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News & Reviews
An unconscious patient’s “Do Not Resuscitate” tattoo on his chest posed quite a dilemma for doctors at the University of Miami recently.
Doctors discovered the tattoo, which appeared to include the man’s signature, after the 70-year-old patient with a history of heart disease and diabetes was brought to the emergency department recently, according to a correspondence in the New England Journal of Medicine.
The man was inebriated and doctors weren’t able to bring him to consciousness or find his next of kin.
“We initially decided not to honor the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty,” the UM doctors wrote. “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 the ethics consultants advised the doctors to honor the tattoo, and the do not resuscitate order was written. The social work department obtained a copy of the man’s Florida Department of Health “out-of-hospital” DNR order, which was consistent with the 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 correspondence said. “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 man’s health deteriorated through the night, and he died without undergoing cardiopulmonary respiration or advanced airway management, the correspondence said.
“In talking with my colleagues, no one has seen a patient with a DNR tattoo before,” Dr. Gregory E. Holt, one of the authors of the letter, told NBC 6 Friday. “Though I am now getting emails of individuals who have this tattoo and a search of Google shows there are many out there with similar tattoos.”