Doctors at a Miami hospital had to figure out whether a tattoo can dictate a patient's end-of-life wishes when they discovered a "Do Not Resuscitate" tattoo on a dying man's chest.
The details of the puzzling case were published in the Nov. 30 issue of The New England Journal of Medicine.
According to the doctors' account, the 70-year-old man was brought to the emergency room at Jackson Memorial Hospital unconscious, his condition rapidly deteriorating. The man had been alone when he collapsed on the street and wasn't carrying any identification. Social workers at the hospital began trying to identify the man's next of kin, but a decision would likely have to be made before they could be notified.
Doctors tried to wake the man, seeking answers about his end-of-life wishes, but all efforts failed, leaving doctors to wonder about the tattoo. The word "Not" was underlined and a signature was tattooed under the command.
"We initially decided not to honor the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty," doctors wrote.
The man was treated with intravenous fluids, antibiotics and blood pressure medication to buy doctors more time, Gregory Holt, a critical care physician at Jackson Memorial, told The Washington Post.
"We had a man I couldn't talk to, and I really wanted to talk to him to see whether that tattoo truly reflected what he wanted for his end of life wishes," Holt said,
Unsure how to proceed, doctors turned to an ethics consultant who advised them to honor the tattoo.
"[The consultant] 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," doctors wrote.
Following the ethics consultant's suggestion, a do not resuscitate order was written for the patient. Immediately after the DNR was written, social workers were able to identify the man and track down his official signed DNR from the Florida Department of Health.
The man died the next morning.
"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," doctors wrote.
The case cited by doctors involved a man with "D.N.R." tattooed across his chest being brought to a hospital in 2012, according to The Washington Post.
In that case, the man was conscious and able to tell doctors he wanted life-saving care despite his tattoo, which he got as the result of losing a bet in poker.