A recent ethical dilemma made headlines when doctors found that a man had the words “Do Not Resuscitate” tattooed on his chest, along with his own signature. Doctors were faced with the question of whether or not they should honor the tattoo as a representation of his wishes.
The patient had no other documentation, and was not accompanied by any family members who could give a better idea of what his wishes might be.
“We initially decided not to honor the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty,” the physicians who treated the patient wrote.
The physicians consulted an ethics panel. The panel advised that the tattoo be honored as a representation of the patient’s wishes, and he passed away the next morning. A traditional, written DNR was later located, so in this case, the tattoo was a reflection of actual end of life wishes.
However, in an earlier case, a patient’s DNR tattoo contradicted his written wishes. The patient was fully conscious, and admitted to the hospital for an amputation. His DNR tattoo conflicted with his written directives for some life-sustaining treatment, so when hospital staff asked him to clarify his wishes, he told them the real reason he got the tattoo: because he had lost a bet he made while intoxicated.
Although hospital staff suggested he consider getting the tattoo removed, the patient declined, claiming he did not think anyone would take the tattoo seriously. As the first case showed, however, some medical professionals would be inclined to honor the tattoo, although many would likely not honor it in the absence of a written order.
In New Jersey, Do Not Resuscitate orders must be signed by a physician. A tattoo might signal that a written order is in place somewhere to EMS or other medical professionals, but it will likely just create more confusion than it resolves.
Some may argue that the tattoo route is easily recognizable if EMS begins to treat an unconscious patient, but New Jersey also recognizes DNR bracelets. They are not required in order for a DNR to be effective, but will deliver the message that one is in place if a person is unconscious or otherwise unable to articulate it themselves.
Beyond being a more traditional method that does not create the same ethical dilemma and confusion, DNR bracelets and written orders are easy to revoke. A patient may rip up a paper DNR, vocalize their revocation to their doctor, or remove a bracelet. Tattoo removal (or covering it up with another tattoo), however, is expensive.
So, if you’re looking for the best way to express your end of life wishes, a tattoo is probably not the way to go. If you have any questions about DNR, Medical Power of Attorney, or other future planning concerns, our estates department is available by phone at (856) 642-6445.