When an unresponsive patient arrived at a Florida hospital ER, the medical staff was taken aback upon discovering the words “DO NOT RESUSCITATE” tattooed onto the man’s chest—with the word “NOT” underlined and with his signature beneath it. Confused and alarmed, the medical staff chose to ignore the apparent DNR request—but not without alerting the hospital’s ethics team, who had a different take on the matter.
“We initially decided not to honor the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty,” wrote the authors of the case study. “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.”
But there was more too it than just the medical ethics. Gregory Holt, the lead author of the new case study, said the biggest question in his mind was the legal aspect of whether or not it was acceptable. “Florida has stringent rules on this,” he told Gizmodo.
While the DNR tattoo may seem extreme, the request to not be resuscitated during end-of-life care is most certainly not. Roughly 80 percent of US Medicare patients say “they wish to avoid hospitalization and intensive care during the terminal phase of illness.” Revealingly, a 2014 survey showed that the vast majority of physicians would prefer to skip high-intensity interventions for themselves. Of the 1,081 doctors polled, over 88 percent opted for do-not-resuscitate status. Indeed, measures to keep a patient alive are often invasive, painful, and costly. DNRs, which hospital staff refer to as “no-codes,” are an explicit request to forego high-intensity interventions like CPR, electric shock, and intubation tubes. More implicitly, it’s a request to not be hooked up to a machine.