Critter Corner: Should You Get a DNR Tattoo?

Dear Ribbit,

I read something about people in Florida getting tattoos that tell doctors that they do not want to be resuscitated. Is this something more people should consider? If someone doesn’t have a tattoo, how do medical professionals find out that someone has a DNR order entered in their medical file?

Dana Riordor

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Dear Dana,

In Florida, they currently have an approved DNR (do not resuscitate) form. However, it doesn’t do any good if the form is lost or not shown to the rescue unit or emergency-room staff. On top of that, many medical facilities in Florida and other states do not accept a previously-signed state-approved Do Not Resuscitate (DNR) form when a patient is admitted. Rather, the patient or the health-care proxy in many states have to sign new DNR forms for each hospital admission or else the patient is resuscitated.

A DNR tattoo might seem to be a perfect solution as it would seem to clearly indicate a patient’s wishes. However, this is not necessarily the case according to the doctors in Florida that recently dealt with this issue. At first, the doctors actually decided not to honor the tattoo, saying they did not want to choose an irreversible path when faced with uncertainty. They cited one other case, found in a review of the scientific literature, involving a person with a DNR tattoo — saying that patient’s tattoo no longer reflected his current wishes.The medical team was also worried about the potential unknown circumstances in which a person might get such a tattoo. What if the patient had done it while under the influence of drugs or alcohol?

However, not everyone on the medical team agreed, and so an ethics committee was brought in to consult on the issue. The ethic committee advised the doctors to honor the DNR tattoo. The ethics team stated that it was reasonable to infer that the tattoo expressed an authentic preference.

The tattoo is not being used (to my knowledge) in Virginia, MD or DC, nor are there any laws allowing the use of such tattoos. However, Virginia does have a Durable DNR statute, which means that people do not have to sign a new DNR each time they are admitted to a hospital. In fact, the Durable DNR is the only DNR form issued by the Virginia Department of Health (VDH). Durable DNR Orders do not expire. They remain in effect until the patient or someone designated to act on the patient’s behalf revokes the order. Click here for more information.

Virginia also allows specialized durable DNR jewelry (bracelets and necklaces) to be purchased and worn by people with a durable DNR order entered in their medical records. This jewelry is only available from two State-approved vendors. Click here for ordering information.

From my limited research, Virginia is the only state that seems to allow Durable DNR orders. However, many other states have a somewhat similar Medical order called a MOLST (Medical Orders for Life-Sustaining Treatment) or MOST (Medical Orders for Scope of Treatment ) or POLST (Physician’s Orders for Life- Sustaining Treatment). These medical orders are typically durable, meaning they do not have to be re-signed upon each admission.

Maryland offers the use of a MOLST form which can be signed by your doctor. Click here for further information http://marylandmolst.org/pages/molst_form.htm.

DC allows use of a MOST form. Click here for more info. Although this law has been enacted in DC, it is not clear whether the DC MOST form actually exist yet.

These forms differ from DNR orders in that they also include directions about life-sustaining measures in addition to CPR, such as intubation, antibiotic use, and feeding tubes.

Despite all of the above, it is important to understand that none of these forms can be used by healthy individuals; they are designed to be used by people who already are extremely sick or elderly. Also, none of these forms are substitutes for a properly-prepared Advance Medical Directive, which is a document that should be signed by individuals of all ages, regardless of current health.

Ready for Incapacity Planning?

Once you have taken the step of speaking with your loved ones about your wishes, it is important to develop incapacity planning documents, including an Advance Medical Directive and General Power of Attorney, to make your wishes legally enforceable. Call Evan to make an appointment for a no-cost initial consultation.

Hop this is helpful!

Ribbit

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