Tale from the ED: Tattoos are not a substitute for end-of-life planning

As an ED nurse, I have seen my share of interesting things and heard stories from colleagues that would be difficult for even the most imaginative person to make up. Recently, the New England Journal of Medicine detailed one of those hard-to-believe stories that exemplifies the need for every individual to have a good estate plan or, at the very least, a living will. In this story, an unconscious man arrived to an emergency department in critical condition. Upon examining the man, the ED staff found the words “Do Not Resuscitate” tattoos across the man’s chest. The directive even came with the man’s signature tattooed below it. Physicians, lawyers, and ethicists debated on whether to honor the man’s wishes. After several hours, the hospital staff was able to identify the man and locate a valid “DNR” form for him.

Although a tattoo in across your chest might seem like a good way to get a rescuer’s attention, it’s a poor way to convey your wishes and can end in disaster for both you and the medical staff. For example, a case published in 2002 in the Journal of Internal Medicine described an instance in which a man tattooed “DNR” across his chest after losing a bet. In that case, the man wanted all life-sustaining measures taken. Had the medical staff honored the man’s tattoo, it would have led to disaster for all involved. While many readers will likely question the intelligence of getting such a tattoo, for whatever the reason, they should keep in mind that the best way to convey your wishes is to create a living will (advance directive), have a copy on-hand with a loved one and attorney, and provide a copy to your nearest local hospital and to your primary care physician.

New Jersey law recognizes Advance Directives (living wills) when such a document is signed by two witnesses or notarized. Thus, as a technical matter, the patient’s signature on his tattoo would not constitute a legally-binding directive in New Jersey. Although providers should and do try to honor the wishes of their patients, everyone involved must ensure that those wishes are set forth under a legally-binding procedure.