A DNR Tattoo – Think Before You Ink

What would you do if an unconscious patient was brought into the Emergency Department with a tattoo across his chest that read: DO NOT RESUSCITATE?

This was the situation faced recently by doctors in a Miami hospital. In this case, the doctors provided initial resuscitation, including BiPAP, intravenous fluids and antibiotics, while attempts were made to contact the patient's family to confirm his wishes. An ethics consultation was also requested. The ethics consultants advised the doctors to honour the patient’s DNR tattoo.

Subsequently, a copy of the patient's written DNR order was obtained, which was consistent with the tattoo. The patient's clinical status deteriorated and he died without undergoing CPR or advanced airway management.

The challenge in this case was to determine if the tattoo was consistent with the patient’s current wishes, especially since patients can and do change their mind about refusal of treatment.

Advance Care Directives in Australia

An Advance Care Directive (ACD) can be made to communicate specific instructions about treatment, including refusal of treatment. The law on ACDs is different in every state and territory. More information about the legislation in each state and territory can be found here.

If an ACD is made by a capable adult, is clear and unambiguous, and extends to the situation at hand, it must be respected. 

This blog contains general information only. We recommend you contact your medical defence organisation or insurer when you require specific advice in relation to medico-legal matters.