DNR tattoo poses ethical dilemma for doctors

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Doctors in the United States were presented with a serious ethical dilemma when a patient was recently admitted to a Miami hospital who had “Do Not Resuscitate” tattooed on his chest. 

Reporting the case in the New England Journal of Medicine, doctors describe how the 70-year-old man was brought to the hospital with an elevated blood alcohol level and in an unconscious state, without identification or family. On evaluation several hours later, hypotension and an anion-gap metabolic acidosis with a pH of 6.81 developed. 

The doctors described how they initially decided not to honour the patient’s tattoo, “invoking the principle of not choosing an irreversible path when faced with uncertainty”. However, after reviewing the patient’s case, ethics consultants suggested it was "reasonable to infer that the tattoo expressed an authentic preference".

The doctors said they were relieved when social workers subsequently obtained a written “out-of-hospital” DNR order for the patient which was consistent with the tattoo. They added the tattooed DNR request had 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”. 

The patient’s condition deteriorated and he died that night.