When someone goes to the extent of conveying their wish by getting them tattooed on to the body, does one consider it? Moreover, does a doctor who is morally bound to do what it takes to save a patient's life go ahead and honor his dying wish?
In what sparked an ethical dilemma, doctors found themselves stumped over an unusual wish that a 70-year-old man from Florida had tattooed across his chest.
It read: "DO NOT RESUSCITATE"
The NOT was underlined and it was followed by the man's signature.
The unidentified man was brought into Miami's Jackson Memorial Hospital, unconscious with breathing problems, and signs of septic shock. He was alone and had no identity. His blood was full of alcohol and its pressure was severely dropping.
The case was detailed in the New England Journal of Medicine and spoke of the medical struggle to discover answers.
It is assumed that doctors would do everything in their power to save a person's life but when they came across someone who did not want to live and made his wish well-known, they faced complications.
Gregory Holt, a critical-care physician and lead author of the paper was shocked when he came across his patient and said in an interview: “I think a lot of people in medicine have joked around about getting such a tattoo — and then when you finally see one, there's sort of this surprise and shock on your face. Then the shock hits you again because you actually have to think about it.”
The doctors initially decided not to honor the man's tattoo by choosing not to take an irreversible path during times of uncertainty. The decision they made, however, did not seem morally right, owing to the patient's obvious effort to make his decision well known. They were conflicted within themselves and hence they decided to call for an ethics consultation.
Meanwhile, they gave the man intravenous fluids, antibiotics, and blood-pressure medication in order to buy themselves some time until they knew they were making the right decision. They resolved against not placing him on a ventilator because “It would have hurt to see a man with a DNR tattoo having a tracheal tube hanging out of him,” Holt says.
The doctors got hold of Ken Goodman, the co-director of the University of Miami’s ethics programs. He suggested they honor the man's wish.
“My view was that someone does not go to the trouble of getting such a tattoo without forethought and mindfulness,” Goodman says. “As unorthodox as it is, you do get a dramatic view of what this patient would want.”
However, tattoos are permanent and we all have fleeting desires. What once mattered the most, does not so anymore. Many have known to regret their past choices and not feel as strongly about something that once meant everything. Hence, the dilemma. Moreover, there is good reason to be cautious because back in 2012, another man had a "DNR" tattoo on his leg but when the nurse confronted him over his tattoo, he said he got it after "losing a poker bet years ago," and would very much like to be resuscitated if need be.
Holt and his team had no way of knowing because the patient was unconscious and he had no family or friends.
According to the study:
"This patient’s tattooed DNR request 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."
"After reviewing the patient’s case, the ethics consultants advised us to honor the patient’s do not resuscitate (DNR) tattoo. They suggested that it was most reasonable to infer that the tattoo expressed an authentic preference, that what might be seen as caution could also be seen as standing on ceremony, and that the law is sometimes not nimble enough to support patient-centered care and respect for patients’ best interests."
Social workers tracked his fingerprints down and discovered his identity. He had come from a nursing facility and much to the doctor's relief, he had an official DNR form printed and signed out.
The man died the next morning.
There are no legal penalties for ignoring a tattoo but letting a man die by taking his wish at face value, with no documents whatsoever to back them can pose a problem. People should make sure their families or friends are aware of their wishes and should carry an official document with them at all times to avoid conflicts and complications.
Holt felt his patient's tattoo was a serious wish and they decided to honor it.
“It also seemed that he didn't trust that his end-of-life wishes would be conveyed appropriately,” he said of the patient. “So, to me, it means we need a better system.
“We need a better system for people to be able to convey their wishes — if these are their wishes — so that we don't do things to them that they don't want, like in the throes of an emergency when a man like this comes into the emergency room unconscious.”
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