Every now and then - just to exercise our pugilistic perspective - we like to argue with trial lawyers. Keeps us fit and feisty, somehow. And one of the coolest places to do so is on law professor Jonathan Turley's website, which is probably one of the finest, most interesting blogs on the planet. Great stuff, there, and we've opined numerous times over the years. If you find yourself bored, you might head on over there.
In December, a blog post addressed the matter of a fellow whose heart had stopped, and when his shirt was opened by rescuers to perform proper CPR, they noted that the man had a chest tattoo, informing the medics that he wanted nothing of the sort to be done. Here's a brief review of the story:
Doctors at Jackson Memorial Hospital faced a novel issue when a 70-year-old man was brought into the emergency room after being found intoxicated and unconscious on the street. (The man lived at a nursing home and had a history of pulmonary disease). The doctors were working to assist the man when someone noticed a large chest tattoo reading “DO NOT RESUSCITATE.” It even had a tattoo signature. After consulting an “ethics expert,” the hospital treated the tattoo as a viable DNR form and allowed the man to die. In my view, the expert was wrong on the law if his decision was based solely on the tattoo.
The problem, professor Turley explained, is that “Do Not Resuscitate” t-shirts and tattoos are common jokes. There was no way that the staff could determine if this was a joke or a waiver.
A similar case was discussed in a 2012 article in the Journal of General Internal Medicine, involving a 59-year-old patient. He had “DNR” tattoo across his chest but he said the tattoo was a joke and the result of losing a bet in poker.
In this case, there are reports that the the hospital may have been able to secure a DNR order from the patient that was signed previously. That would obviously impact the decision greatly and support a DNR decision. It would be the waiver, not the tattoo, that should be determinative.
The question is whether to err on the side of life and the answer, in my view, is clearly yes. The staff should not have made an assumption that this tattoo was meant as a substitute of a DH Form 1896 or constructive waiver of resuscitation.
What do you think?
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Well, very cool of you to ask, because the Paramedic Heretic probably has an opinion. And when one attorney on the blog responded to professor Turley's article by saying, “The tattoo is meaningless,” well, we just can't help ourselves. We had to jump into the fray.
“The tattoo is meaningless,”
To which we answered, Oh, contraire, mon lawyer frere.
No, actually, the tattoo isn’t meaningless at all – not in the real world of EMS, for numerous good reasons:
1. Although Mr. Turley is correct that “DNR” is sometimes scribed as a joke – its existence on the very place on the body where chest compressions would be performed, is taken at face value, by those of us who do this stuff for a living in my area. We never assume “jokes.”
2. This man was confined to a long term care facility with 3rd-stage lung disease. He knew he wasn’t ever going home. The “P” in CPR stands for pulmonary. Pulmonary means lungs. Both the staff and the gentleman likely knew full well that dying lungs don’t get better. Patients in a SNF don’t expect miracles.
3. Those of us in the world of rescue know several things that the lay-public should be taught from about 8th grade – but aren’t. And that’s a pity. The most important is that CPR almost never “saves” the unhealthy patient. CPR was never created for the elderly with serious organ failure. Quite the contrary. Its purpose is to buy a survivable patient – one with a healthy heart and lungs and brain, such as drowning – time to get to advanced care needed to fully recover.
4. This gentleman confined to a bed in a SNF had bed baths by staff members. Don’t ever for a minute think the staff was unaware that he wanted no “heroic” procedures.
5. This fellow not only had the tattoo'd statement - he had it signed.
Lastly, for those interested, in research for one of my books, I questioned 400 physicians on several matters, one of which was this:
“When the time comes for your medical crisis, Doctor, do you want CPR performed on YOU?”
Out of 400 MDs nationwide, do you know how many responded, “Yes?”
In fact, more than a few physicians have their own chest tattoos.
So next time you decide to smoke - put that in your pipe.