, 2017

Doctors Confused By "Do Not Resuscitate" Tattoo On Dying Patient

Doctors Confused By "Do Not Resuscitate" Tattoo On Dying Patient

By: Angelina Gibson

A 70-year old patient’s tattoo presented a dilemma for Doctors at the University of Miami Hospital - it clearly stated, “Do Not Resuscitate” and included his presumed signature. 

The report published in the New England Journal of Medicine explains the case in further detail.

The unknown man arrived at the emergency department with no identification and was unconscious with an elevated blood alcohol level. He had a history of chronic obstructive pulmonary disease, diabetes mellitus, and atrial fibrillation. Upon examination, staff discovered the tattoo and attempted to revive the man for several hours while social workers made efforts to locate kin. 

They originally decided to honor the tattoo and continued attempts to reverse his unconsciousness. As reported, the healthcare team chose to invoke “the principle of not choosing an irreversible path when faced with uncertainty.”   

The team’s efforts to reverse unconsciousness or to locate family were unsuccessful.

The Doctors were still undecided about the tattoo and stated, “this decision left us conflicted owing to the patient’s extraordinary effort to make his presumed advance directive known; therefore, an ethics consultation was requested.“

The ethics consultants decided to honor the tattoo and wrote a DNR order. 

“They suggested that it was most reasonable to infer that the tattoo expressed an authentic preference, that what might be seen as caution could also be seen as standing on ceremony, and that the law is sometimes not nimble enough to support patient-centered care and respect for patient's’ best interests,” reads the case report. 

Later that night the social workers were able to locate a copy of his Florida Department of Health “out-of-hospital” DNR order. 

The unnamed man died that night without undergoing cardiopulmonary respiration or advanced airway management.

The Doctors reported feeling relieved to have located the DNR documents and made reference to other patients with similar tattoos that were not consistent with their present beliefs. 

However, the Doctors neither support nor oppose the use of tattoos to express end-of-life wishes and acknowledge the difficulties faced by patients when making end-of-life decision. 

Are "DNR" Tattoos Worth It? 

DNR laws vary by state and a tattoo simply is not a legal document. While healthcare professionals will likely not be able to miss a tattoo, they may not always respect and honor such a tattoo. The tattoo might confuse practitioners or even slow down life-saving procedures during times when quick decisions need to be made. 

Having a “do not resuscitate” tattoo permanently inked on the body may sound appealing to those with strong beliefs. Carrying official DNR documents might not always work out - especially in cases of emergency. 

For patients with such beliefs, it might be a good idea to cover all the bases. Go through the legal processes of obtaining official DNR documents. There are also DNR bracelets available to be worn on the body as well. 

What do you think about how this healthcare team handled the situation? Would you have honored the tattoo? 

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