Doctors at the emergency room of a University of Miami hospital faced a troubling ethical dilemma when paramedics brought in an unconscious, barely breathing man who had the words “Do Not Resuscitate” tattooed on his chest.
When the -year-old man was wheeled in, doctors immediately began efforts to save his life. The patient, a diabetic, had a high blood alcohol level and a history of pulmonary disease.
However, tattoos giving the order not to resuscitate are not considered valid by the Florida Department of Health, which has strict rules on the matter. The doctors were unable to locate or identify the man’s family members, neither could they find anything on his identity, Fox News reports.
A DNR is a legal order from a patient, telling doctors not to take any steps should they stop breathing or their hearts stop.
The doctors wrote in the study,
We initially decided not to honor the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty.
The doctors started administering antibiotics and intravenous fluids to revive the man.
“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,” they said.
Ethics consultants told the hospital that the tattoo was most likely a representation of the man’s wishes and should be honored. The doctors later found an official copy of the man’s DNR order from the Department of Health.
The consultants said that “the law is sometimes not nimble enough to support patient-centered care and respect for patients’ best interest.”
“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.
He died without undergoing any further interventions.
The case was published in the New England Journal of Medicine.