The Problem with Actually Tattooing DNR across Your Chest
No doubt JGIM readers have heard a clinician exclaim, after participating in a code or witnessing the suffering of a resuscitated patient, “I should have DNR tattooed across my chest!” For those individuals who strongly desire not to be resuscitated, the tattoo idea is appealing. By its nature, a tattoo implies a preference against resuscitation so strong that the person has etched the image onto their body. The tattoo is inseparable from the body. Unlike Do Not Resuscitate (DNR) paperwork or medic-alert bracelets, it cannot be misplaced, easily removed, or lost. Emergency responders are unlikely to miss seeing a DNR tattoo on the chest prior to attempting resuscitation.
To the extent that we should find ways of respecting persons’ deeply held preferences not to be resuscitated, we agree with the sentiment, if not the method. Clinicians are morally and legally obligated to respect the preferences of patients to forgo life-sustaining treatment.1 The notion of a tattoo stems in part from ...
- Lo B. Legal Rulings on Life-Sustaining Interventions. Resolving Ethical Dilemmas: A Guide for Clinicians. Baltimore: Lippincott Williams & Wilkins; 2009:170-174.
- Wenger, NS, Phillips, RS, Teno, JM (2000) Physician understanding of patient resuscitation preferences: insights and clinical implications. J Am Geriatr Soc 48: pp. S44-S51
- Smith, AK, Fisher, J, Schonberg, MA (2009) Am I doing the right thing? Provider perspectives on improving palliative care in the emergency department. Ann Emerg Med 54: pp. 86-93 CrossRef
- Cooper L, Aronowitz P. DNR Tattoos: A Cautionary Tale. J Gen Intern Med. 2012; doi:10.1007/s11606-012-2059-8.
- Rosenfeld, KE, Wenger, NS, Phillips, RS (1996) Factors associated with change in resuscitation preference of seriously ill patients. The SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Arch Intern Med 156: pp. 1558-1564 CrossRef
- Halpern, J, Arnold, RM (2008) Affective forecasting: an unrecognized challenge in making serious health decisions. J Gen Intern Med 23: pp. 1708-1712 CrossRef
- Fromme, EK, Zive, D, Schmidt, TA, Olszewski, E, Tolle, SW (2012) POLST Registry do-not-resuscitate orders and other patient treatment preferences. JAMA 307: pp. 34-35 CrossRef
- The Problem with Actually Tattooing DNR across Your Chest
Journal of General Internal Medicine
Volume 27, Issue 10 , pp 1238-1239
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- 1. Department of Medicine, Division of Geriatrics, University of California, 4150 Clement St (181 G), San Francisco, CA, 94941, USA
- 2. San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- 3. The Greenwall Foundation, New York, NY, USA
- 4. Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, CA, USA