A medical emergency became a bewildering moral dilemma in a Florida hospital when doctors were uncertain whether an unconscious patient’s ‘Do Not Resuscitate’ tattoo was a legitimate order.
Reported in the New England Journal of Medicine, the case details the difficult life-ending decisions and investigations into a patient’s background required of medical professionals.
The 70-year-old male patient, with a history of chronic obstructive pulmonary disease and diabetes, was brought into the emergency room unconscious by paramedics. The man had an elevated blood alcohol level and, when doctors assessed him, a curious tattoo was found on his chest, stating: ‘Do Not Resuscitate.’ It was accompanied by what appeared to be tattooed signature.
— NEJM (@NEJM) November 30, 2017
According to Florida’s Department of Health, do not resuscitate, or DNR orders, are enforced by specific requirements which state that they must be written on yellow paper. Health care professionals are not obligated to honor such a request unless it meets this requirement.
With no identification or next of kin information, the emergency team had to decide whether this man’s tattoo was symbolic of an actual wish to prevent a life-saving intervention.
“We initially decided not to honor the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty,” the medical article reads. “This decision left us conflicted owing to the patient’s extraordinary effort to make his presumed advance directive known.”
As a result, authorities from an ethics department were consulted as the man received antibiotics and intravenous fluid. After reviewing the patient’s case, however, it was suggested that doctors could reasonably infer the tattoo expressed an “authentic preference.”
The health of the unnamed man subsequently deteriorated and he died without receiving artificial ventilation.
Further investigation into the man’s background uncovered an out-of-hospital DNR order. According to the journal account, the tattoo created “more confusion than clarity.”
“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 adds.
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