How an Unusual Do Not Resuscitate Request Can Affect Your Healthcare
When end-of-life decisions such as a Do Not Resuscitate request are presented in an unusual or nonstandard manner, your healthcare can be severely affected depending on whether an ER doctor guesses rightly or wrongly on what you really want when unconscious.
According to a recent article published in the New England Journal of Medicine, doctors at a University of Miami hospital were stymied on what to do when an unconscious man with a “Do Not Resuscitate” chest tattoo was wheeled into their ER. Do Not Resuscitate is a legal declaration of one type of an advance directive that tells your doctor what kind of care you would like to have if you become unable to make medical decisions, such as when unconscious or in a severely mentally altered state of mind and presenting with a life-threatening condition.
Typically, Do Not Resuscitate requests are made by individuals who have a chronic medical condition that has necessitated one or more resuscitation events. While successful in some cases, a patient may decide that their time has come and find their quality of life compromised by repeated resuscitation and would prefer to die as peacefully and naturally as possible. Hence, the patient usually signs an Advance Directive form that informs their doctor that they do not want to be resuscitated if their heart stops beating. The DNR order will be placed in their medical chart. All states accept DNR orders and all physicians are expected to honor the request.
But what if the DNR request is a tattoo on a patient’s chest and they are unconscious such as in the aforementioned medical journal article? Should a tattoo be considered a serious wish of the bearer, or the more-likely drank too much and got a regretted tattoo indiscretion?
In the journal article, care was provided while awaiting a decision from medical ethicists for a final decision and efforts made to locate family or some documentation supporting the tattoo. Historically, this is not the first time a similar case has presented itself to doctors with the result that the DNR tattoo was not the actual wish of the patient when confronted with a life and death situation.
As it turned out, the ethicists sided with the tattoo and recommended the DNR to be honored. Shortly after, paperwork was discovered that showed the patient indeed desired no resuscitative efforts should his heart stop beating. Afterward, the doctors reported that the patient’s clinical status deteriorated throughout the night, and the patient died without undergoing CPR or advanced airway management.
According to authors of the article, “We were relieved to find his written DNR request, especially because a review of the literature identified a case report of a person whose DNR tattoo did not reflect his current wishes,” the doctors involved in the case stated.
What to Do to Ensure Your DNR Wishes Are Clear:
1. Do not rely on non-standard ways such as tattoos or fad-jewelry or T-shirts to convey your end of life wishes.
2. Talk to your physician and have him or her provide the necessary forms to fill out stating your wishes and witnessed by others upon signing. Only a licensed professional’s signature with your own makes the form legal.
3. Let your family members know of your decision.
4. Carry on your person a special card or medical alert bracelet identifying you as a DNR patient. Emergency personnel typically go through your wallet looking for medical info.
Here’s why your Surgical Outcome May Be Affected by Your DNR Orders.
1. An Unconscious Patient with a DNR Tattoo, New England Journal of Medicine November 30, 2017; 377:2192-2193, Gregory E. Holt, M.D., Ph.D. et al.
2. DNR tattoos: a cautionary tale. Journal of General Internal Medicine 2012; 27:1383-1383, Cooper L, Aronowitz P.