Living Will Tattoo

[jeastridge]

In this morning's NY TIMES, I read an astounding article about a person who took his advance directives so seriously that he had them tattooed on his chest: His Tattoo Said ‘Do Not Resuscitate.' Doctors Wanted Another Opinion. - The New York Times

Why should a step like this be necessary? Why is it that with our EMRs, our focus on paperwork, and our multitudinous permission slips on admission--why is it that something radical like this has happened? Did this man fear that his wishes would not be honored? Was he afraid that someone wouldn't be able to find the paperwork?

As the article points out, he came in unaccompanied and unconscious--a challenging situation for the care team no matter what. After consulting an ethicist, they honored his stated wishes and he died.

What are your thoughts on this?

How can we improve our end of life conversations?

Do you have some ideas about what we could do better?

How can our current EMRs help or hinder?

EDITED TO ADD

After reading this story, I was prompted to write an article about the necessity of talking to our patients about their end of life decisions. To read the article, go to Can We Talk? End of Life Discussions.

[sunny time]

thank you, as I have said many times the patient is incapable or incapacitated to make decisions the family can rule no matter what the Polst states. the POA had better be someone that is trusted to carry out the wishes. I have my friend not my son because I know what he would do and it is all selfish on his part. I am a DNR with transplant wishes.

[sunny time]

legal? whose going to sue? the patient who is now vegatative,or the family that refused to honor his wishes?

[Rose_Queen, BSN, MSN, RN]

thank you, as I have said many times the patient is incapable or incapacitated to make decisions the family can rule no matter what the Polst states.

Please provide a legit source for this claim. Family, unless a POA, cannot overrule established wishes. Does it happen? I'm sure it does on occasion. Does it happen routinely? I sure hope not! Doing so violates both nursing ethics and the patient bill of rights. Autonomy, nonmaleficence, etc.

the POA had better be someone that is trusted to carry out the wishes. I have my friend not my son because I know what he would do and it is all selfish on his part.

That is simple common sense.

[Rose_Queen, BSN, MSN, RN]

legal? whose going to sue? the patient who is now vegatative,or the family that refused to honor his wishes?

Just because the family may sue doesn't mean they'd have a leg to stand upon in the courtroom.

[sunny time]

obviouly a new nurse. there is no legit source except the experiences that seasoned nurses have. so keep thinking your purest thoughts and then when it finally happens to you, you can then sue for the vegetative state patient. not everything Is black and white. every time a person goes to the hospital or LTAC or SNF a POLST is signed. The answer may vary from place to place. The patient may then decide to change their requirements. Pt may now decide to be temporarily tube fed, so the POLST has now changed. So unless the POA knows that the decision has changed or is able to say we will uphold the recent POLST we follow the family decisions.

[heinz57]

This seems to be a popular tattoo to get right now. A couple of 20 y/o EMTs were showing off their Do Not Resuscitate tattoos in the ER. The impulsive actions of the young or impaired judgement of a drunken dare may also bring questions of legitimacy. Even those who might have health concerns and pursue the tattoo option versus discussions with their physician, attorney and family might raise questions for state of mind. Those who commit or attempt suicide and have a hand written DNR directive lying beside them have been seen many times. Without some evidence the person has discussed mental and physical health with others to substantiate a need for a DNR, we do not know the true intent.

[OCNRN63, RN]

From a legality standpoint, how do we know the patient had it tattooed on his chest? He could have had a long night of drinking with his friends and passed out. His buddies could of thought "Hey, Fred is really passed out, he looks dead. Wouldn't it be funny if we get DO NOT RESUSCITATE tattooed on his chest?" Fred never bothers to get it changed or removed and then this happens.

I think the selling point was that the "Do Not Resuscitate" was accompanied by the patient's signature.

[Rose_Queen, BSN, MSN, RN]

obviouly a new nurse. there is no legit source except the experiences that seasoned nurses have. so keep thinking your purest thoughts and then when it finally happens to you, you can then sue for the vegetative state patient. not everything Is black and white. every time a person goes to the hospital or LTAC or SNF a POLST is signed. The answer may vary from place to place. The patient may then decide to change their requirements. Pt may now decide to be temporarily tube fed, so the POLST has now changed. So unless the POA knows that the decision has changed or is able to say we will uphold the recent POLST we follow the family decisions.

New nurse? Nope, I've got well over a decade of experience. Have yet to end up in court because I've been part of a team that respected a patient's wishes despite family wanting something else. I do believe you are conflating being a family member and being the designated POA. Wishes of family, unless they are the POA, don't matter in the presence of established wishes. If they are the POA, then the patient has given them the permission to make decisions and they are within their scope to do so.

[she244]

I read in the article not only did it say Do Not Resuscitate. He also had tattooed his signature under the wording. I myself have a Living Will, but am not sure the Hospital would even bother to look to see should I go there for an emergency. As I was with my father when each time he went to the same Hospital they asked did he have a living will. He had filled out one and it was suppose to be on file 20 years earlier. So evidentially, they did not know or his chart have never been marked that Yes, he had a Living Will and Health Care Power of Attorney.

[sunny time]

you win

[noctanol]

I didn't read the replies nor did I read that article so this may be a repetition of answers already given. My 2 cents, tattooing DNR or no intubation is not an actual living will though. There has to be more to the story. My guess is he was a "frequent flyer" and had signed a DNR in the past. In Texas back in the days when I was working skilled nursing we used to receive transfers with in hospital DNR orders signed by 2 physicians and a specialist. It was trash, we could not honor it. The patient or resident had to have an out of hospital DNR. if we can't honor a paper with 3 physicians signatures, imagine a tattoo. Anyway, that was my 2 cents. Peace!!!!!!