Aging Options

“Do Not Resuscitate” Tattoo Causes Ethical Confusion in a Miami ER

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When is a tattoo a matter of life and death? Apparently when it contains the words “Do Not Resuscitate.” That’s what happened recently in the Emergency Room at a University of Miami hospital. (You can read about this unusual story here on the MSN website.) The story, as odd as it sounded to us, does bring up an issue that is vitally important to millions of Americans: how do you ensure that your end of life wishes, including your desire to avoid any extraordinary measures to resuscitate you in the event of a health crisis, are honored?

In the Miami story, originally reported  here in the New England Journal of Medicine, an unconscious 70-year-old patient was brought into the Emergency Room.  The man was diabetic, had an elevated blood alcohol level, and a history of pulmonary disease. He also had the words “Do Not Resuscitate” clearly tattooed across his chest.  Doctors “at first began lifesaving efforts,” reports MSN, because “tattooed ‘do not resuscitate’ requests are not considered valid by the Florida Department of Health.” Besides that, doctors and hospital officials could not locate the man’s family members or even identify him. They began giving the man intravenous fluids and antibiotics.

However, even as they worked to save the man’s life, the physicians sensed an ethical and medical dilemma. “This decision left us conflicted owing to the patient’s extraordinary effort to make his presumed advance directive known,” the doctors wrote in their report of the incident in the New England Journal of Medicine. To resolve the matter, they asked for an immediate ethics consultation. In the words of the MSN article, “Ethics consultants soon advised the doctors that the tattoo likely represented his wishes and should be honored.” MSN reports that, even though the decision to abide by the tattooed instructions was inconsistent with state law, it clearly was “in support patient-centered care and respect for patients’ best interest.”

In this case the patient passed away during the night with no further intervention on the part of physicians. Also, the situation was clarified significantly when a written copy of the man’s “Do Not Resuscitate” order from the Florida Department of Health was located. This, said the attending doctors, was a major relief: there had been an earlier case, uncovered during the ethics research, in which another patient had a “DNR” tattoo that apparently did not reflect this person’s changing wishes. It’s an important reminder – not to seem flippant – than your end-of-life wishes can change but a tattoo is forever.

So if a tattoo is not a good recommendation, what is the best way to ensure that doctors and family members honor your wishes should you find yourself in a similar situation? It might be helpful to consider what a “DNR” or “Do Not Resuscitate” order is and what it does.  We found this basic description on the LegalMatch website. “A Do Not Resuscitate (DNR) order is a written document instructing health care providers to forgo resuscitative measures. If a person with a DNR suffers a heart attack or stops breathing, it lets the medical personnel know not to try to revive them with CPR, defibrillators, or other life-saving procedures. The DNR order can be drafted by an attorney as part of a living will, or as a separate stand-alone document.”

(This 2014 article from the AgingOptions Blog also provides some helpful background information.)

Remember that a Do Not Resuscitate order will only apply if you are incapacitated in some way. That means key people in your life will need copies beforehand, including your physician, your close family members, a close friend if one is involved in your affairs, and officials at a retirement home or other senior residence if that is where you live.  You may also want to carry a card in your wallet stating that you have a DNR Order and include the phone number of someone who has a copy. This link to the Washington State Department of Health includes additional helpful information about how to document your end of life wishes, and describes the document which has been adopted by the Washington State Medical Association called a “Physicians Orders for Life Sustaining Treatment” (or POLST) form.

Do you need an attorney to draft your DNR form or can you do it yourself? Some websites will tell you that downloading a form and filling it out is all you have to do. However, we definitely advise you to consult an elder care attorney for this type of decision – not merely because the form requires certain legal language in order to be valid, but because making your end of life wishes known is part of a much larger picture in proper retirement planning. Your number one goal should be to plan comprehensively for your retirement years – not just on how you wish to die, but on how you choose to live. This means that medical decisions become part of a much larger picture that includes finances, legal affairs, and housing choices. In the case of a DNR or other similar medical directive, it is also vital that your family members are well informed about your desires. In order to accomplish this, we urge our clients to schedule a family conference, moderated by one of our attorneys, where a full range of retirement-related issues can be thoroughly reviewed. It’s the best way we know of to avoid the problem of families fracturing as mom and dad age and their care becomes more challenging and costly.

This comprehensive approach to retirement planning, blending health, finances, housing, legal and family matters into one seamless plan, is called LifePlanning, and it’s only offered by AgingOptions. If you’re ready for a fresh approach to retirement planning, come discover the power of a LifePlan by joining Rajiv Nagaich at an AgingOptions LifePlanning Seminar. These are held throughout the Puget Sound region, so for a complete listing of dates, times and locations, click here – then register online or call us during the week for assistance.

As we said, something as important as a Do Not Resuscitate order may tell those who love you how you want to die – but do they know how to want to live? Make sure they do, and protect your dreams, with an AgingOptions LifePlan.  Age on!

(originally reported at




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