Last week, a Washington Post article caught my eye ‘A Florida man collapsed with a ‘Do Not Resuscitate’ tattoo. Doctors didn’t know what to do’.
The full article in the New England Journal of Medicine described doctors in Miami who found themselves caught in what they describe as an usual ethical dilemma. Reportedly, an unconscious man was brought to the ER with a chest tattoo that read ‘DO NOT RESUSCITATE’; his signature was underneath. He did not have any identification or family with him. The doctors initially decided not to honor his wishes ‘invoking the principle of not choosing an irreversible path when faced with uncertainty.’ The ethics team advised them to honour his tattoo as “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.” The DNR order was signed. Subsequently the hospital was able to locate a copy of his Florida Department of Health, DNR order which was in keeping with the tattoo. The gentleman passed away that evening.
The NEJM article concludes “this case report neither supports nor opposes the use of tattoos to express end-of-life wishes when the person is incapacitated.”
A professor of bioethics, Dr. Arthur Caplan opined that the DNR tattoo is not substitute for an advance health-care directive. He recommends keeping the actual document in your pocket or wallet.
Most of us don’t want to think about this dying process and if we had, we do not carry this document around with us. In Ontario we do not have a central registry. I am not sure why it cannot be part of our OHIP record. Quebec is the only province that does have a central registry. I have previously blogged about the Alberta ‘Green Sleeve’ program and gains they had made in having doctors spend time with their patients reviewing and discussing issues/concerns.
It does seems pretty clear to me having instructions tattooed on one’s chest should be a clear message. However until practice, policy and the law are consistent, we can all start with having the conversation with our loved ones.