A man collapsed with ‘Do Not Resuscitate’ tattooed on his chest. Doctors didn’t know what to do.

Doctors in Miami faced an unusual ethical dilemma when an unconscious, deteriorating patient was brought into the emergency room with the words “Do Not Resuscitate” across his chest.
The 70-year-old man was taken earlier this year to Jackson Memorial Hospital, where doctors made their startling discovery: a chest tattoo that seemed to convey the patient's end-of-life wishes. The word “Not” was underlined, and the tattoo included a signature.
It left the medical team grappling with myriad ethical and legal questions.
Was it an accurate representation of what the patient wanted? Was it legally sound? Should they honor it?

The case was detailed Thursday in the New England Journal of Medicine, in a report that laid out the medical team's struggle for answers.
“This patient’s tattooed DNR request produced more confusion than clarity, given concerns about its legality and likely unfounded beliefs that tattoos might represent permanent reminders of regretted decisions made while the person was intoxicated,” the paper's authors wrote.
Gregory Holt, a critical-care physician and lead author of the paper, said in an interview that “I think a lot of people in medicine have joked around about getting such a tattoo — and then when you finally see one, there's sort of this surprise and shock on your face. Then the shock hits you again because you actually have to think about it.”

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Holt said the patient, who had a history of pulmonary disease, lived at a nursing home but was found intoxicated and unconscious on the street and brought to Jackson Memorial.
He arrived with no identification, no family or friends, and no way to tell doctors whether he wanted to live or die.

Holt said the man had an infection that led to septic shock, which causes organ failure and extremely low blood pressure.
When his blood pressure started to drop, emergency room doctors called Holt, who specializes in pulmonary disease — and they first agreed not to honor the tattoo, “invoking the principle of not choosing an irreversible path when faced with uncertainty,” according to the case study.