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.
Explore This IssueACEP Now: Vol 37 – No 04 – April 2018
Some 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.
- 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.