Should doctors heed ‘do not resuscitate’ tattoos?

A team of Miami doctors was stumped.

Paramedics brought an unconscious 70-year-old man to Jackson Memorial Hospital’s emergency room.

He had a history of chronic obstructive pulmonary disease (COPD), diabetes, and an irregular heartbeat.

Doctors thought he was homeless.

His blood alcohol level was elevated. He had the smell of alcohol on his breath.

They assumed he was drunk.

“They were going to let him sleep it off,” said Dr. Greg Holt, a critical care physician at the hospital.

But over the next several hours in the ER, the patient got very sick. His blood pressure was too low, his breathing was erratic, his body was shutting down from septic shock.

“We started examining the patient,” Holt told the CBC’s Kas Roussy. “You couldn’t  miss it.”

“It” was emblazoned on the man’s chest, in bold black inked letters — a tattoo with the unmistakable words: “DO NOT RESUSCITATE.”

Holt said he and his colleagues were shocked and stunned.

The doctors weren’t sure what to do next. The patient had no ID and no family.

A hospital staff member was dispatched to try and locate next-of-kin.

In the meantime, they decided not to honour the tattoo and its directive.

“It was really nerve-racking, looking at the tattoo and thinking we’re going to resuscitate a man who really thought he needed to tell us he didn’t want to. We put a mask on him.”

But they didn’t do all of the things they would normally do to revive someone, because they’d been thrown into this unusual ethical debate.

Is a tattoo a legal DNR order?

“We really thought this man must be serious about not wanting to be resuscitated, given the tattoo.  But we didn’t know. And we didn’t know the legal aspects.”

That was for the hospital’s ethics consultants to figure out. And after reviewing the case, they decided the tattoo was good enough for them.

Holt and his team were advised to honour the patient’s wishes.

The patient’s ID was eventually located. He’d been living in a nursing home. And much to the relief of Holt, a document with the patient’s wish not to be revived was also found.

“That made us feel great,” said Holt, who wrote about the experience for the New England Journal of Medicine. “We respected his wishes.”

The tattooed patient died that night.
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