Hospital Staff Ethically Baffled Upon Finding A “Do Not Resuscitate” Tat

Well this is a fun one, if you consider the incredibly heavy questions of medical ethics to be ‘fun’. A letter posted to the New England Journal of Medicine from a group of doctors described a particularly unusual conundrum: what the hell do you do with a patient with a DO NOT RESUSCITATE tattoo?

According to the letter, a 70-year-old man with a “history of chronic obstructive pulmonary disease, diabetes mellitus, and atrial fibrillation” was brought into a hospital in Florida. Paramedics and doctors were surprised to see DO NOT RESUSCITATE tattooed across his chest, along with a little signature – definitely an odd way to make a medical request of that nature. In fact, you could imagine someone doing it as a (monumentally stupid) gag.

Medical staff chose not to obey the command, but did pass it on the hospital’s ethics team. This is what the team wrote in the letter:

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.

Generally, DNR requests are formalised with paperwork and communicated to a person’s family and medical community. A tattoo is… unorthodox.

The ethics consultants told the medical team that they should honour the tattoo, which they saw as a clear expression of preference. Gregory Holt, the lead author of this case study, spoke to Gizmodo in more detail.

After reviewing the patient’s case, the ethics consultants advised us to honour the patient’s 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 [i.e. adherence to medical tradition and norms], and that the law is sometimes not nimble enough to support patient-centred care and respect for patients’ best interests.

And it turned out to be the right decision. In the initial panic, the man’s ‘formalised’ DNR status could not be confirmed, but it was later found by a social worker, confirming that the tattoo reinforced an existing DNR order. So there you go.

Here’s what I would have done: freaked the hell out. That’s why I’m not a doctor.

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