DNR Tattoos: Are You Kidding Me?

Here is one for all the paramedic legal eagles out there: You arrive on the scene of an unconscious 80 year old female. During the course of your patient assessment you notice a tattoo on her chest stating “Do Not Resuscitate”. Do you have to honor that request?

We have discussed DNR orders here quite a bit, but this case is a bit different. Not that 80 year olds should be prohibited from getting inked, nor that people should be limited in their decisions on the extent to which their lives should be prolonged, but seriously? A DNR tattoo?

That is how an 81 year old grandmother from the UK, Joy Tomkins, has chosen to make her last wishes known to emergency responders and hospital personnel. That’s not all. Tomkins also had the letters “PTO” tattooed on her back along with an arrow directing viewers to her front. Click here for the photos.

Tomkins was quoted by Mirror.com as saying: “I do not want to be half dead, I want to be fully dead. I’m afraid the medical profession will, with the best of intentions, keep me alive when I don’t want to be alive. …I don’t want to lie for hours, months or even years before dying. I do not want to end up as a vegetable. I don’t want my family to remember me as a lump. That is why I got the tattoo.”

The news article reports that a British General Medical Council spokesperson said most UK doctors would ignore the tattoo. I would have to agree. Here in the US she would still have to comply with what ever state law requirements were applicable for a DNR request to be honored. The tattoo alone would not cut it. However, the tattoo should serve as notice to check further.

About Curt Varone

Curt Varone has over 40 years of fire service experience and 30 as a practicing attorney licensed in both Rhode Island and Maine. His background includes 29 years as a career firefighter in Providence (retiring as a Deputy Assistant Chief), as well as volunteer and paid on call experience. He is the author of two books: Legal Considerations for Fire and Emergency Services, (2006, 2nd ed. 2011, 3rd ed. 2014) and Fire Officer's Legal Handbook (2007), and is a contributing editor for Firehouse Magazine writing the Fire Law column.
  • Don Rimgale

    A DNR order in my state has to have a physician’s signature, so the tattoo would not be sufficient reason to withhold resuscitation. As the article suggests, however, it would give us motivation to take a look around for the official paperwork (if she arrested at home).

    • Thanks Don

      EMS personnel in most if not all states will be in the same boat.

      Funny thing is – a patient has the right to revoke a DNR order at any time… how exactly would Ms. Tomkins go about doing that if she changed her mind? (assuming that the tattoo was a valid DNR…). I suppose the same issue would arise if someone had their will tattooed on their body… witness signatures, notary stamps and all….. You can’t make this stuff up! Dot Net!

  • I have a new idea for the latest in DNR, and other medical information storage. There have been implanted RFID chips in pets that store information on where they live. It is not much of a stretch to envision the use of a similar system that would store a person’s medical history, meds, allergies, etc (including a copy of a DNR if applicable). I’ll double check, but IIRC, EMS in MA (where I live and work) may honor a photocopied DNR, as long as it is properly filled out, and all the signatures clearly legible.

    • Thanks Band-Aid Bandit

      Another interesting idea. In preparing a new course on Managing Fire Departments in the Digital Age I came across some laws that a few states have enacted laws to prohibit employers from requiring employees to have RFID chips embedded in them (and you think your boss is a monster….).

      My gut tells me there still needs to be a way for a patient to change their mind as the last moment approaches – which tattoos don’t lend themselves to – perhaps there could be a technological solution with the chip where the patient could be given a way to reprogram it. Interesting thought.

      There was an article not that long ago that said implantable chips cost pennies now (BTW – I can’t believe we have reached the point where this conversation is actually happening).

  • Mike

    The interesting question is how does a person stop first responding EMS or emergency room personnel for that matter from reviving them? From what I am reading on the subject, it would appear that an individual desiring not to be revived would have to wear their written desires taped to their chest. While this sounds sarcastic, it is really not intended to be. With medical advances being what they are and first responders doing what they are trained to do, I find it hard to conceive that while a person lays unconscious and not breathing on the floor that they are going to take the time to look for paperwork or to scan an RFID.

    It is actually a very timely and relevent subject for discussion given medical advances and what can be done to bring a body back to life.

    An interesting question for which I would guess there exists some data is how often in either an EMS situation or an emergency room setting is a body brought back but the person or not all of the person makes it back.

    Several of my friends have thought of getting the DNR tatoo and wondered whether any medical personnel would honor the DNR tatoo so at least I can tell them the answer is don’t bother. It will be ignored most of the time.

  • Bobby Dupont

    I want a tattoo that states “Euthanize If Possible” I plan to get the DNR tat also.

    I have seen too many family members be tortured by medical facilities for years before they died.

    I have serious medical conditions and have been paralyzed as well as horrible chronic pain. I want to live but if my situation gets worse, I don’t want to be kept alive. I tell my friends and family, “if I couldn’t survive lying in the woods, I don’t want to go on, euthanize me”. They say they want to know when to let me go. They are afraid to allow me to die, I am terrified they might allow me to live.

    I have considered suicide at times ONLY because once incapacitated, I would have no control. I have seen what happens then and it is pure torture.

    And don’t give me that permanent solution/temporary problem bullshit….I am not a teenager depressed about lost love. I have a degenerative brain disease which causes more pain and terror than most could handle.

    I already have a living will, notarized etc. The DNR tattoo will be next. After that, fingers crossed I guess.

    • Bobby

      Thank you for adding in your thoughts. Hopefully you read and understood my posting – that a tattoo will not do anything in terms of making sure that ALS/BLS treatment is withheld. You must work with your doctor to obtain formal DNR status as permitted by state law in your state.

  • Bobby Dupont

    Yes Curt,

    I understand that. I was just venting. Emotions run high in situations like these. I already have a DNR order which is recognized by my state. I am just very scared that I cannot be euthanized if necessary. That is not exactly legal and some people commit suicide because they know they might be forced to live in torture. In some countries where euthanasia has been made legal, less people have committed suicide due to the knowledge that they will not suffer if worse comes to worse. I know how they feel.

    • Thanks Bobby

      I had never considered that legalizing euthanasis would reduce suicide (outside of the obvious) – but the logic does make sense.

  • Reason

    I really wish we had a right to die as American citizens, indeed my view is that if in one’s pursuit of happiness one determines they’d be happier dead, don’t they have the right to die?

  • Melissa

    Living in chronic oftentimes unbearable pain from a spinal cord injury (degenerative disc, no one I can sue) in a corrupt and criminal state where correct pain management is impossible to obtain (FL) has left me no longer wishing to prolong my life by any means. I am in the process now of completing all paperwork through my law office to make this possible. I have dedicated my entire life to public service and volunteerism and find that social security will most likely not even be possible for me because as far as I can tell everyone I see who is collecting social security can get out of their cars and walk just fine into the grocery store. That appears to have gone corrupt here too. Poverty and death are my only up and coming rewards for my service to this country so I’d like death to not be postponed please. I plan to carry my DNR papers in my car, my purse and everywhere I go. I was a volunteer FF/EMT for 7 years back in the day too. Trust me… DO NOT DO THAT TO ME… LET ME GO! I had a full and rewarding life, better than anyone I know. The body is just broken now. It’s over. When it goes, let it go.

  • Michaela

    Where would I find information on my state’s laws on DNR related events? I live in PA and would like to know what I can do to make sure I am DNR.

    Thanks guys!!

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