Issues with DNRs and Consent

The article, “An Unconscious Patient with a DNR Tattoo”, raises many important questions about the issue of consent and how to behave in ambiguous situations like this one. According to the article, the doctors initially disregarded the DNR tattoo on the chest of the unconscious, unidentified patient, treating him with IV antibiotics and vasopressors in attempts to stabilize his condition. Later, after seeking advice from an ethics consultant, it was determined that the doctors should honor the patient’s tattooed wish of not being resuscitated.

As Avery mentioned in her blog post regarding this same article, “where does consent start and begin?” Does giving consent to something mean providing verbal consent, written consent on a document, or tattooed consent? A couple of months ago at work, I too witnessed a sort of ethical dilemma in which a patient verbally said that they do not give consent to something yet treatment continued. The patient had come in for a dental procedure but began to seize, forcing us to call 9-11. By the time the paramedics arrived the patient was somewhat lucid, and knew where they were. When the paramedics went to transfer the patient onto the stretcher the patient kept screaming “I do not give you consent to touch me, I do not give you consent to restrain me, I do not give you consent to take me to the hospital.” Even if the patient was having an epileptic episode, were the paramedics right in doing this? The patient was continuously voicing her consent, yet it was disregarded. It is possible that the patient was hallucinating or going through a schizophrenic episode, but the patient was conscious enough to formulate the words “I do not give you consent”. This situation too, was very complex, and I thought that this encounter strongly paralleled with the article in that the male patient was unconscious, but was still expressing some form of consent.

To combat this issue, I feel that we need to develop a better system for people to clearly express their wishes, so there is no confusion whatsoever. Perhaps something could be created similar to the organ donation symbols on drivers’ licenses, where there is some sort of indication of a DNR.  However, this seemingly simple solution might not be satisfactory as the wishes of some people can be very complicated when it comes to DNRs. I know of people who only want the DNR to be followed when there is a low chance of survival (ie: being attached to a ventilator).

Jumping back to the article, I am glad that the doctors did initially begin to treat the patient and disregarded the tattooed DNR. Had the doctors not been able to find his DNR paperwork and followed the patient’s outward desire, it is possible that these doctors or the hospital could have been sued by family/friends. Even though I am not an expert, I think that this system needs to definitely be rebooted and professionals need to consider instances and patient desires such as these when determining what a proper method of obtaining consent is.

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