University of Miami doctors faced a vexing ethical dilemma when paramedics wheeled an unconscious man with a “Do Not Resuscitate” chest tattoo into emergency room, according to a case study published Thursday in the New England Journal of Medicine.
Doctors treating the 70-year-old diabetic patient, who had an elevated blood-alcohol level and a history of pulmonary disease, at first began lifesaving efforts.
Official do-not-resuscitate requests can only be issued in writing by the Florida Department of Health, and the doctors were unable to immediately locate the man’s family members or even identify him.
“We initially decided not to honor the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty,” four University of Miami doctors wrote in NEJM.
They began administering antibiotics and IV fluids.
“This decision left us conflicted owing to the patient’s extraordinary effort to make his presumed advance directive known,” the doctors wrote in NEJM. “Therefore, an ethics consultation was requested.”
Ethics consultants soon advised the doctors that the tattoo, which was signed with the patient’s name and scrawled across his chest, likely represented his wishes and should be honored.
The consultants told the physicians that “the law is sometimes not nimble enough to support patient-centered care and respect for patients’ best interest,” according to the doctors.
After a DNR order was written, officials found an official copy of the man’s DNR order from the Florida Department of Health. He died overnight without further lifesaving efforts, the doctors wrote in NEJM.
“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,” the doctors added.