Imagine the dilemma: You’re about to resuscitate a dying man, but when you peel back his shirt, you see a bold black tattoo saying ”DO NOT RESUSCITATE”. The word “not” is underlined and his signature is below the final word. Do you consider the tattoo a real medical warning? Or just a dark-humored joke?
That’s what happened to Dr Gregory Holt at Miami’s Jackson Memorial Hospital. In a case report for The New England Journal of Medicine, he explained how they handled the experience, along with the profusion of ethical dilemmas and confusion caused by the man’s choice of body art.
The 70-year-old man was brought to the hospital unconscious, heavily intoxicated with alcohol, and with dropping blood pressure. They quickly discovered the man’s tattoo, but initially decided to ignore it. A "Do Not Resuscitate" (DNR) tattoo is not a legally-binding document after all. In Florida, you can only request to not be resuscitated if you have signed a Do Not Resuscitate Order – Form 1896 on a piece of yellow paper (they are very particular about the yellow paper bit).
Stuck with this predicament, they requested an ethics consultation with some experts on the matter. The consultants argued it was “reasonable to infer that the tattoo expressed an authentic preference.” Fortunately, the situation was quickly settled when they obtained an official copy of his Florida Department of Health DNR order.
The man died later that evening, as per his wishes.
The doctors behind the case say the story highlights how DNR tattoos can put medical professionals in a very sticky situation, although they note that their report "neither supports nor opposes the use of tattoos to express end-of-life wishes." However, they do say that it is much more effective to simply sign the appropriate forms if this really is a patient’s true request.
“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,” Dr Holt explains.
Their decision to not follow the tattoo's orders without further investigation was well-founded. In 2012, the Journal of General Internal Medicine reported that a team of doctors were placed in a similar position when a physical examination revealed a “D.N.R.” tattoo on the man's chest. In this case, they decided to ignore the tattoo and resuscitate him. That was a pretty good call considering this guy had only received the tattoo because he had lost a bet in a poker game with friends.