July 18, 2018

Patient's 'DO NOT RESUSCITATE' tattoo leaves doctors with dilemma

04 December 2017, 10:07 | Silvia Roy

New England Journal of Medicine

New England Journal of Medicine

The 70-year-old had "Do Not Resuscitate" on his chest - complete with an apparent signature and the word "not" underlined.

And other doctors agree that publishing your resuscitation preference via a simple tattoo is not the best idea compared to having a living will or healthcare directive readily available. Should they honor it?

"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", the doctors added.

"Do not resuscitate" (DNR) is a legal order, which usually requires written paperwork, that prevents doctors from performing cardiopulmonary resuscitation (CRP) or providing advanced life support if a patient's heart stops beating.

Holt said the country might want to follow in the footsteps of OR, where an online registry allows people to record their wishes and allows emergency rooms to quickly find those requests. "Then the shock hits you again because you actually have to think about it".

The article said the man, who had a history of pulmonary disease, was taken to Jackson Memorial Hospital in a deteriorating condition that turned deadly.

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

Instinctively, doctors wanted to ignore the tattoo, citing an oath all doctors take "invoking the principle of not choosing an irreversible path when faced with uncertainty", death being the most irreversible path you can take.

They gave him intravenous fluids, blood pressure medication, and antibiotics to give themselves more time to make the life-or-death decision.

The medical team used a breathing mask on the man, Holt said, but struggled the most with the decision to hook him up to a machine that would breathe for him.

Sometimes patients change their mind about what kind of treatment they're willing to endure in a health crisis, Holt told Reuters Health by phone.

The patient's medical team looked to a 2012 study in the Journal of General Internal Medicine for guidance.

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When his doctors asked why he had the tattoo, the patient replied that he "lost a bet playing poker", according to the paper.

Ethics consultants told the hospital that the tattoo was most likely a representation of the man's wishes and should be honored.

Doctors wrote a DNR request, after which the social work department obtained a copy of the patient's Florida Department of Health "out-of-hospital" DNR order.

The patient died the following morning.

"He seemed very serious about this", Holt said of the patient's tattoo.

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