Medicine

A Patient's 'Do Not Resuscitate' Tattoo Had Doctor's Debating Saving His Life

A Patient's 'Do Not Resuscitate' Tattoo Had Doctor's Debating Saving His Life

Florida requires do-not-resuscitate orders to be printed on yellow paper and signed by a physician, so doctors at Jackson Memorial called an ethics consultant to discuss the legal aspects of the tattoo. Lori Cooper, MD, a private practice endocrinologist in Seattle, once treated a 59-year-old patient at California Pacific Medical Center in San Francisco who had gotten "D.N.R." tattooed on his chest after losing a bet playing poker and wanted to be resuscitated if he went into cardiac or respiratory arrest.

But they noted the man had clearly made an "extraordinary effort" to make his end-of-life wishes known; the word "not" in "do not resuscitate" was underlined, and he had even added his initials as a signature.

The report was published November 30 in the New England Journal of Medicine. Indeed, there is at least one previous report of a man with a "DNR" tattoo that did not reflect his wishes.

However, this decision left the medical team conflicted, and they brought in an ethics committee to consult on it further.

He ultimately advised the doctors to honor the man's tattooed wishes, regardless of their skepticism that the permanent message could have been an impulsive decision in the man's past. The man's health deteriorated throughout the night, and he died without undergoing CPR or intubation to assist his breathing, the doctors reported.

Social workers later used the man's fingerprints to track down his DNR paperwork, required in Florida to make such a request legally valid, supporting the end of life wishes inked on his skin. What if the patient had done it while under the influence of drugs or alcohol?

Татуювання стало причиною смерті пацієнта у США
A Patient's 'Do Not Resuscitate' Tattoo Had Doctor's Debating Saving His Life

"There's no law that says you have to respect or recognize a tattoo", Caplan told CBS News.

Caplan, the founding head of the Division of Medical Ethics at NYU School of Medicine, was not involved in the patient's case.

Holt said the consultant determined doctors didn't need to be entirely "dogmatic" and could presume the tattoo was an accurate reflection of the patient's wishes. After reviewing the case, the team decided that it made sense to assume that the tattoo expressed the man's "authentic preference" to not be resuscitated, and a DNR order was written for the man. "Probably not, because I wouldn't know if I could trust it", he said. What if had changed his mind since getting the tattoo? "There's too much uncertainty".

"At the end of the day, tattoos are not substitutes", he said.

He arrived with no identification, no family or friends and no way to tell doctors whether he wanted to live or die.

More news: Jag Capital Management LLC Has Lifted Celgene Corp. (CELG) Holding


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