Skip to main content

A DNR Tattoo? Really? Great Teaching Image for Geriatrics or Palliative Care

(To see the JGIM image click this link )
Perhaps you have said, or heard someone declare, "I want DNR tattooed across my chest!"

Well, someone actually had it done.  See this image in JGIM of the tattoo and the unusual story behind it.  In this case, the DNR tattoo was the result of a lost bet in a drinking game - bad idea jeans - the patient actually wanted to be full code!   


In an accompanying editorial, Bernie Lo and I describe the problem with actually tattooing DNR across your chest.  As we say, the idea is intuitively appealing, but flawed as policy.


This could be used a teaching image about respecting individuals' rights to avoid resuscitation.  The idea is to provoke a thoughtful discussion.  Questions for trainees could include:

  • What is behind the idea of the DNR tattoo?  Why would someone say that, or do it?
  • Imagine you are seeing a new patient who arrests in front of you.  Preparing to do CPR you see a DNR tattoo on the chest.  How do you respond?  Why? Should DNR tattoos be respected?
  • What can we do to protect the interests of people who really do not want to be resuscitated?
  • Should we as a society put greater ironclad protections in place for people to irrevocably fix their code status at DNR?  What are the risks?  What if someone codes from anaphylaxis? Chokes on some food in front of you?
  • What do you think about allowing leeway or flexibility in decision making?  In all cases? Giving the surrogate leeway? The clinician?  Do the advance directive forms or POLSTs you use allow for leeway? Should they?
  • What do you think about Ulysses contracts? (Then Ulysses said, "Eurylochus, come quickly! Tie me to the mast, for I shall hear the Sirens song and live!").  Caringadvocates offers such documents (run by frequent GeriPal commenter Stan Turman). Example: do not give me food or water when I have advanced dementia, no matter what I say or do.

Feel free to share your teaching experiences in the comments.  I think the geriatrics and palliative care communities really appreciated the discussion about how to use this video from a previous post as a teaching tool. 

by: Alex Smith

Comments

Suzana Makowski said…
Alex,
Thanks for posting this.
I thought to share the article from BBC news about Joj Tomkins and her tatoo:
http://www.bbc.co.uk/news/uk-england-norfolk-14802369
Anonymous said…
This link, ( http://news.bbc.co.uk/2/hi/health/2819149.stm ), apparently from 2003, shows the same tattoo but with a different story.
Alex Smith said…
Please note that the image in the picture above is not the same as in the story described in JGIM. Click on the link in the caption or text to see that image (i didn't want to violate copyright).
Pashta MaryMoon said…
I have two DNR tattoos -- DNR on my right wrist, and 'No CPR' on my left chest -- to ensure that paramedics/etc. understood my intentions. The photos can seen at http://cindea.ca/advance-planning.html#AssuranceAD
Anonymous said…
I took care of a hospice patient once with a tattoo on his chest, "NO CPR, no resuscitation". He was a quadraplegic post MVA many years previously. It was not considered valid once he died. Due too, " NO WITNESSES signatures". So this mans extreme measures to have his wishes known, we're to no avail! I thought this was very sad!
Anonymous said…
I'm an EMT working in NYC, and I've been talking about getting a tattooed DNR for ages, though I plan to wait until it becomes legally valid. My idea is to pass a bill that would establish the legality of a tattooed DNR if it included a tattooed copy of my signature, my doctor's, and a witness. Part of obtaining the DNR would include the text of the tattoo on carbon paper complete with the original signatures, which a tattoo artist could then just use as his template.

All I know is that I want one. I've seen too many dying and dead people to ever want that kind of quality of life.

Popular posts from this blog

The Future of Palliative Care: A Podcast with Diane Meier

There are few names more closely associated with palliative care than Diane Meier.  She is an international leader of palliative care, a MacArthur "genius" awardee, and amongst many other leadership roles, the CEO of the Center to Advance Palliative Care (CAPC).  We were lucky enough to snag Diane for our podcast to talk about everything we always wanted to ask her, including:
What keeps her up at night?Does palliative care need a national strategy and if so why and what would it look like?The history of CAPC and the leadership centersAdvice that she has for graduating fellows who want to continue to move palliative care forward as they start their new careersWhat she imagines palliative care will look like in 10 or 15 years?What is the biggest threat facing palliative care? So take a listen and if you want to dive a little deeper, here are two articles that we discussed during the podcast:
A National Strategy For Palliative Care. Health Affairs 2017Palliative Care Leadership…

Advance Care Planning before Major Surgery: A Podcast with Vicky Tang

This week's podcast is all about the intersection of geriatrics, palliative care, advanced care planning and surgery with our guest Dr. Vicky Tang.  Vicky is an assistant professor and researcher here at UCSF.  We talk about her local and national efforts focused on this intersection, including:
Her JAMA Surgery article that showed 3 out of 4 older adults undergoing high risk surgery had no advance care planning (ACP) documentation. Prehab clinics and how ACP fits into these clinicsThe Geriatric Surgery Verification Quality Improvement Program whose goal is to set the standards for geriatric surgical care including ACP discussions prior to surgeryHow frailty fits in and how to assess it (including this paper from JAGS on the value of the chair raise test) So take a listen and check out some of those links.  For those who want to take a deeper dive into how GeriPal and surgery fit together, check out these other podcasts: Zara Cooper on Trauma Surgery, Geriatrics, and Palliative Car…

Psychedelics: Podcast with Ira Byock

In this week's podcast, we talk with Dr. Ira Byock, a leading palliative care physician, author, and public advocate for improving care through the end of life.

Ira Byock wrote a provocative and compelling paper in the Journal of Pain and Symptom Management titled, "Taking Psychedelics Seriously."

In this podcast we challenge Ira Byock about the use of psychedelics for patients with serious and life-limiting illness.   Guest host Josh Biddle (UCSF Palliative care fellow) asks, "Should clinicians who prescribe psychedelics try them first to understand what their patient's are going through?" The answer is "yes" -- read or listen on for more!

While you're reading, I'll just go over and lick this toad.

-@AlexSmithMD





You can also find us on Youtube!



Listen to GeriPal Podcasts on:
iTunes Google Play MusicSoundcloudStitcher
Transcript
Eric: Welcome to the GeriPal Podcast. This is Eric Widera.

Alex: This is Alex Smith.

Eric: Alex, I spy someone in our …