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Thread: DNR tattoo

  1. #1

    DNR tattoo

    This story came across in my email. Is this a legal document or a night out and getting drunk then going for a tattoo? FYI.

    https://www.menshealth.com/guy-wisdom/dnr-tattoo-leaves-doctors-confused?utm_campaign=DailyDose&utm_source=menshea lth.com&utm_medium=newsletter&smartcode=YN_0002721 323_0001646031&sha1hashlower=57a5db96ff26e3d8c793c 675c49eaff3c5b79efa&md5hash=2024d73e3bf17a6faaa031 d4e4479f5c

    This Guy's 'Do Not Resuscitate' Tattoo Stumped an Entire Hospital
    A man was admitted to an ER with ink that raised some serious legal questions

    By Danielle Zickl December 1, 2017
    New England Journal of Medicine



    Florida, we love you, but weird things have been known to happen in your state. There's been a 10-hour
    kangaroo chase, a stabbing over mac and cheese and beer, and a strip club that offered free flu shots to name just a few. (Okay, that last one actually seems pretty helpful, but you get the point.) Most recently, an unresponsive man was admitted to a Florida hospital emergency room with a "Do Not Resuscitate" tattoo on his chest, leaving doctors extremely confused at how to proceed.

    According to Gizmodo, the word "not" was underlined on the tattoo and the man's signature was inked beneath. It may seem like a pretty straightforward thing but doctors initially thought they should ignore the unidentified man's request since a tattoo isn't a legitimate legal document, even if it appears that it was designed to send an explicit message.

    According to the case report, published in the New England Journal of Medicine, "paramedics brought an unconscious 70-year-old man with a history of chronic obstructive pulmonary disease, diabetes mellitus, and atrial fibrillation to the emergency department, where he was found to have an elevated blood alcohol level."

    There were no family or friends present when the man was admitted, and he had no identification on him either.

    "We initially decided not to honor the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty," the authors of the report wrote. "This decision left us conflicted owing to the patient?s extraordinary effort to make his presumed advance directive known; therefore, an ethics consultation was requested."


    Ti
    Credits and photo: menhealth.com, New England Journal of Medicine.

    "We must overcome difficulties rather than being overcome by difficulties."

  2. #2
    Much better to have an advance directive in the format approved by your state, including designation of an agent(s) to be sure that your wishes are carried out. Note that this man's tattoo was honored, but only after consultation with the hospital ethics team, which can take some time since this tattoo did not designate an agent, nor is it in the legal form designated by the state.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  3. #3
    A person better be sure they are serious with a DNR form on file. I was in ER last year with a pretty serious situation. The docs couldn't get my heart rate above 40. He asked the nurse what my form said, which was a DNR directive. When he mentioned he was going to try one more thing and if it didn't work, he was going to let me go. It was like a peaceful feeling came over me and I didn't care if I went or not. I never experienced a feeling like it before or since. I guess that's what it feels like being really close to death. Glad it worked and am back to normal..

  4. #4
    Senior Member Oddity's Avatar
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    Quote Originally Posted by Patrick Madsen View Post
    A person better be sure they are serious with a DNR form on file. I was in ER last year with a pretty serious situation. The docs couldn't get my heart rate above 40. He asked the nurse what my form said, which was a DNR directive. When he mentioned he was going to try one more thing and if it didn't work, he was going to let me go. It was like a peaceful feeling came over me and I didn't care if I went or not. I never experienced a feeling like it before or since. I guess that's what it feels like being really close to death. Glad it worked and am back to normal..

    So, ?Do Not Resuscitate?, in your state, includes letting conscious people die? It is my understanding, in VA, DNR ONLY covers measures to revive someone unconscious and that needs ACLS, CPR or intubation to survive. You were awake and heard the doctor say he was gonna stop treating you? You didn?t need resuscitation yet and he was already gonna quit on you?! Does DNR really include not receiving treatment even before you require resuscitation?
    "Live your life in such a way that the fear of death can never enter your heart." -Tecumseh.

    A Buddhist monk walked up to the guy working behind a hot dog cart and said, "Make me one with everything."

    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus

  5. #5
    DNR orders can be reversed at any time by patients who are conscious and able to communicate. DNR orders state the preferences of people in the event that they become incapable of making autonmous choices in the moment.
    MS with cervical and thoracic cord lesions

  6. #6
    This is why an advance directive that is VERY specific about what you do or do not want done is so important! My advance directive has a whole typed page of things I do or do not what done if I am unable to make my wishes known at the time. For our clients, when we were helping them develop their own advance directive, we encouraged them to include their wishes about the following: CPR, being placed on a ventilator, tube feeding, IV fluids, pain and sedation medication as comfort care, and "chemical" codes, which would include (I assume) what Patrick was describing above.

    I had an experience where one of my clients was admitted to the ED with pneumonia, and was delirious. The ED physician didn't want to treat him because she made the assumption that as a C5 quad he had no "quality of life". The man's attendant tried to tell them that his wishes were for treatment under such conditions. The physician still refused to treat him. The attendant called our SCI Center, where we had a copy of his advance directive on file, which also indicated he would want treatment, and we contacted his agent (his son) who was out of town. He called the ED and told the physician if she continued to refuse to treat his father he would be filing suit, and to either provide all emergency care or transfer his father to another hospital. She did, he was admitted, and was discharged home in good health. This, for me, was validation for EVERYONE having a detailed advance directive, and have copies provided to your primary care physician, your family members, your named agents, and keep a copy to take with you for any hospitalizations as well.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  7. #7
    My father has a DNR and they still put him on a ventilator.

  8. #8
    A website named CaringInfo, sponsored by the National Hospice and Palliative Care Organization provides advance directives forms and instructions by each
    state in the United States. Note that in many states the advance directive has to be notorized or witnessed by two adults. These forms are not intended to take the place of getting legal advice, but they provide a starting place to understand how an advance directive is constructed and the kinds of issues you need to consider. http://www.caringinfo.org/i4a/pages/...fm?pageid=3289

    Some states require a Pre-Hospital Do Not Resuscitate order separate from an advance directive. Some states require a specific color of paper for the Do Not Resuscitate form to be considered a legal document. For instance, Arizona requires the Pre-Hospital Do Not Resuscitate order be printed on orange colored paper. Florida requires yellow colored paper.

    A complement to an Advance Directive is the POLST or Physician Orders for Life-Sustating Treatment. This form is a legally binding order signed by you physician. This form may be required to be printed on a specific color of paper. In California, it is suggested that the form be printed on 65# cover stock pink paper. This color of the form helps to distinguish it in the patient's record. See POLST.org for more information: http://polst.org/advance-care-planni...ce-directives/

  9. #9
    The laws around end-of-life issues have become so complex and byzantine that my husband and I decided to have an attorney, working in conjunction with our primary care doc, draw up and file all of our papers. The attorney brought up issues that we never would have thought of on our own - it was worth the expense to have all bases covered, because we weren't even aware of some of the bases.
    MS with cervical and thoracic cord lesions

  10. #10
    Quote Originally Posted by August West View Post
    My father has a DNR and they still put him on a ventilator.
    Did it spell out specifically that he did not want to be on a ventilator? DNR really doesn't mean anything without detailing the specifics. Many people, including health care providers, assume it means just no CPR.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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