Having an end-of-life directive tattooed on your body may provide peace of mind – but spare a thought for those tasked with interpreting it.
A case report published in the NEJM highlights the ethical conundrum faced by staff at a US emergency department after the arrival of an unconscious 70-year-old man with the words “do not resuscitate’ accompanied by a presumed signature inked across his chest.
The man had a history of chronic obstructive pulmonary disease, diabetes mellitus, and atrial fibrillation.
Upon arrival he had an elevated blood alcohol level and within hours developed hypotension and an anion-gap metabolic acidosis (pH of 6.81).
Doctors initially opted not to honour the tattoo’s directive, invoking the principle of not choosing an irreversible path when faced with uncertainty.
But the decision left them conflicted.
They considered the patient’s extraordinary effort to make his presumed advance directive known.