Culture&Arts

Miami doctors face conundrum with 'do not resuscitate' tattoo

Miami doctors face conundrum with 'do not resuscitate' tattoo

The 70-year-old male patient, with a history of chronic obstructive pulmonary disease and diabetes, was brought into the emergency room unconscious by paramedics.

"We initially decided not to honor the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty", the doctors wrote. "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".

While it may seem clear that someone who would go as far as tattooing "Do Not Resuscitate" on their chests would be serious about their wishes, that isn't always the case. "Then the shock hits you again because you actually have to think about it". A 59-year-old man had "D.N.R." tattooed on his chest but was fortunately conscious to explain to doctors that it was only there because he "lost a bet playing poker".

Overnight, a copy of the man's original do-not-resuscitate order was found and he died according to his wishes some hours later.

New York University School of Medicine professor of bioethics Arthur Kaplan said, "The safer course is to do something", adding that a DNR tattoo alone is not sufficient to protect doctors against possible legal action in the event no actual DNR order exists.

Doctors were puzzled on how to proceed after finding this patient's tattoo.

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"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-cantered care and respect for patients' best interests".

There are no legal penalties for ignoring a tattoo that instructs medical personnel not to resuscitate, Caplan said. While successful in some cases, a patient may decide that their time has come and find their quality of life compromised by repeated resuscitation and would prefer to die as peacefully and naturally as possible. But, he added, doctors routinely have to make hard decisions. Is your family aware of your wishes and have you set out your requests in writing?

The unknown man arrived at the emergency department with no identification and was unconscious with an elevated blood alcohol level.

As it turned out, the ethicists sided with the tattoo and recommended the DNR to be honored.

This article was originally published by The Washington Post.


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