When emergency medical personnel encounter an individual with life threatening circumstances that involve loss of pulse or loss of breathing, these individuals must know whether or not the patient has authorized a “do not resuscitate order,” or DNR order. This is a medical order that requires the signature of a doctor. It states that the person does not want doctors (or nurses, or EMTs, etc.) to attempt life-saving procedures.

Without this order, medical personnel are responsible for using all available resources to the life. If medical professionals make the wrong decision under the pressure of time, they risk becoming subject to charges of wrongful death.

With that information in mind, consider this: A 70-year-old Florida man in critical condition is brought into an emergency room. He possesses a history of chronic obstructive pulmonary disease, atrial fibrillation, and diabetes. He currently has a high blood-alcohol level. The man has no traceable family, friends, or identification on his person. The only visible indication of his wishes is a tattoo on his body that reads “DO NOT RESUSCITATE,” with his signature as part of the tattoo.

Of course, DNRs are routinely used in the medical arena – most often when patients have incurable diseases or terminal illnesses and do not want their doctors and family members to prolong their life in a continuous vegetative state with a very low probability of recovery, at least to the point where they can enjoy some measure of quality of life. What made this case unbelievable, and also an on-the-spot dilemma for emergency medical professionals, is that a direct message indicating the patient’s preference of “do not resuscitate” was present with a signature.

But the signature was on skin, not on paper. So, does it count?

The ethical and legal questions

The questions that required an immediate answer were threefold:

• Did the tattoo convey the man’s actual wishes?
• If so, should it be honored as such, ethically?
• Were the medical personnel legally obliged to honor it?

The doctors initially did not honor the message of the tattoo. Instead they erred on the side of saving the man’s life. The problem at hand was how to determine the legitimacy of the message in the tattoo – was it something the man received many years ago possibly on the spur of the moment, and under the influence of alcohol? Or, was it a purposeful directive to medical personnel in charge of his critical medical care at a future point in time?

As explained by the doctors in an article published by the New England Journal of Medicine, the dilemma was resolved in this case when ethics consultants authorized the recognition of the tattoo as a legitimate DNR. The doctors, therefore, did not continue to take resuscitative measures to keep the man alive. Later on, the man’s written DNR was found that confirmed the decision. However, there are questions that remain from this scenario. Was the tattoo sufficient legally to act upon if no ethics consultants were available at the time, and no written DNR was ever found?

The answer in the state of Florida where this scenario occurred is “no.” Florida requires a legally binding signed form in order for a request for a refusal of resuscitation to be granted. Without the form, the doctors would not be held liable for attempting to keep the man alive, despite the presence of the tattoo’s message. Other states, including Tennessee, require these forms as well.

Have you or your loved one been the victim of wrongful death? At Delius & McKenzie, we can develop a strategic plan on your behalf to fight aggressively on your behalf to recover the compensation you and your family are owed. We serve clients in and around Somerville, Pigeon Forge, Gatlinburg, and Seymour. Call us at 865-428-8780 or email us through our contact form to set up a free, no obligation consultation about your case.