Does a “Do Not Resuscitate” Tattoo Accurately Reflect A Patient’s Wish?

by Brooks Evan Doyne

The word “tattoo” comes from the Tahitian word “tatu” which means “to mark something” and historians believe the practice began roughly between 3370 and 3100 BC. However, in 2017 medical physicians faced an ethical dilemma that few have experienced when an unconscious man arrived in the emergency room with a tattoo that read “Do Not Resuscitate” illustrated on this chest.

Doctors at Jackson Memorial Hospital in Florida had discussed this quandary but had never been faced with it. The 70-year-old man’s blood pressure was dropping and he had a history of chronic obstructive pulmonary disease and diabetes. Medical ethicist Dr. Arthur Caplan, Ph.D., who was not involved in the patient’s case, reported to CBS News “there’s no law that says you have to respect or recognize a tattoo”. In the United States people have the right to ask not to be resuscitated in the event of a medical emergency and can express their wishes known ahead of time in the event they one day find themselves alone or incapacitated.

Naturally, not all inscriptions are to be taken literally. Nonetheless, medical tattoos have been on the rise for the past few years. As reported in USA Today, medical tattoos first appeared in 2014 to alert doctors to conditions such as diabetes. While a tattoo certainly has a penetrating power, legibility and decipherability may be an issue, especially during a medical emergency.

Normally when faced with ethical conundrums, doctors do not want to choose an irreversible path. As such, doctors attempted to wake the unconscious patient, but he was in a delirious state and unable to respond. The patient also arrived at the hospital without ID or family and next of kin could not be reached. The ethical team eventually ruled that the tattoo expressed his wishes and told doctors to follow his orders. The patient’s status deteriorated throughout the night and he eventually died without intervention. Eventually, the patient’s written DNR request was later found at his home.

Dr. Gregory Holt, an assistant professor of medicine at the University of Miami helped write a case study that was published in The New England Journal of Medicine. The case study conveyed that the tattoo “produced more confusion than clarity, given concerns about its legality and likely unfounded beliefs that tattoos might represent permanent reminders of regretted decisions made while the person was intoxicated.” In the event medical tattoos become more popular it will be interesting to see if legislation is passed on how to properly treat a patient who has medical instructive ink.

For patients, while a tattoo might seem like the most convenient way to convey one’s wishes, it is still important to have a formal Do Not Resuscitate order and to consider a living will or advance directive to make your wishes clear and alleviate potential confusion. For providers, this case study highlights the evolving cultural trends and individuals involved in critical and emergency care must be prepared to address such a situation should it arise since many times there is limited time to research and debate whether such a tattoo will be honored.