The Meeting Place

‘Do not resuscitate’ tattoo causes ethical dilemma

Emergency room doctors at a University of Miami hospital faced a moral dilemma when paramedics wheeled in an unconscious man with a “Do Not Resuscitate” chest tattoo.

The case is described in a case study published in the New England Journal of Medicine.

Doctors treating the 70-year-old diabetic patient at first began lifesaving efforts. The patient had an elevated blood alcohol level and a history of pulmonary disease.

But tattooed "do not resuscitate" requests are not considered valid by the Florida Department of Health and the doctors were unable to immediately locate the man's family members or even identify him.

“We initially decided not to honour the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty,” the University of Miami doctors write in the case study.

So they began administering antibiotics and intravenous fluids.

“This decision left us conflicted owing to the patient’s extraordinary effort to make his presumed advance directive known,” the doctors write. “Therefore, an ethics consultation was requested.”

Ethics consultants soon advised the doctors that the tattoo likely represented his wishes and should be honoured.

The consultants told the physicians that “the law is sometimes not nimble enough to support patient-centred care and respect for patients’ best interest,” according to the doctors.

After a DNR order was written, officials found an official copy of the man’s DNR order from the Florida Department of Health. He died overnight without further lifesaving efforts, the doctors write.

“We were relieved to find his written DNR request, especially because a review of the literature identified a case report of a person whose DNR tattoo did not reflect his current wishes,” the doctors add.

What do you think the doctor’s should do in the case of ‘do not resuscitate’ tattoos? Would you consider tattooing your medical requests on your chest?


I would say if someone when to the trouble of getting this Tattoo it would mean that they meant what it said!

Or maybe his ex-wife put it on while he was in a self induced coma?

Frank, that's wicked, :-)))

I thought it was a Doctors job to save life at all costs. Do they not have to adhere to the Hipocratic oath to save life .

Yep, if I were the medical staff, I would be checking to ensure it was not just drawn on.

Sidney70 There is no obligation to save a life at all costs if a person has a do not resuscitate oder in place or living will or other legal instrument to do this.  If a person is elderly (like me) and has medical problems that make it unlikely they would live a decent life after treatment or an operation, they may choose to do without that treatment or without that operation.   This is not against the Christian faith

I think the Hippocritcal Oath means "First do no harm". If someone has made it clear they don't want medical help that should be respected, and get on helping the ones that do.

Why go to all that trouble when you can buy one of these?

Image result for do not resuscitate bracelet

Gday Reagan;  would you know where does one buy those ??

Hi johnp,

Couple of places I found on the internet. I don't know if they're binding in Australia, so would suggest making a legal document and telling someone where it can be found.

Interesting dilemma. A few years ago, a local man had those words tattoed on his chest and the TV station asked a paramedic what he would do if he was called to assist the man. The paramedic's response was that he was trained to do everything within his power to save lives and that was the job that he was paid to do. He also said that his conscience wouldn't allow him to just stand by and ignore the patient. I wonder what the laws in Australia say about a medical person failing to do their job.

Old Man,

The law in Australia is that ambulance attendants and paramedics have to ignore any NFR directive.  Only doctors can act on this.

When entering hospital and filling out the usual forms, one can just add NFR and sign it.

Regarding a NFR bracelet, I would be very surprised if these were legal in Australia.

In unscrupulous hands, these could be abused.

Good info from Reagan which is appreciated. Some other good comments also on this forum. Also see info posted by Louise, an intensive care nurse, in the mediband link given by Reagan. 


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