An unconscious man came to a hospital with a 'do not resuscitate' tattoo — and doctors didn't know what to do

NEJM/Twitter

• An unconscious man came to a hospital with the words "do not resuscitate" tattooed on his chest.
• The New England Journal of Medicine just published a new case report about the patient.
• Doctors weren't sure whether or not to honor the tattoo.
• Eventually, the hospital located the man's written "do not resuscitate" order, and he later died.

A 70-year-old man came to a Florida emergency room unconscious, with no identification, and an elevated blood alcohol level. Doctors tried to bring the man to consciousness but couldn't — and hospital staff weren't able to locate any next of kin. 

It was a complicated situation made even more complicated by a tattoos across the man's chest. It read "DO NOT RESUSCITATE," complete with a signature. 

That tattoo is the subject of a new case report published by the New England Journal of Medicine (NEJM) on Thursday. And it's not just a story about unusual body art — it also raises some fascinating ethical questions.

Here's what the tattoo looked like:

At first, the report says, doctors decided not to honor the tattoo, but they were conflicted. If the man went to all the effort of getting such a prominent, permanent statement, maybe it really was what he wanted. They requested an ethics consultation at the hospital.

"After reviewing the patient's case, the ethics consultants advised us to honor the patient’s do not resuscitate (DNR) tattoo," the authors wrote. "They suggested that it was most reasonable to infer that the tattoo expressed an authentic preference."

Later, the hospital's social workers found that the man had already filed an "out-of-hospital" DNR with the Florida Department of Health — further evidence for the authenticity of the tattoo. Throughout the night, his status worsened, and he eventually died with no attempts at resuscitation.

Believe it or not, this isn't the only time that doctors have reported a DNR tattoo. The NEJM cited a 2012 case report about a patient who got a similar chest tattoo because he lost a bet during a poker game — it didn't actually reflect his wishes.

But in the case of the Florida man, the inked DNR was at least consistent with a written one.

In an interview with Gizmodo, lead author Gregory Holt said that tattoo regret is "not rare," but also acknowledged that this particular tattoo offered a pretty clear expression.

"My position would be if someone went to the great length of having DNR tattooed with a signature," Holt told Gizmodo, "it indicates a strong and clear wish."

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