A Florida hospital faced an unsettling ethical quandary when paramedics brought in an unconscious patient with "Do Not Resuscitate" tattooed across his chest -- leaving doctors grappling with whether the message accurately conveyed his end-of-life wishes.
The 70-year-old man was admitted to the Jackson Memorial Hospital in Miami with respiratory problems, a high blood alcohol concentration and no identification documents, according to the doctors' story published on Thursday in The New England Journal of Medicine.
"This patient's tattooed DNR request produced more confusion than clarity," doctors said, saying they "initially decided not to honour the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty."
But considering the patient might have gone to extreme lengths to ensure his will was understood -- the word "No" on his chest was underlined, and the message included his signature -- medical personnel requested an ethics consultation.
Doctors meanwhile gave the man basic care to buy time while they considered the life-or-death choice.
The consultants advised the doctors to honour the tattoo, suggesting "it was most reasonable to infer that the tattoo expressed an authentic preference."
Doctors opted to follow that advice, and the man died during the night.
Social workers eventually found a copy of the man's "out-of-hospital" DNR order from the southern US state's health department -- and doctors were "relieved" that it was consistent with the tattoo.
The Miami medical team had hesitated due to a 2012 case of a 59-year-old man who was hospitalised with the message "DNR" on his chest.
The patient later confirmed the tattooed message was not indicative of his wishes, saying it was simply the result of a bet made during his youth while intoxicated.
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