DR Looks Down at Patient’s Chest Tattoo, Lets Him Die. Ethics Expert Says DR Did the Right Thing

Earlier this May, a patient admitted to the Miami Jackson Memorial Hospital gave doctors a big surprised when they found a message written beneath his shirt.

The letters, tattooed across the patient’s chest and written in bold, read simply: “Do Not Resuscitate.”

The word “not” had been underlined, seeming to make his meaning clear. Additionally, the man’s signature was printed underneath the phrase.


The man had been admitted to the Florida hospital unconscious, without identification and with a high blood alcohol level.

The 70-year-old had a history of medical conditions including lung disease, diabetes and heart problems.

Doctors Gregory E Holt, Bianca Sarmento, Daniel Kett and Kenneth W. Goodman wrote a letter to The New England Journal of Medicine with details of the account.

The doctors wrote that they “initially decided not to honor the tattoo,” but the patient never regained consciousness to speak.

“This patient’s tattooed DNR request produced more confusion than clarity,” they stated. “Given concerns about its legality and likely unfounded beliefs that tattoos might represent permanent reminders of regretted decisions made while the person was intoxicated.”

Holt, Sarmento and Kett decided to consult with Goodman, an ethics expert who advised them to honor the man’s printed wishes.

“Here’s a guy who went through the trouble of getting a tattoo, which has the word ‘not’ underscored; he had his tattoo artist include his signature,” said Goodman, the director of the Institute for Bioethics and Health Policy at the University of Miami’s Miller School of Medicine, told The New York Times.

“You don’t go through that trouble, look at it every day in the mirror and actually not mean it,” Goodman added.

Treatment was stopped, and the man later died in the hospital.

Documentation of end-of-life wishes varies by state, and sometimes even by hospital. In Florida, people can fill out a form asking not to be resuscitated in case of a medical emergency.

It was discovered before his death that the man had filled out one of these forms prior to his admittance, but he did not have it with him. Social workers discovered the form after he entered the hospital.

Goodman expressed his hope that this case could increase awareness of ways to outline end-of-life wishes and cause more people to think about the future.

A health care ethics expert and research scholar at the Hastings Center, Nancy Berlinger told the Times there is a growing movement to improve the communication of resuscitation wishes between doctors and patients, but many people are hesitant to talk about mortality.

“Despite the well-known difficulties that patients have in making their end of life wishes known,” the letter concluded.

“This case report neither supports nor opposes the use of tattoos to express end-of-life wishes when the person is incapacitated.”

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