Unconscious Patient With 'Do Not Resuscitate' Tattoo Causes Ethical Conundrum at Hospital

By: Guest Author | Posted on: Dec 04, 2017

This article was originally published on gizmodo.com by George Dvorsky View the original article by clicking here.

Cascade Training Center

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.

As described in a New England Journal of Medicine case report, the unnamed 70-year-old man was brought to the ER by paramedics in an unconscious state, and with an elevated blood alcohol level. The patient had a history of chronic obstructive pulmonary disease (a type of lung disease), diabetes, and an irregular heart rate. His condition began to deteriorate several hours after being admitted, and dramatic medical interventions were needed to keep the patient alive.
 
But with the “DO NOT RESUSCITATE” tattoo glaring back at them, the ICU team was suddenly confronted with a serious dilemma. The patient arrived at the hospital without ID, the medical staff was unable to contact next of kin, and efforts to revive or communicate with the patient were futile. The medical staff had no way of knowing if the tattoo was representative of the man’s true end-of-life wishes, so they decided to play it safe and ignore it.

“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.


View Full Article


Cascade Training provides certification training for individuals and organizations as well as complaince and safety solutions. Each year, Cascade trains over 100,000 people, equipping them with the skills necessary to provide healthcare in various situations. Contact us to learn about the certification classes we offer, or click the button below to find classes near you today! 

http://www.cascadetraining.com/courses/