Jackson Memorial Hospital recently encountered the case of a patient who was brought into the emergency department unconscious, with a deteriorating medical condition, and without identification or family. Tattooed on the patient’s chest were the words, “Do Not Resuscitate,” followed by what appeared to be the patient’s signature. Understandably, this created an ethical dilemma for the University of Miami doctors treating the patient.
Fla. Stat. § 401.45(3)(a) provides that resuscitation of a patient may be withheld or withdrawn if a valid order not to resuscitate in the form approved of by Florida’s Department of Health is signed by the patient’s physician and the patient or, if the patient is incapacitated, one who is authorized to make health care decisions on behalf of the patient, such as a health care surrogate or proxy, court-appointed guardian, or attorney in fact under durable power of attorney. This form – DH Form 1896 – must be printed on yellow paper, and it has the words “DO NOT RESUSCITATE ORDER” printed in black and displayed across the top of the form.
In the unique case presented at Jackson Memorial Hospital, although the doctors initially questioned whether the tattoo was a true indication of the patient’s wishes and sought not to honor the tattoo absent a valid order not to resuscitate, after an ethics consultation, they decided that it was reasonable to infer that the tattoo indicated a genuine preference and an order not to resuscitate was prepared for the patient. The social work department eventually did locate the patient’s valid DH Form 1896 confirming the patient’s wishes, and the patient died without undergoing life-sustaining measures. Nonetheless, the case highlights the importance of planning for the future, particularly as it relates to one’s health care preferences, in order to avoid any confusion and ensure that the decisions are yours.