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DNR Tattoo Put to the Test

A 70-year-old man was taken to an emergency room in Florida, unconscious, alone, with no ID. When his condition worsened, the staff found a tattoo on his chest that said DO NOT RESUSCITATE, with a signature. With no other information about the man, besides his numerous and obvious physical problems, the emergency room staff gave him emergency treatment anyway. They did call the hospital's ethics team, who discussed the matter and decided that the tattoo should be honored.

While the DNR tattoo may seem extreme, the request to not be resuscitated during end-of-life care is most certainly not. Roughly 80 percent of US Medicare patients say “they wish to avoid hospitalization and intensive care during the terminal phase of illness.” Revealingly, a 2014 survey showed that the vast majority of physicians would prefer to skip high-intensity interventions for themselves. Of the 1,081 doctors polled, over 88 percent opted for do-not-resuscitate status. Indeed, measures to keep a patient alive are often invasive, painful, and costly. DNRs, which hospital staff refer to as “no-codes,” are an explicit request to forego high-intensity interventions like CPR, electric shock, and intubation tubes. More implicitly, it’s a request to not be hooked up to a machine.

Typically, DNRs are formal, notarized documents that a patient gives to their doctor and family members. Tattoos, needless to say, are a highly unorthodox—but arguably direct—means of conveying one’s end-of-life wishes. That said, this patient’s tattoo presented some undeniable complications for the hospital staff. Is a tattoo a legal document? Was it a regretful thing the patient did while he was drunk or high? Did he get the tattoo, but later change his opinion? On this last point, a prior case does exist in which a patient’s DNR tattoo did not reflect their wishes (as the authors wrote in this 2012 report: “...he did not think anyone would take his tattoo seriously...”).

There's always someone in the bunch who will ruin it for everyone. The patient in Florida died later, as extraordinary lifesaving measures were discontinued per the decision of the ethics team. But should the staff have honored the request when they first found it? Read more on the incident at Gizmodo.

(Image credit: NEJM/University of Miami)

Should the ER staff have honored the tattoo when they first saw it?

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