FORT LAUDERDALE, Fla. – It was a scenario that emergency room doctors at Jackson Memorial Hospital had discussed but never seen in person: an unconscious patient with a tattoo on his chest that said "Do not resuscitate."
A 70-year-old man at the Miami hospital raised a disturbing ethical dilemma and a decision had to be made quickly. His blood pressure was going down and he was not breathing well. He had a history of chronic obstructive pulmonary disease, diabetes and had a high level of alcohol in the blood.
"If we did not do something soon, we would lose it," said Dr. Gregory Holt, an assistant professor of medicine at the University of Miami who worked on the case this summer.
In the end, the doctors followed the tattoo instructions, but not before some kinks and a quick reference to the hospital's ethics team.
The doctors immediately had two questions about the tattoo.
"First, is it legal and second is it truly man's desire?" Holt recalled on Friday during a telephone interview with The Associated Press. He also helped write a case study that was published last week in The New England Journal of Medicine.
In general, when confronted with ethical riddles, doctors do not want to choose an irreversible path. In this case, they tried to wake him up, but he was in a state of delirium and unable to respond.
Doctors had previously heard of similar DNR tattoo cases. Some were just a joke. This one did not seem to be, said Holt. It was written on his chest with what appeared to be his signature tattooed underneath. The word "no" was underlined.
Still, the doctors had questions. He arrived at the hospital without identification or family and could not communicate with his closest relatives, further complicating the matter.
"We did enough to keep him alive while we talked to the ethics team," said Holt, who said the patient was pumped with antibiotics and intravenous fluids, along with other measures.
Often in these cases, the patient has a piece of paper in his house somewhere that also indicates his desire not to be resurrected, but there was no time to look. 19659002] The ethics team finally ruled that the tattoo expressed its wishes and told the doctors to obey his orders.
"He underlined the word & # 39; no & # 39 ;. He signed it in. We think he probably had some medical knowledge." He placed it on his chest where someone would have to do chest compressions … so we felt that this was a true and accurate statement that reflected his wishes, "said Holt.
The state of man deteriorated throughout the night and died without intervention.
The man's DNR written request was later found on his h Some doctors wrote in the case study that the tattoo "produced more confusion than clarity, given the concern about its legality and the unfounded beliefs that tattoos could represent permanent reminders of regrettable decisions made while the person was intoxicated. "