An Unconscious Patient With a 'DO NOT RESUSCITATE' Tattoo (nejm.org)

A real-life case study, published on New England Journal of Medicine, documents the ethical dilemma that a Florida hospital faced after a 70-year-old unresponsive patient arrived at the hospital. The medical staff, the journal notes, was taken aback when it discovered the words "DO NOT RESUSCITATE" tattooed onto the man's chest. Furthermore, the word "NOT" was underlined with his signature beneath it. The patient had a history of chronic obstructive pulmonary disease, diabetes mellitus, and atrial fibrillation. Confused and alarmed, the medical staff chose to ignore the apparent DNR request -- but not without alerting the hospital's ethics team, which had a different take on the matter. From the report: We initially decided not to honor the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty. This decision left us conflicted owing to the patient's extraordinary effort to make his presumed advance directive known; therefore, an ethics consultation was requested. He was placed on empirical antibiotics, received intravenous fluid resuscitation and vasopressors, and was treated with bilevel positive airway pressure. After reviewing the patient's case, the ethics consultants advised us to honor the patient's do not resuscitate (DNR) tattoo. 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. A DNR order was written. Subsequently, the social work department obtained a copy of his Florida Department of Health "out-of-hospital" DNR order, which was consistent with the tattoo. The patient's clinical status deteriorated throughout the night, and he died without undergoing cardiopulmonary respiration or advanced airway management.

Comments

Re:Henna stencil.

[blindseer]

Perhaps I would have believed you before the UK government refused to allow Baby Charlie to go to the USA for lifesaving treatment.

The UK did not have the ability to treat this child's condition, but people in the USA could. Or at least they claimed they could have. The parents were forced to sue the government to allow them to take the child to the USA for treatment, treatment that would have cost them nothing. They held this up in the courts until the child was too ill to be treated. The UK government could not allow this child to go to the USA because that would have exposed their government funded health care system to be second rate.

The UK government allowed this child to die so that they could save face.

European health care "light years" ahead of the USA? I call bullshit. But we won't know if Baby Charlie could have been saved in the USA, right? If Charlie had lived then he'd have been a walking and talking example of the superior medical care in the USA for decades. Now that he's dead most people have forgotten all about how the UK government all but murdered this infant.