Patient with DNR Tattoo Raises Legal, Ethical Questions

An unconscious patient with a do not resuscitate (DNR) request tattooed on his chest “produced more confusion than clarity" in the emergency department (ED) where he was being treated, according to a November 30, 2017, letter to the New England Journal of Medicine. The patient, a 70-year-old man with a history of chronic obstructive pulmonary disease, diabetes mellitus, and atrial fibrillation, arrived at the ED unconscious with an elevated blood alcohol level. All efforts at treating the causes of his failing consciousness failed to produce a mental status capable of discussing goals of care. He presented without identification, so the social work department was called in to help identify and notify his next of kin. The tattoo on his chest read “Do Not Resuscitate" and was accompanied by what was presumed to be his signature. The authors initially decided to attempt to save the man's life, they said, “invoking the principle of not choosing an irreversible path when faced with uncertainty. " An ethics consultation was also requested. After reviewing the case, the ethics consultants advised the authors to honor the patient's DNR tattoo. They said it was reasonable to infer that the tattoo represented the man's most accurate feelings and that ignoring it could be seen as “standing on ceremony."