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A 70-year-old man with an unusual chest tattoo caused doctors to call for the assistance of ethics consultants:
Emergency medicine doctors in Florida struggled to figure out how to respectfully care for an unconscious 70-year-old man with a chest tattoo that read "Do Not Resuscitate" followed by what appeared to be his signature. In a case report published Thursday in the New England Journal of Medicine, the doctors recounted:
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.
The unresponsive patient was brought to the emergency department by paramedics. He had high blood-alcohol levels and no identification or family with him. After a few hours, hospital staff saw his condition slipping. His blood pressure dropped and acids were building up in his blood. Despite the prominent tattoo, the doctors didn't know if they should trust it. They contacted social workers to try to find his next of kin and made several attempts to revive him enough to get him to confirm his wishes. But the revival attempts failed.
The consultants advised that the tattoo be treated as an authentic preference, and a Do not resuscitate order was written. Later on, the patient's official out-of-hospital DNR order was found, and it matched the preference expressed by the tattoo. The patient ended up dying later that night.
Let this be a lesson to you: Don't get an ironic "Do Not Resuscitate" tattoo.
An Unconscious Patient with a DNR Tattoo (open, DOI: 10.1056/NEJMc1713344) (DX) (PDF)
(Score: 2) by All Your Lawn Are Belong To Us on Monday December 04 2017, @05:20PM
Actually it's catch-22 either way, because an erroneous act of resuscitating can only still be corrected if the patient doesn't have Return of Spontaneous Circulation. The heart starts beating and you're not going to stop it. And many people who choose a DNR path are afraid of waking up with a busted ribcage and never truly recover from the injuries and die a perceived worse death.
Being wrong either way even when totally clear about desire and with legal orders properly filed (either way) can result in lawsuits and loss of licenses. Because the opposite wish - resuscitate at any cost - can be filed as well as part of advanced directives.
What I've been trained on in this has morphed over the last twenty plus years. It used to be that next of kin could call a stop order no matter what. But there have been enough questionable cases (did John really want it stopped or did Jane just want to get her hands on the money and be done with John?) that today in the field it has to be a signed order and an effort has to be made to both validate the order and confirm the identity of the patient. A signed medical power of attorney might help at the hospital, but generally it is assumed that without a presigned DNR or POLST (the physician in-hospital order to not resuscitate) that you attempt resuscitation.
There have been anecdotes of people getting those tattoos on a bet.
Resolution would be the tricky part, but if you actually had a full legal DNR form in your jurisdiction (California's: https://emsa.ca.gov/wp-content/uploads/sites/47/2017/07/DNRForm.pdf [ca.gov] ) complete to physician and patient signature replication tattooed on your chest..... THAT would be trickier.
This sig for rent.