A default to proceeding with life-sustaining measures does not mean that tattoos or other non-standard means of communicating preferences should be ignored. The tattoo, an alternative form of communication, should be used as piece of information in the decision-making process. A major limitation of AD and POLST documents is that in most states they must physically accompany the patient and are often not available when providers are making key decisions.
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ACEP Now: Vol 37 – No 04 – April 2018Some states, such as Oregon and California, have electronic databases that providers can access, but the lack of this type of accessible database may cause patients to be concerned that their wishes may not be known. In our era of smartphones, patients should be encouraged to enter “ICE” (In Case of Emergency) data into their phones, which can include medical information and emergency contacts. Emergency providers should also be encouraged to routinely search for available ICE data on the phones of incapacitated patients.
Dr. Vearrier is clinical assistant professor in the department of emergency medicine at Drexel University College of Medicine in Philadelphia.
References
- Holt GE, Sarmento B, Kett D, et al. An unconscious patient with a DNR tattoo. N Eng J Med. 2017;377:2192-2193.
- Marco C, Savory EA, Treuhaft K. End-of-life terminology: the ED patients’ perspective. AJOB Prim Res. 2010;1:22-37.
- Vearrier L. Failure of the current advance care planning paradigm: Advocating for a communications-based approach. HEC Forum. 2016:28(4):339-354.
- Burris K, Kim K. Tattoo removal. Clin Dermatol. 2007;25:388-392.
- Cooper L, Aronowitz P. DNR tattoos: a cautionary tale. J Gen Intern Med. 2012;27(10):1383.
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6 Responses to “Do-Not-Resuscitate Tattoos: Are They Valid?”
April 16, 2018
Ferdinando L. Mirarchi, DOEmergency and physicians of all specialties need to be aware that this article is in contrast to what occurs in law. The law provides providers with immunity if they allow the Patient to die when they have a LW or POLST. If you save a patients life first and you happen to be wrong then you are at risk for Wrongful Prolongation of Life Litigation. TRIAD VIII and the use of Patient to Clinician Video is the Most Accurate Way to get a patient’s wishes correct and protect both patients and medical providers. The use of smart phones now allow patient to clinician video (MIDEO) to be retrieved in seconds. MIDEO will be featured at the ACEP solutions Conf May 23rd in DC.
It’s time to to be state of the art and not accept status quo and be advocates of our patients.
April 19, 2019
Joseph B.Vocabulary lesson: “Pedantic” — caring too much about unimportant rules or details and not enough about understanding or appreciating a subject.
The amount of over-thinking and over-analyzing on display here is a disgrace. You’ve “lost sight of the forest for the trees” … it’s time to take a big step back and use a little common sense. To the average person, “do not resuscitate” means “allow death to occur.”
Perhaps you want to go down the rabbit hole of “Informed decision-making cannot be presumed” from a tattoo; how do you know an advance directive was full understood or that the person wasn’t suffering from depression when the signed paper documents…? This mentality of moving-the-goalpost anytime you disagree with a patient is unacceptable.
In the ***VAST*** majority of cases, I believe that a D.N.R. tattoo is a clear representation of the person’s desire to allow death and it should be fully respected.
July 14, 2019
Patricia KWhat Joseph B said. If somebody wants to let death occur should something happen to the point they have it PERMANENTLY BRANDED ONTO THEIR BODY…. perhaps you ought to consider that’s what they actually want and respect that.
July 28, 2019
TerrieI do believe if you have a tattoo that says do not resuscitate or D.N.R. that it should be legal because you’re stating your wishes. I don’t want somebody to keep me on machines for years. I had to make the horrible decision to take my youngest son off machines after 7 Days of waiting to find out if he had brain waves or not. So if I have a tattoo on my body that says do not resuscitate or a D.N.R. a doctor should except my wishes… I don’t think anybody has the right to decide for me I will decide for myself with the tattoo
October 10, 2019
GiaTerrie,
I am sorry to hear about your son. I also have lost a daughter and miss her so much. I always say, don’t bring me back if I am already gone, I don’t want to die twice and I get to be with my daughter.
November 14, 2019
DanI’ve been concerting getting a DNR tattoo.
Given this information do you think I should still get it?