Jan 6, 2018

Is A Tattoo a Valid DNRO?

By law and training, doctors and emergency medical technicians must do all they can to save lives. That includes administering CPR in the event of cardiac or pulmonary medical emergency. CPR can be withheld only if medical personnel can verify that the patient has a valid Do Not Resuscitate Order (DNRO).

DNRO's are kept in medical charts and by bedsides in hospitals, nursing homes and other medical facilities. When emergency medical personnel are summoned to homes, they look for it on refrigerators or at bedsides. If there's any doubt that a valid DNRO exists, they will err on the side of caution and provide resuscitation.

But what happens if there is no document - just a tattoo?  This is precisely what happened in a case recently reported in the New England Journal of Medicine: 

An unconscious 70-year-old man was brought into a Florida emergency room, unaccompanied by family or friends. He had pulmonary failure, and an elevated alcohol blood level. He had the words Do Not Resuscitate, and his signature, tattooed across his chest. The physicians now faced a perplexing ethical quandary. The tattoo is not a legally binding document; but presumably, this man had wanted the tattoo applied. Even so, did the tattoo reflect the patient's current wishes? Might he have changed his mind and just failed to have the tattoo removed? Erring on the side of caution, the physicians went ahead a treated him with antibiotics and other life-saving measures.

Later, the hospital’s social work department delivered the definitive answer. Through the Florida Department of Health, they were able to confirm that the patient had a DNRO. The physicians ceased treatment, and the patient passed on.

That was a case in which a tattoo accurately reflected an individual's wishes. But another curious incident demonstrates that's not always the case. "DNR Tattoos: A Cautionary Tale," published in the Journal of General Internal Medicine in 2012, describes a 59-year-old man admitted to the hospital for a leg amputation. He suffered from diabetes and chronic non-healing wounds. During the admission process he insisted he wanted CPR in the event of cardiac or pulmonary arrest. But here's the curious part: he also had the letters "DNR" tattooed on his chest. When puzzled staff inquired about it, the patient explained he'd gotten the tattoo years ago as a result of losing a bet in poker game. Medical staff suggested he have it removed, but the patient declined. He insisted the tattoo was obviously a joke and no one would ever take it seriously.

If you are one of the many millions of Americans who would prefer to avoid CPR under certain circumstances, or if you are the health care surrogate or proxy for someone who would want to avoid such measures, no need for a tattoo. What you do need is a Do Not Resuscitate Order. Here are some specifics you will need to know about this important document:
  • The Florida Department of Health DNRO form (#1896) may be downloaded, or call the department to request a form at 800-226-1911 or 850-245-4440, ext. 2795.
  • The form must be signed by you and your physician (but it does not need to be notarized). 
  • To be valid, the form must be printed on YELLOW paper.
  • At the bottom of the form is a “Patient Identification Device” which may be detached from the form, laminated and worn around your neck, clipped to clothing or bed, etc., so it is always with you.

For more information on the DNRO, check out the Florida Department of Health's frequently asked questions about DNRO's.

For information on all types of medical advance directives, click here. 

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