Tattoos and resuscitation orders.

[DJ TT 2002]

Originally Posted by GB-man

How long have you been a tattoo artist?

That's funny !!!!
And such a quick wit
Well done

[Tony64]

Originally Posted by DJ TT 2002

I'm in the business
I've seen these in the real world.
I have not and would not make a decision based on a tattoo. I've never known a colleague to do so, either.


If a person with a possible DNR status is resuscitated, you have done no harm. Things can subsequently be de-escalated

If resuscitation is not performed, then nothing can be undone


This post is based on my personal experience only!!

Thanks Doc, I appreciate the input of someone who's lived it.

The only thing I have issue with is the underlined part of your response. I would think that if a patient is truly a DNR and you decide to disregard this directive, then you have done harm.

Still, I would have to agree that the only irreparable harm would come from incorrectly failing to resuscitate.

Among our forum members (presumably a jury of ones peers) we lack consensus, despite excellent defenses of each position. I'd be curious to see if the medical community shares a more unified view.

We all can agree that a person has a right to choose or refuse lifesaving measures. A written document (on paper) seems to suffice. Written elsewhere, It appears less clear.

Interesting...

[DJ TT 2002]

I should have emphasized that I was referring to a situation in which the true DNR status was unclear or in question

People would be surprised how often this happens


I have always honored an established DNR staus
That is the person 's choice and their right!

[tritium8]

Originally Posted by Tony64

Thanks Doc, I appreciate the input of someone who's lived it.

The only thing I have issue with is the underlined part of your response. I would think that if a patient is truly a DNR and you decide to disregard this directive, then you have done harm.

Still, I would have to agree that the only irreparable harm would come from incorrectly failing to resuscitate.

Among our forum members (presumably a jury of ones peers) we lack consensus, despite excellent defenses of each position. I'd be curious to see if the medical community shares a more unified view.

We all can agree that a person has a right to choose or refuse lifesaving measures. A written document (on paper) seems to suffice. Written elsewhere, It appears less clear.

Interesting...

I think his point is you'll always have another chance to die

[Tony64]

Originally Posted by DJ TT 2002

I should have emphasized that I was referring to a situation in which the true DNR status was unclear or in question

People would be surprised how often this happens


I have always honored an established DNR staus
That is the person 's choice and their right!

Hey Doc, thanks for clarifying! Really appreciate getting an insider's look at this.

Can I get your opinion on another scenario? Imagine you are evaluating a terminally ill patient with no written (paper) advanced directive. The patient is barely conscious and non verbal, but with seemingly deliberate effort looks you directly in the eyes and points assertively to the tattoo on his chest which very clearly spells out the words "Do Not Resuscitate", before quickly losing consciousness.

In the absence of a more formal written declaration, and with no available friends or family to corroborate his wishes, how would you proceed?

Unusual circumstances I realize, but in that setting would a tattooed DNR suffice or would hospital policy still prevail?

[Tony64]

Originally Posted by tritium8

I think his point is you'll always have another chance to die

True, but harm has still occurred if life was prolonged against a person's wishes, i.e. prolonged suffering, denied death with dignity, etc.




Edit: Doc clarified his point above.

[DJ TT 2002]

Originally Posted by Tony64

Hey Doc, thanks for clarifying! Really appreciate getting an insider's look at this.

Can I get your opinion on another scenario? Imagine you are evaluating a terminally ill patient with no written (paper) advanced directive. The patient is barely conscious and non verbal, but with seemingly deliberate effort looks you directly in the eyes and points assertively to the tattoo on his chest which very clearly spells out the words "Do Not Resuscitate", before quickly losing consciousness.

In the absence of a more formal written declaration, and with no available friends or family to corroborate his wishes, how would you proceed?

Unusual circumstances I realize, but in that setting would a tattooed DNR suffice or would hospital policy still prevail?

Within the parameters of your question:

If I witnessed this exchange and had other healthcare workers witness this exchange with me,
I would honor the DNR request of the patient

[Tony64]

Originally Posted by DJ TT 2002

Within the parameters of your question:

If I witnessed this exchange and had other healthcare workers witness this exchange with me,
I would honor the DNR request of the patient

Then at least in some instances, a tattoo can be used to determine a patient's intention.




It's important to consider carefully the things you have tattooed so that there's no regerts later on.

[Widows Son]

I've been to several rescue calls involving DNR'S. The patient is in Hospice at home because that's where he/she has decided to expire. DNR is in Hospice paper work and copies are posted everywhere but the doghouse. 3AM, and patient starts having difficultey breathing. Some shirt tail relative calls 911. Puts everyone including the patient in a difficult position.

[pickettt]

Originally Posted by DJ TT 2002

I have not and would not make a decision based on a tattoo. I've never known a colleague to do so, either.

I would agree with this. That's how I like my doctors......intelligent, not rote.

[Tony64]

Originally Posted by pickettt

That's how I like my doctors......intelligent, not rote.

^^^ Absolutely agree with this 100%

Interesting though in the actual case presented the hospital ethics consultants decided to honor the tattoo...

"After reviewing the patient’s case, the ethics consultants advised us to honor the patient’s do not resuscitate (DNR) tattoo. They suggested that it was most reasonable to infer that the tattoo expressed an authentic preference, that what might be seen as caution could also be seen as standing on ceremony, and that the law is sometimes not nimble enough to support patient-centered care and respect for patients’ best interests. A DNR order was written."


I genuinely appreciate everyone who has expressed an opinion on this issue as it seems not at all as straight forward as some would like, and puts the healthcare providers in a difficult situation.

[Tony64]

Originally Posted by Abdullah71601

x3

A tattoo isn't legally binding. I've known too many people who regretted a tattoo to think that some old ink would be an affirmative defense when the family's attorney knocked on my door.

See my comments above. In the actual case presented, the hospital ethics panel advised that the patient's tattoo should be honored. Ultimately they found actual DNR paperwork, but it seems their decision was independent of this later discovery.

I'm not a lawyer so I can't really comment on the legality of that decision, but at least in this one hospital the tattoo was in fact binding.

[Abdullah71601]

Originally Posted by Tony64

See my comments above. In the actual case presented, the hospital ethics panel advised that the patient's tattoo should be honored. Ultimately they found actual DNR paperwork, but it seems their decision was independent of this later discovery.

I'm not a lawyer so I can't really comment on the legality of that decision, but at least in this one hospital the tattoo was in fact binding.

The tattoo was irrelevant. The signed DNR ruled the day in the end. Had there been no DNR, and the family was convinced the tattoo was an old joke, the hospital would likely have paid out to make this case go away.

The hospital ethics board decided they weren’t at fault. Gee, I’m so surprised.

[Tony64]

Originally Posted by Abdullah71601

The tattoo was irrelevant. The signed DNR ruled the day in the end. Had there been no DNR, and the family was convinced the tattoo was an old joke, the hospital would likely have paid out to make this case go away.

The hospital ethics board decided they weren’t at fault. Gee, I’m so surprised.

Respectfully, that's not how I read it. I understood that when confronted with the dilemma as to whether or not to respect the tattoo the doctors initially decided not to. They then turfed it to the hospital ethics panel who advised honoring the tattoo. There was never an evaluation of fault.

What happened afterword is irrelevant. The hospital panel had already made their decision.

Now whether or not that was the correct decision, or whether it was a legally defensible decision, we'll never know because, as you pointed out, the DNR paperwork was later found.

[Larry302]

Interesting . So I'm guessing EMS or fire brought him to,the hospital , what did they do ?
As a FF and emt I've done CPR / difib 100's of time . I need to see the dnr or in my state molst form, and trust me I love it when there is one , but if it can't be produced our hands are tied . It can be " called " under certin circumstances , but a tattoo alone in the field would be hard to act on , a call to,medical control would be in order though .