Unconscious Man with DNR Tattoo Presents Ethical, Legal Challenges

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Monday, December 4, 2017

An article in the New England Journal of Medicine describes the case of a man — unconscious, in deteriorating health, and without identification or family — who was admitted to a Miami emergency room. Upon examination, doctors found a large tattoo that said DO NOT RESUSCITATE (DNR) on his upper chest. The ER doctors were initially inclined to disregard the DNR, "invoking the principle of not choosing an irreversible path when faced with uncertainty." However, an ethics consultant advocated that the patient's wishes, expressed through his tattoo, be honored. The patient died the next day. Hastings Center Scholar Nancy Berlinger opines, "[It] might have been the most reliable way to make his voice heard. It was right to take it seriously." She is co-author (with Consortium chair Susan M. Wolf and Bruce Jennings of the Center for Humans and Nature) of the definitive Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying. In the Washington Post, bioethicist Arthur Caplan discusses the legal implications of the case, noting "there are no legal penalties for ignoring a tattoo that instructs medical personnel not to resuscitate." He goes on to say, “'A tattoo, I think, is best seen as a way to alert medical staff to your wishes or trigger an inquiry to family and friends and partners'. . . adding that patients should keep the actual [advance health-care directive] in a pocket or wallet."