Who would get a tattoo on their chest saying, “Do Not Resuscitate” or “No CPR”? Apparently, a lot of people, and it’s creating controversy in the medical world.
Bio-Ethicist Tom Tomlinson argues that DNR tattoos have benefits. They don’t get lost; they go wherever you go. That’s unlike written advance directives, which are seldom in the emergency room when you get there, often not presented upon admission and hard to get into the medical record even when you have one. If you show up unconscious in the Emergency Room and your Advance Directive’s in a file at home, how will doctors know what you want? This concern is what has spurred the growing interest in DNR tattoos.
If you want to be in control of what happens to you at end of life, however, don’t count on your tattoo, because it’s unlikely your wishes will be followed.
According to the American College of Emergency Physicians (ACEP), tattoos are not legal advance directives, in part because they do not include a witness or notary. That’s bad news for this person who thought he had his bases covered.
ACEP says that for a DNR to be legal, informed decision-making must be presumed, and tattoos don’t prove you have a clear understanding of what DNR status means. ACEP also says tattoos don’t provide enough information: Does the tattoo mean no chest compressions, no intubation, no vasopressors? Written documents include information to help patients understand the meaning of various procedures, and to help medical professionals understand what is and is not included.
What about initials? ACEP asks. “Do Not Resuscitate” tattoos are commonly abbreviated DNR. This could mean grim news if your name is David Neil Rosen, or Deborah Nan Ryan.
Plus, end of life preferences change, says ACEP, based on factors like age, health status, prognosis and advances in treatment. Documents are changed easily; tattoos, not so much.
Then ACEP discussed tattoo regret, stating that more than 50% of individuals regret getting their tattoos. I found this hard to believe. Today, most tattoos are the culmination of long planning, not the unintended result of a night of intoxication. Yes, there are stories of people who got DNR tattoos because they were drunk or lost a poker bet, but to suggest that this is the majority or even a significant portion of today’s DNR tattoos, ignores thousands of people who take their DNR tattoos quite seriously.
For all these reasons, ACEP suggests that emergency physicians ignore DNR tattoos and should initiate life-saving interventions, since these can always be withdrawn if more information (i.e. a written advance directive) is obtained. However, discontinuing life support is different from not starting it.
The bottom line is, if you want a tattoo, go for it. You’ll be joining thousands of folks over 65 who are getting their first tattoos. But if you are doing it to tell paramedics and doctors about your end of life preferences, you will need more than a tattoo, you’ll need a properly executed advance directive as well.