A recent case in Florida has raised a novel question for emergency medical personnel. In December an unaccompanied, unconscious man was brought into a Florida emergency room. He had no identification with him. Tattooed on his chest in bold, clear letters were the words “Do Not Resuscitate” together with a signature. At first the doctors decided to disregard the tattoo, but an ethics committee later advised them to honor it, concluding “that it was most reasonable to infer that the tattoo expressed an authentic preference.” A formal DNR form that complied with Florida law was later found to confirm that the tattoo indeed reflected the man’s legal intent. What lessons can Nevada EMS professionals draw from the Florida case?
Florida and Nevada have similar DNR rules
A key issue raised by the Florida man’s tattoo is whether a tattoo can create a legally binding DNR order. Like Nevada, Florida’s DNR rules impose specific technical requirements that must be met for a DNR order to be legally binding upon medical staff. A Florida DNR order must be printed on yellow paper and signed by both the patient and the patient’s physician. Medical professionals are only obligated to comply with a DNR order if the original is presented, or if the patient is wearing a DNR identification device, which under Florida law is a miniature version of the larger form and also gets signed by a physician. FAC 64J-2.018.
Nevada’s rules are fairly similar to Florida’s, though they add an extra step for someone to obtain a binding DNR order. Once an application form is signed by the patient and physician, the form is submitted to the Nevada Division of Public and Behavioral Health. The Division issues a special identification card that alerts medical personnel to the patient’s binding preference.
A tattoo may not be legally binding, but it creates an ethical question
A narrow reading of Nevada’s DNR rules leaves little room for interpreting a tattoo like the one encountered in Florida as a binding order. The tattoo lacked the elements of a formal DNR application, including a physician signature. An EMS professional who encounters a similar tattoo therefore may not have a legal obligation to follow it. At the same time, such a tattoo does appear to give notice to medical personnel that the patient has a preference against resuscitation. If circumstances permit, EMS professionals should take the time to inspect the patient’s home or personal belongings for a valid DNR order. Questions should be asked of anyone else present who might know about the provenance of the tattoo, in case they can help uncover a more binding document.
Perhaps the most important lesson of the Florida case for EMS professionals is that the decision of whether to honor a DNR tattoo ideally should rest with individuals with the authority to make formal decisions on behalf of the employer. Although a decision in the field to honor a do-not-resuscitate tattoo might seem like the ethical choice, it is not supported by the law.
GGRM is proud of its work with the Las Vegas EMS community
The attorneys at Greenman Goldberg Raby Martinez have a long track record of supporting clients in the Las Vegas first responder community. We are happy to answer your questions about Nevada’s laws regarding DNR orders. For a no-cost attorney consultation, call us today at 702-388-4476, or ask us to call you through our contact page.