Life Matters Media
Quality of life at the end of life

Man’s Do Not Resuscitate Tattoo Causes Confusion In ER

BY DANIEL GAITAN | daniel@lifemattersmedia.org

A patient inked his do not resuscitate order — just not on paper.

When an unresponsive man arrived in an emergency room in Miami, Fla, medical staff ignored his code-status preference because it was written on his body.

The man had “Do Not Resuscitate” tattooed on his chest with “Not” underlined and his signature beneath it, according to an essay published in prestigious medical journal The New England Journal of Medicine.

The 70-year-old man — who had a history of chronic obstructive pulmonary disease, and suffered diabetes and atrial fibrillation — was brought to the ER by paramedics. He also had an elevated blood-alcohol level.

Throughout the night, his health continued to decline.

Because he was without identification or family, social workers were called in to assist in contacting immediate family.

Unfortunately, all “efforts at treating reversible causes of his decreased level of consciousness failed to produce a mental status adequate for discussing goals of care,” according to the essay.

Uncertain hospital staff initially decided not to honor his DNR.

“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,” Dr. Gregory E. Holt, Dr. Bianca Sarmento, Dr. Daniel Kett, and Kenneth W. Goodman, Ph.D. write.

However, after reviewing the case, ethicists advised staff to honor his medical order because “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.”

Social workers later obtained a copy of his Florida Department of Health “out-of-hospital” DNR, which was consistent with his wishes expressed on the tattoo.

The patient died that night, without undergoing cardiopulmonary respiration or advanced airway management.

Still, the man’s tattoo produced “more confusion than clarity,” partly because of concerns about its legality.