But a recent saga involving a patient at a Miami hospital proved that question is a little more fraught than it seems. Doctors at Jackson Memorial Hospital, located at the University of Miami, were presented with a unconscious 70-year-old man who had a “Do Not Resuscitate” tattoo, along with his apparent signature, emblazoned on his chest. (Not was underlined, of course.)
They weren’t able to contact any next of kin. No identification, either. It created a really confusing situation for the doctors, one recalled in a letter to the New England Journal of Medicine.
“We initially decided not to honor the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty,” the 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.”
Eventually, after an ethics consultation—and later, finding the man’s records, they were able to confirm that the tattoo reflected his wishes. Whew.
Shockingly though, this is not the first time this issue has come up. A 2012 article in the Journal of General Internal Medicine made the point that such a tattoo—as in this case—just tends to freak out the emergency providers, who are presented with documentation outside the norm of their routine. Additionally, there’s a question of whether a tattoo is actually a legally binding document—especially in a case where the acronym “DNR” is used, rather than “Do Not Resuscitate.”
“Actually tattooing DNR on one’s chest is intuitively appealing, but flawed as policy,” authors Alexander K. Smith and Bernard Lo write. “Emergency responders and clinicians in health care settings are not obligated to respect a DNR tattoo.”
There are all sorts of problems. What if you change your mind? What if you lost a bet? And what if you got it because you were drunk and you thought it would be funny?
A tattoo is a record that’s way too permanent to be trusted, apparently.
(Above: The tattoo in question.)