A story about a man’s unique tattoo went viral last week. An unidentified, unconscious 70-year-old man was rushed to the Emergency Room at University of Miami Hospital. The hospital began to try to help the man, but upon removing his shirt, they found a tattoo reading: “Do Not Resuscitate” with a signature below it. Legally, in the state of Florida, Do Not Resuscitate (DNR) orders must be printed on yellow paper and signed by a doctor. DNR orders, like all medical directives, should be easily amended (whereas a tattoo is obviously permanent and expensive to remove).
The man arrived alone, unidentified, and could not communicate, so the tattoo was the only indication of any end-of-life wishes. When considering their options, the doctors talked about a story about another man with a DNR tattoo on his chest that he only got as part of a drunken bet but didn’t really mean it. So, initially the doctors ignored the tattoo on their patient and treated him, worried that if they had withheld CPR, they might be have been liable for an erroneous interpretation of the tattoo.
They later learned that the patient had a history of chronic obstructive pulmonary disease, diabetes and an irregular heart rate. A few hours later, the patient’s condition worsened. The doctors began to feel conflicted, wondering if the man’s end-of-life wishes were being ignored. They asked ethics consultants to review the situation. The ethics board at the hospital recommended following the DNR request based on the assumption that it is reasonable to believe the request is authentic.
A DNR Order was written. Soon after, the hospital found that the patient did submit the proper legal paperwork to the Florida Department of Health to prevent resuscitation. The man’s condition deteriorated as the day went on, and he passed away.
A doctor at Jackson Memorial said, “It seemed he didn’t trust that his end of life wishes would be conveyed appropriately. So to me, it means we need a better system so that we don’t do things to people that they don’t want.”
According to a study in PLOS One, an estimated 80% of Medicare patients would prefer to avoid high cost care including resuscitation, at the end of their life, but those preferences are often overridden.
Firm Partner, Ed Price recommends that in order to ensure that your wishes are followed, you should have a legally binding living will, as well as a card in your purse or wallet directing emergency personnel to call your designated health care agent for end-of-life instructions in the event of an emergency.
What is a health care agent? A health care proxy or medical power of attorney. He or she is someone that you appoint (typically a spouse, relative, or close friend) willing to honor your healthcare preferences if you are unable to speak for yourself. Prior to appointing a health care agent, you should make sure that this person is aware of your wishes and willing to honor them – even if they disagree with them – in the event of a medical emergency.
What is a living will? A written statement detailing a person’s desires regarding their medical treatment in circumstances that they are no longer able to express informed consent, especially an advance directive.
Living wills may not always be followed, especially in emergency situations (some states have different laws), so a medical order is also recommended.
A medical order, called a POLST (Physician Orders for Life-Sustaining Treatment), makes those advance directives binding on medical staff, including emergency room and ambulance personnel. The medical order is also what indicates whether a patient has a DNR order.
This tattoo may express this man’s end-of-life wishes, but a hospital is still liable if they do not have the properly executed DNR form and do not resuscitate him. So, they are better off searching for the form, and if there is not enough time, resuscitating the man. Yes, this is a flaw in the medical system regarding end-of-life wishes, but hospital administrators choose to err on the side of keeping someone alive until such time as the DNR form and or medical order can be authenticated. Price & Keir can help you create a living will, so that your end-of-life wishes are clear. Give us a call today at 410-528-7205.