Philip J. Goscienski, M.D.
A 60-year-old Kansas City pathologist, apparently in good health, has No CPR tattooed in the middle of his upper chest. What do you think a paramedic or emergency medical technician would do upon finding him unconscious and not breathing after opening his shirt?
A No CPR tattoo is not the same as a written, properly authenticated DNR (Do Not Resuscitate) directive. DNR directives are common and they are legal. For someone who is very old, has poor quality of life and is in the throes of a serious, terminal condition it is reasonable to forego resuscitation that may add only days, perhaps a few weeks, to one's life. Without such a written directive, emergency medical responders have no choice but to take those steps that are necessary to revive the victim.
A person may be unresponsive for some reason other than cardiac arrest. Examples include choking on a foreign object, accidental drug overdose, head injury, insulin overdose, etc. The outcome in these situations is usually favorable with assisted breathing and/or medication. Chest compressions and defibrillation are not always required when a person becomes unconscious.
A tattoo is not a legal document. This is not a recent argument. It was the subject of a medical article in the Western Journal of Medicine in 1992. In that case, a 65-year old surgeon had the universal "Do not defibrillate" symbol tattooed on his chest. He was in good health but he was dismayed by the poor results of defibrillation that he encountered in his emergency room practice. Of course, in 1992 CPR and defibrillation were not at the stage of development that they are at today. As an example, the percentage of "saves" (resuscitation/defibrillation that result in return to a normal heartbeat) at San Diego's Lindbergh International Airport is a remarkable 76 percent.
Emergency personnel cannot withhold care when they discover a NO CPR tattoo. They can only do so when they are presented with the original DNR document. Some have already stated, however, that the tattoo would slow the process, if only to look for such a document.
A search of the medical literature reveals no recent studies that shed light on this issue. One thing is certain: more such tattoos will show up as the pathologist's story gets around. A better solution is to develop ways to communicate a person's wishes in order to avoid fruitless intervention when the situation is truly hopeless.
Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at email@example.com.