Could this be considered legally binding? Picture: NEJM/University of Miami
Could this be considered legally binding? Picture: NEJM/University of Miami

'Do not resuscitate' tattoo: Doctor's ethical dilemma

WHAT would you do if you were a doctor treating an unresponsive patient with the words "do not resuscitate" and his signature tattooed on his chest?

Medical staff at a Florida hospital ER chose to ignore the DNR request without alerting the hospital's ethics team, who later criticised them for the decision.

The curious case was recently explored in the New England Journal of Medicine, which explained the unnamed 70-year-old man was brought to the ER by paramedics, unconscious and with an elevated blood alcohol level at the time.

To make matters worse, the medical staff were unable to contact next of kin as the patient was admitted without identification and efforts to revive him were unsuccessful.

With no way of knowing if the tattoo was what the patient wanted, they chose to resuscitate the man.

"We initially decided not to honour the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty," the case study explained.

"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."

Lead author of the case study Gregory Holt said the biggest question in his mind was if the DNR tattoo could be considered legally viable.

Uncertain, the ICU team attempted to keep the patient alive while the ethics team explored the legalities of the situation.

"After reviewing the patient's case, the ethics consultants advised us to honour the patient's DNR tattoo," he told Gizmodo.

"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 (i.e. adherence to medical tradition and norms), and that the law is sometimes not nimble enough to support patient-centred care and respect for patients' best interests."

The patient passed away later that night, although not before the hospital's social work department discovered the patient's Florida Department of Health "out-of-hospital" DNR order, which was consistent with the tattoo.



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