A man admitted to a Florida hospital had an unusual order not to resuscitate, a new study shows.
Picture this: a man enters a hospital, unconscious, with a history of serious health problems and a high level of alcohol in the blood. He has no identification or family with him. On his chest, he has a tattoo: "Do not resuscitate".
What would you do?
It seems the worst hypothesis of a medical ethics course, but it really happened recently in Florida hospital. A study recently published in The New England Journal of Medicine explored the ethical and medical questions staff faced when they presented with a 70-year-old patient whose denial of potentially life-saving treatment was there on their skin.
At first, the doctors wanted to ignore it
According to the study, written by a team of medical professionals from the University of Miami, the doctors who treated the man did not want to honor the tattoo because there was no way to Be absolutely sure that this is what the man wanted.
"Initially we decided not to honor the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty," the study said.
Doctors chose to treat the patient with antibiotics and other rescue measures.
However, they called the hospital ethics consultant, who had a different opinion.
Different view of an ethics consultant
Laws about n Resuscitation orders are sometimes complex and vary from state to state. According to an article in the Journal of General Internal Medicine, "doctors are morally and legally obliged to respect the preferences of patients to forgo life-sustaining treatment." However, this usually means that an official signed an agreement not to resuscitate as a doctor. Treatment to maintain life.
Tattoos, although clearly administered with the wishes of a patient, are not legally binding and are generally considered too ambiguous to act.
"The emergency responder may ask: (d) or the letters Represent Not Resuscitate, or the Department of Natural Resources, or someone's initials? Second, the tattoo may not be the result of a decision Considered to renounce resuscitation, errors in interpretation can have life or death consequences, "said the article in the Journal of General Internal Medicine.
In the case of the man at the Florida hospital, the establishment's ethics consultant said doctors should honor the tattoo.
They suggested that it was more reasonable to infer that the tattoo expressed an authentic preference, that what could be seen as a precaution could also be considered a ceremony and that the law is sometimes not agile enough to support patient-centered care and Respect for "The best interests of patients," says the study.
There was also another development that supported the decision of the consultant: the department of social work of the hospital located a copy of the Department of Health of the state of Florida "extrahospitalario" did not resuscitate the order, which supported the request for his tattoo.
Ultimately, an order not to resuscitate was issued and the man died. The study authors said they were "relieved to find their written request for DNR," but the initial confusion over the tattoo brought up a curious topic that has been debated in the medical community on several occasions.