Emergency room doctors faced a confusing ethical dilemma when an unconscious man was wheeled into a University of Miami hospital with a “Do Not Resuscitate” tattoo.
The 70-year-old man, who was inebriated when he arrived, had a history of lung and heart diseases. Unable to reach his family as his heart pressure dropped, the medical staff started to attempt to revive him despite his tattoo, according to a case study in the New England Journal of Medicine.
“We initially decided not to honor the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty,” wrote Drs. Gregory E. Holt, Bianca Sarmento, Daniel Kett and Kenneth W. Goodman. “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.”
But after going over his case, ethics consultants told the doctors that they should follow the orders on his tattoo, which included what was presumably his signature.
“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, and that the law is sometimes not nimble enough to support patient-centered care and respect for patients’ best interests,” the doctors write.
The doctors stopped his care, and the man died later that night. But they were still concerned that the tattoo is not a legally binding contract like a true, signed Do Not Resuscitate order, and that the tattoo might just be a joke, or as the doctors put it, “permanent reminders of regretted decisions made while the person was intoxicated.”
Thankfully, their decision not to continue care was confirmed as correct when they found the patient’s written Do Not Resuscitate order.
“Despite the well-known difficulties that patients have in making their end-of-life wishes known, this case report neither supports nor opposes the use of tattoos to express end-of-life wishes when the person is incapacitated,” the doctors write.