Doctors struggled with how to handle an unconscious patient with a tattoo that read, "Do Not Resuscitate" that even contained the man's signature. It is fairly well known that patients struggle to clearly communicate their end-of-life wishes to doctors medically responsible for them. But was this tattoo a drunken regret or a legally sound request?
Emergency room doctors in Florida were stumped by how to handle the situation and respectfully care for the unconscious 70-year-old. Doctors recounted the incident in the New England Journal of Medicine, "This patient’s tattooed DNR request produced more confusion than clarity, given concerns about its legality and likely unfounded beliefs that tattoos might represent permanent reminders of regretted decisions made while the person was intoxicated."
The patient was unresponsive when paramedics brought him to the hospital and he had high blood-alcohol levels with no way to identify him or contact his family. Hours later, the patient's condition was worsening and his blood pressure dropped while acids built up in his blood.
Doctors didn't know if they should trust the tattoo and let the man die or revive him. They ended up contacting social workers to try to locate his next of kin and made several attempts to revive him but were unsuccessful. The doctors reported, "We initially decided not to honor the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty."
The conundrum continued to nag at doctors who eventually contacted ethics consultants who sided with honoring the tattoo. The doctors report read, "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 patients' best interests."
Fortunately, social workers were able to locate his patient information and a copy of his Florida Department of Health “out-of-hospital” DNR order which matches the desire expressed in the tattoo. "We were relieved to find his written DNR request, especially because a review of the literature identified a case report of a person whose DNR tattoo did not reflect his current wishes," the report said.
The patient suffered from chronic obstructive pulmonary disease, diabetes mellitus, and atrial fibrillation. Doctors stopped trying to resuscitate him as per his wishes and the patient died.
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