By: Jim Dossey, MS, MBA, JD -
A client recently told me a story about a man who absolutely did not want to be resuscitated. The man felt so strongly that he had "Do Not Resuscitate" tattooed on his chest. The man later had a medical emergency and the ER physicians ignored the tattoo and resuscitated him. When the man asked the ER doctors why they ignored his tattoo, they said that it was not notarized. The man then had a notary public stamp his chest and had a tattoo artist make the stamp permanent by outlining the stamp with a tattoo.
For those that feel strongly about not being resuscitated, having "do not resuscitate" tattooed on their chest is a very appealing idea. The tattoo is permanently affixed to the body. It cannot be lost and the wearer does not have to carry formal DNR documents around. Furthermore, emergency room practitioners are unlikely to miss the tattoo prior to attempting resuscitation. In a recent study, it was shown that physicians only understood 46% of hospitalized, seriously ill patients' preferences to forgo CPR.
Despite the appeal, there are several reasons why ER doctors probably will not respect a patient's DNR tattoo. First, physicians are only provided liability protection if the DNR order is legally recognized. A tattoo is not a legal document. In Texas, a DNR form requires signatures from the patient, their doctor, and two witnesses. Secondly, a DNR tattoo can create uncertainty for emergency responders who must make decisive and immediate life or death decisions. An ER doctor may wonder, if the tattoo really means "do not resuscitate", or does DNR stand for "Department of Natural Resources"? Given that the tattoo is permanent, the doctor may wonder if the patient has changed their view on resuscitation, but has not changed the tattoo. Finally, a legally binding DNR must be revocable, which is made much more difficult with a permanent tattoo.
If the patient has strong feelings about being resuscitated, the best approach is to go through the process of obtaining a legally binding DNR document. Legally sanctioned DNR bracelets can also be obtained from the Texas Medical Association and other approved vendors. However, the DNR bracelets can only be obtained after the patient has executed a valid Texas DNR document.
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