A patient gave his doctors orders, but they hesitated to follow them.
A 70-year-old man with a history of serious health problems was admitted to a hospital with an elevated blood alcohol level and a tattoo on his chest reading, “Do Not Resuscitate.”
The instruction was accompanied by letters presumed to be his initials, The New England Journal of Medicine reported.
The man was unconscious, and medical staff failed to identify any relatives.
The tattoo, rather than providing clear direction on how to handle the patient’s end-of-life care, led doctors into an ethical quandary.
“We initially decided not to honor the tattoo, invoking the principal of not choosing an irreversible path when faced with uncertainty,” the report read.
But staff were conflicted, knowing that the man had gone to great lengths to make his presumed advance directive known.
And so doctors consulted with an ethics committee to determine whether they should treat the tattoo like they would an advance directive, or write it off as art not meant to be literally interpreted.
The tattoo was ultimately honored, after consultants advised 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, and that the law is sometimes not nimble enough to support patient-centered care and respect for patients’ best interests.”
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.
Medical staff was relieved that the order was consistent with the man’s tattoo. “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 report’s authors wrote.
The patient died that evening without undergoing cardiopulmonary respiration or advanced airway management.
The authors of the report say that ultimately, the man’s tattoo created more confusion than clarity.
But they don’t take a stance on the use of tattoos to express end-of-life wishes when people are incapacitated.