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Doctor forced to make call on ‘do not resuscitate’ tattoo found on unresponsive patie

Jabberwocky

Frumious Bandersnatch
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Nov 3, 1999
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Doctor forced to make call on ‘do not resuscitate’ tattoo found on unresponsive patient

We present the case of a person whose presumed code-status preference led him to tattoo “Do Not Resuscitate” on his chest. Paramedics brought an unconscious 70-year-old man with a history of chronic obstructive pulmonary disease, diabetes mellitus, and atrial fibrillation to the emergency department, where he was found to have an elevated blood alcohol level. The staff of the medical intensive care unit evaluated him several hours later when hypotension and an anion-gap metabolic acidosis with a pH of 6.81 developed. His anterior chest had a tattoo that read “Do Not Resuscitate,”

nejmc1713344_f1.jpeg


Photograph of the Patient’s Tattoo Entered into the Medical Record to Document His Perceived End-of-Life Wishes.). Because he presented without identification or family, the social work department was called to assist in contacting next of kin. All efforts at treating reversible causes of his decreased level of consciousness failed to produce a mental status adequate for discussing goals of care.

We initially decided not to honor the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty. 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. He was placed on empirical antibiotics, received intravenous fluid resuscitation and vasopressors, and was treated with bilevel positive airway pressure.

After reviewing the patient’s case, the ethics consultants advised us to honor the patient’s do not resuscitate (DNR) tattoo. 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. A DNR order was written. Subsequently, the social work department obtained a copy of his Florida Department of Health “out-of-hospital” DNR order, which was consistent with the tattoo. The patient’s clinical status deteriorated throughout the night, and he died without undergoing cardiopulmonary respiration or advanced airway management.

This patient’s tattooed DNR request produced more confusion than clarity, given concerns about its legality and likely unfounded beliefs1 that tattoos might represent permanent reminders of regretted decisions made while the person was intoxicated.

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.2 Despite the well-known difficulties that patients have in making their end-of-life wishes known,3-5 this case report neither supports nor opposes the use of tattoos to express end-of-life wishes when the person is incapacitated.



Source: http://www.nejm.org/doi/full/10.1056/NEJMc1713344?af=R&rss=currentIssue&
 
I saw this on my front page yesterday and, although I really have nothing to add, I thought it was a really neat ethics concern.
I have always worried about life-changing brain trauma to which I really wouldn't want to deal with and have looked into a DNR a few times just to get more information. Again, I really don't have anything to add I just thought it was a neat situation....sad but I'm glad he got his wish given the circumstances.
 
I saw this on my front page yesterday and, although I really have nothing to add, I thought it was a really neat ethics concern.
I have always worried about life-changing brain trauma to which I really wouldn't want to deal with and have looked into a DNR a few times just to get more information. Again, I really don't have anything to add I just thought it was a neat situation....sad but I'm glad he got his wish given the circumstances.

The thing is can you sue the hospital if they did resuscitate you?
 
The thing is can you sue the hospital if they did resuscitate you?

That's quite ironic, don't you think?

On another note, modernity has such a contempt for death it's almost laughable.
 
Am surprised liberals haven't stepped in here and petititioned for such rights
 
Dog tags with his id, next of kin and DNR status would have been a lot cheaper and more effective.

Maybe with just ID but I would presume most chronic illness and terminal patients would have some contact with their hospital, their wishes can be on file and the issue was just ID.


Poor guy
 
The thing is can you sue the hospital if they did resuscitate you?

Nah. Youre a john doe until you have been udentified.

Its just a little thing but walking around with your walket and some form of ID is a really good idea.

Its msndatory to have your license on you when driving so most ppl do carry ID.

After hes been id then they can cease treatment .
 
Am surprised liberals haven't stepped in here and petititioned for such rights
this is such a lame discussion technique. you're criticising 'liberals' for something they've not done. the statement says everything about your erroneous assumption and nothing about liberals. it's just lazy, divisive and inflammatory.

alasdair
 
The thing is can you sue the hospital if they did resuscitate you?

That's exactly why it makes for a good conversation in ethics.

As dumb as this sounds I could see some person getting a tattoo like that thinking it to be badass.....I don't think a lot of people would, don't take that the wrong way. Not like a weapon or something tattooed on you but I could still picture someone thinking that makes them cool. However I think that most people who would do such a thing would be genuine about their desire to not be resuscitated.

Edit: and I don't think a hospital would/could take a tattoo as a legal order but I think in this case it did cause them to look a little harder and it seems like that tattoo, ultimately, is what got them to find his paperwork.
 
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True enough, but wallets, dog tags, what have you can be and are separated from the individual in any number of ways, whether by accident or done so intentionally by another person or group. That said, a tattoo can be forcibly removed with some messy work. I can't seem to think of anything surefire when it comes to ensuring to always have personal identification/DNR info/etc. available and on one's person.
 
yeah i didn't understand that "liberals" comment either alaisdair
 
yeah i didn't understand that "liberals" comment either alaisdair

I wasn't being serious as such but just trying to get the point across. Most liberals would petition for such rights for the sake of it hence for the pun.

Bad humour and I apologise
 
^well, "conservatives" are just as much about their rights as "liberals" are. They tend to like rights from X as opposed to rights to Y though, so sometime it seems like they'e not interested in their rights. But insofar as rights are something related to the obligations one can legitimately claim from their government, rights are rights, whether they're related to the right to non-interference or the right to social security.
 
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