For Va. man DNR tattoo underscores end-of-life desires

Since a Do Not Resuscitate tattoo is not revocable emergency responders are obligated to initiate resuscitation until a valid DNR is shown


By Elizabeth Simpson
The Virginian-Pilot

PORTSMOUTH, Va. —J. Brewer Moore has planning in his blood.

He comes by it naturally, having served as Portsmouth’s city planner for 21 years.

Moore sent me an email after I wrote a column about advance medical directives, legal documents that outline your end-of-life wishes. Moore, 85, keeps his attached to his refrigerator door with a magnet. There’s one for his wife, Joan, as well.

The directives ask that no extraordinary measures be taken to keep them alive.

No ventilators. No feeding tubes. No artificial heart machines.

It’s an action that millions of people have taken, though too many others haven’t bothered.

Moore followed that legal step with another, less common measure:

He had the letters DNR tattooed on his right wrist.

That stands for Do Not Resuscitate.

That idea intrigued me so I went to his house to have a look-see.

Sure enough, there in bold inked letters on his right wrist was “DNR,” along with a red medical alert symbol.

It was his first and only tattoo.

The idea of a DNR tattoo is not new; Google “tattoo and DNR” and you’ll find plenty. One example even supplied two witnesses’ signatures.

(Ouch! Find someone with a short name.)

The idea behind it is you don’t have to worry about carrying around legal papers, or remembering to wear a medic alert bracelet. In an emergency, a paramedic or emergency room physician is likely to see a tattoo etched on the chest – where CPR is performed – or the wrist, where emergency workers would take a pulse.

But the drawback is that tattoos are not legal documents. A legal DNR must be revocable, and that’s difficult when it’s in tattoo form. It must have the sign-off of a physician because it’s technically a medical order that instructs emergency responders not to use CPR to revive someone who has stopped breathing, or whose heart has stopped.

One comment below an online photo of a DNR tattoo says: “Talk about a DNR you can’t ignore.”

But that’s not true; just ask some local first-responders.

In Virginia, emergency workers have a couple of instruments they recognize in holding back from performing CPR. One is a Do Not Resuscitate order signed by a doctor; another is a medical alert bracelet or necklace authorized by the state and supported by a signed DNR. Also, a doctor can tell a first-responder not to revive a patient.

A tattoo would not hold them back from reviving someone.

It does help let people know your wishes.

Virginia Beach EMS spokesman Ed Brazle said he’d look extra hard for a copy of a DNR order if he saw the tattoo on someone he was treating, which he hasn’t yet.

Daniel Norville, battalion chief and chief medical officer for the city of Norfolk, cited the same official code that emergency medical techs follow, and added this advice: Let your family know your wishes.

The tattoo idea is well known among emergency-responders – somewhere between urban legend and running joke – because they’re often the ones who revive someone who they know will not survive or have any meaningful recovery.

In some cases, they know their actions will be futile on frail bodies, but they press on because of legal protocol and family standing by saying, “Do everything you can do.”

A DNR signed by a doctor could reduce those situations, and EMTs recommend you keep it in an armband, on the bedside table, on the bedroom door, or the refrigerator door. Norville said he understands Moore’s sentiment and feels the same: “When I get called home, I’m getting on the bus.”

David Murray, who directs As You Wish Advance Care Planning, told me about a third type of advance directive called Physician Orders for Scope of Treatment form. That’s a medical order written for people with a serious illness that specifies the medical care the patient does or does not want.

Moore says he has his legal documents on hand and has discussed them with his family and doctor. The tattoo serves the purpose of underscoring those desires: “You hear the stories of people saying, ‘Keep him alive, keep him alive.’ No one should be put through the torture of tubes and machines. You go to a nursing home and lay around, and what is the quality of life?”

The tattoo has also been a heck of a conversation starter.

“In these end-of-life decisions, this says to me, ‘This person has told the world what he wants. This is an indication the man has thought it out,’ ” Moore said.

He cites an essay written by 57-year-old oncologist and bioethicist Ezekiel Emanuel last September in The Atlantic magazine. The doctor created quite a buzz by saying he wanted to die at 75, the age he says he won’t have any more screenings, or treatments or extraordinary interventions or even flu vaccines. By that time, he believes his major accomplishments will be complete, and his health prospects will dim.

Moore and Emanuel have made their wishes known. The rest of us should, too. (Ink on paper works for me!)

Another image of a tattoo on the Internet caught my interest since it highlights a desire at the other end of the spectrum. Maybe it’s real, maybe it’s fake, but the tattoo is a list of simple CPR instructions, and a circle in the center of the chest that says: “Press here.”

©2015 The Virginian-Pilot (Norfolk, Va.)

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