Paramedics brought an unconscious 70-year-old man to the hospital.
The man had a history of chronic
obstructive pulmonary disease, diabetes mellitus, and
atrial fibrillation; the man also had an elevated blood alcohol
level. Although patients like this one are seen everyday,
this man was unique because of his "Do Not
Resuscitate" tattoo on his chest. Since the man
was unconscious physicians and social attempted to find next of
kin and family members. They attempted to decrease his level
of unconsciousness, but they all failed. The physicians initially did
not want to honor the tattoo and gave him antibiotics and IV
fluids. The ethics consultant advised them to respect the patient's
DNR tattoo. The consultant claimed that it was reasonable to infer
that the patient's tattoo showed a genuine preference.
This presents a huge ethical dilemma because DNRs can be revoked.
I also think that finding some family member could have
better assisted them with this struggle. A lot of people have crazy tattoos;
for all they know it could have been the title of a song. I think
that because of the central location of the tattoo, they assumed that
the tattoo was to be seen and understood. While doing their
lit review, they also found a patient that their DNR tattoo did
not reflect their current wishes. Later, the team found a previous DNR from
Florida that the man had signed. I do believe that when it comes to DNRs there
should be clearly written documentation. Some patients wear medical bracelets
to disclose their medical status; they should also have DNR bracelets in order
to avoid any confusion. People are not going to carry DNR documentation
everywhere they go, but having a bracelet would make the patient’s request
clear. What are your thoughts about DNR tattoos?
http://www.nejm.org/doi/full/10.1056/NEJMc1713344#t=article
http://www.nejm.org/doi/full/10.1056/NEJMc1713344#t=article
In most states, the law is that unless the provider has the DNR in front of them, with a current physician's signature, it doesn't exist, regardless of what the family members say. On scene, I would have resuscitated this patient, and would have completely disregarded the tattoo, unless I was given a legitimate DNR. In a perfect world, the physician would have had ample time to contact the family, or find documentation. Unfortunately, the decision of whether or not to resuscitate usually has to happen in a split second, as CPR must be started immediately, and once started cannot be stopped (again, unless someone finds and brings out the DNR). I would also disregard a bracelet that says "DNR", as I still need to have the paperwork in front of me. This is protective for both the provider and the patient. If I resuscitate you because there was no paperwork and you sue me (this happens), I cannot be held responsible, as I was following the law. Unfortunately, there are also stories of families lying about the DNR status of a patient due to ulterior motives, which is why these laws are so stringent. I have, however, seen tattoos that disclose that the patient is a diabetic, or an epileptic (typically on the wrist). If you have these tattoos, you will be treated as though you have that condition, which can spell death for you if you are treated as an epileptic and don't actually have epilepsy. I personally believe that it should be illegal to get a "Medical Tattoo" similar to this unless you actively have the condition. If someone gets a tattoo that says Do NOT Resuscitate in big letters across their chest despite not wanting a DNR and someone doesn't resuscitate them, then I feel like that's on them for getting that tattoo in the first place, NOT the provider.
ReplyDeleteThis is a particularly complicated situation because of the nature of a tattoo, permanent. I'll pose a hypothetical situation of a man with terminal cancer. This man has a DNR and is nearly sure that he is going to die, so he gets a tattoo on his chest that says just that "Do Not Resuscitate". However, the man does not die, he lives and goes into remission thanks to, for lack of a better term, a medical miracle. Now this man has just undergone very expensive treatment for his cancer so he cannot afford to get the tattoo removed despite his not having the DNR anymore. In this case, but not resuscitating him, you are defying his wishes, simply bacuse he could not afford to have the tattoo removed or covered. DNRs require the documentation (itieven has to be original) because they are such an important decision for a person. It is something the medical world does not want to mess up, so we put stringent rules on them to make sure everything is as the patient wishes it to be.
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