When people are brought into hospital emergency rooms, doctors work as hard as possible to ensure the patient gets the treatment they need. However, there is a system in place, which suggests physicians should not attempt resuscitation if those are the patient's wishes.
But doctors were well and truly stumped when a man was taken to the University of Miami hospital emergency room after he was found unconscious and drunk.
Sure, there are thousands of people who come in for intoxication or alcohol poisoning, but where this bloke stood out from all the rest was a big 'Do Not Resuscitate' tattoo written across his chest.
Credit: New England Journal of Medicine/University of Miami
The experts were immediately thrust into an ethical predicament because although it appears the 70-year-old didn't want to be revived, it's not an official DNR request.
Florida has some pretty strict laws on the practice and a tattoo definitely doesn't fall into those guidelines. The request has to be on yellow paper, with doctor and patient both having to sign it before physicians can legally stand back and let the person die.
The case has been highlighted in a recent article in the New England Journal of Medicine.
Dr Greg Holt, one of the doctors who treated the man, has told the publication: "We always kind of joked around about doing that. A lot of physicians say: 'Boy, I'm going to have that tattooed on my chest so everyone knows my status.' Then you see it and... holy crap."
The NEJM adds that DNR orders are made by about 80 percent of Americans with chronic illnesses.
But when this drunk patient's vitals started dropping, doctors had to work quickly to find out how to proceed. They eventually settled on treatment over the unauthorised request and gave him IV fluids, antibiotics and some medication to keep his blood pressure up.
Dr Holt adds: "[The tattoo] was exactly where you would have to do chest compression, the guy had to have had some knowledge of the medical system.
"It's a concern for both physicians and patients because you want to do right by someone and if you don't know, you do everything you can think of because we always pick the reversible choice, not the one you can't take back when faced with uncertainty."
Eventually, hospital staff found the actual DNR documentation that the 70-year-old had previously signed and doctors decided to let him go.
Dr Holt says the experience was a wake-up call to him and his team and definitely should serve as a reminder to regular people that they should have their wishes well-known to their friends and family as well as hospital staff.
Sources: New England Journal of Medicine
Featured Image Credit: New England Journal of Medicine/University of Miami