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Miami Doctors Debate Whether to Honor DNR Order Tattooed on Patient’s Chest

Planning

Every Florida resident should a valid power of attorney for health care and a living will. The former names a person to make medical decisions for you or speak with your doctors if you are unable to do so. The latter provides advance instructions as to your wishes in the event you have a terminal or end-stage condition or are left in a “persistent vegetative state.”

Florida law also permits an individual to sign a “do not resuscitate” or DNR order. Basically, a DNR directs physicians to withhold or withdraw CPR–including artificial ventilation, cardiac compression, intubation, or defibrillation–in the event you suffer a heart attack or stop breathing. If you have already signed a power of attorney, your agent may sign a DNR order on your behalf.

Under Section 401.45 of the Florida Statutes, paramedics and emergency room personnel are obligated to attempt resuscitation of a patient unless the patient’s physician presents “evidence” of a valid DNR order. In an emergency situation there may be some confusion as to whether or not the patient has such an order. This is why it is always a good idea to also have a valid power of attorney so there is someone who can speak with the doctors directly.

Of course, some people have resorted to more creative means of informing doctors as to their wishes. Physicians at the University of Miami hospital’s emergency department recently presented an unusual scenario to the New England Journal of Medicine. In this case, paramedics brought a 70-year-old man to the emergency room. He had a history of heart disease and other serious medical ailments. He also had the words “Do Not Resuscitate” tattooed on his chest.

Initially, the doctors declined to honor the “DNR tattoo,” and proceeded to attempt various resuscitation measures. But the hospital’s ethics consultants later advised the emergency room personnel to honor the tattoo. According to the physicians’ report, the ethics consultants “suggested that it was most reasonable to infer that the tattoo expressed an authentic preference.” And while a tattoo was a non-traditional means of executing a DNR, “suggested that it was most reasonable to infer that the tattoo expressed an authentic preference.”

As it turned out, a social worker at the hospital later identified the patient and located his signed DNR order on file. The doctors honored this order and the patient passed away the next morning “without undergoing cardiopulmonary respiration or advanced airway management.”

Bring Clarity, Not Confusion, to Your Estate Planning

The Miami doctors concluded the “tattooed DNR request produced more confusion than clarity.” In the end, it is always best to stick with the traditional written forms for informing your doctors about your preferences regarding extraordinary or end-of-life care. An experienced Fort Myers estate planning attorney can help you prepare a power of attorney and other documents that will hopefully preempt the need for unusual methods of communication like a tattoo. Call the Kuhn Law Firm, P.A., at 239-333-4529 to schedule a free consultation today.

Source:

nejm.org/doi/full/10.1056/NEJMc1713344?af=R&rss=currentIssue&

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