A tattoo is not a legal document

According to a recent letter in the New England Journal of Medicinedoctors at Florida’s University of Miami Hospital had to decide whether an unconscious patient’s “Do Not Resuscitate” tattoo should be honored:

His anterior chest had a tattoo that read “Do Not Resuscitate,” accompanied by his presumed signature.  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…

The doctors noted that “tattoos might represent permanent reminders of regretted decisions made while the person was intoxicated.”

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A few too many Duff beers, and this could happen to you.

The decision was subsequently reversed, however, with an ethics consultant determining that if the guy went so far as to get a tattoo reading “Do Not Resuscitate,” he really meant it.  And it turned out that he had filed a written directive confirming these instructions:

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.

The physicians conclude, “this case report neither supports nor opposes the use of tattoos to express end-of-life wishes when the person is incapacitated.”

My own suggestion is that you draft (or have a lawyer prepare for you) a personal directive setting forth your wishes regarding treatment should you become incapacitated, and/or appointing a substitute decision-maker.  And make sure your close friends and family know where it is and what it says.

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