Here’s a surprising twist that doctors in a University of Miami hospital emergency room wouldn’t have expected when paramedics brought in an unconscious man.
They discovered that the man had a “Do Not Resuscitate” chest tattoo, complete with his signature, according to a case study published in a recent New England Journal of Medicine.
The man, a 70-year-old diabetic patient, was first treated by doctors to save his life, but the tattoo raised some interesting questions. A tattoo is not a valid request, according to the Florida Department of Health, and in the absence of locating the man’s family members or identifying him, the doctors had to make a decision.
In the case study, the University of Miami doctors explained: “We initially decided not to honor the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty.”
They were unclear about that path for treatment, however, as they further note that were “conflicted” because of “the patient’s extraordinary effort to make his presumed advance directive known.”
Faced with this dilemma, they explained, “an ethics consultation was requested.” The ethics consultants believed that the tattoo was the man’s wishes and that it should be honored. The doctors noted in the case study that “the law is sometimes not nimble enough to support patient-centered care and respect for patients’ best interest.”
Officials were able to locate an official copy of his DNR order from the Florida Department of Health, as the doctors explained: “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.”
An interesting debate over the tattoo unfolded on the People.com Facebook post about the story, with one person noting: “I just think the hospital took a really big chance here. Yes they were right this time but next time a situation like this presents itself they may not be so lucky.”
Another person explained: “There is no ethical dilemma here. A tattoo is not a binding legal document like a DNR. Maybe the person had this tat put on as a running joke among friends or because he was drunk and thought it was a good idea at the time. In the emergency room, they don’t have time to debate crap like this so they go with standard operating procedures.”
Still another commenter added: “A DNR is a legal document, that must also be signed by a physician, to ensure that the person is able to comprehend the decision they are making. The tattoo could have been done while he was drunk, a lost bet, or a dare…They were right to use caution…Could have been a potential for a lawsuit filed by the family for the medical staff NOT having supporting documents in hand.”
One commenter, however, argued: “If you permanently ink something on your body, I’d say your feelings about it are pretty strong. They should have abided by his wishes. Seeing that this tat was placed right above his heart, the meaning is very clear.”