美国国家公共电台 NPR When A Tattoo Means Life Or Death. Literally

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LULU GARCIA-NAVARRO, HOST:

In the U.S., end-of-life decisions are fraught¹ and often frustrating². Many people struggle to communicate how they do or don't want to be treated as they die, which is why one man's simple and extreme solution has caught the attention of medical ethicists all over the country. Rebecca Hersher reports.

REBECCA HERSHER, BYLINE⁴: The standard way to tell people that you want to be allowed to die is to sign an official form saying, do not resuscitate⁵ me. But it doesn't guarantee that's what will happen. If you lose consciousness and end up in the ER, that form may not come with you, in which case, many doctors err⁶ on the side of not letting you die.

KENNETH GOODMAN: Look. You can always be dead later. Don't take a course that's irreversible.

HERSHER: Kenneth Goodman is the medical ethicist³ for the University of Miami Hospital. Goodman has seen a lot of dying people in his 30 years on the job. But even he was shocked last summer, when he got a call about a patient who had done something drastic with his end-of-life wishes. The patient had tattooed⁸ do not resuscitate across his chest. The word not was underlined. His signature was tattooed at the end.

GOODMAN: Here's one no one's ever seen before.

HERSHER: The man was 70 years old. He was unconscious when he arrived at the hospital - no ID, no one with him. The doctors asked Goodman, what should we do? It's not an official form. There's no way to know when he got this tattoo⁷ or how he feels about it now. On the other hand...

GOODMAN: He's gone to the trouble of getting a tattoo that says, please don't do this to me. And he's probably seen it pretty frequently since then. I suppose every time one's looking in the mirror, one would see this.

HERSHER: ...In the end, Goodman decided⁹ the tattoo was convincing.

GOODMAN: If we take a piece of paper at face value, where, in fact, someone might've changed their mind, we really should probably take this tattoo at face value, even though he might've changed his mind.

HERSHER: Goodman advised the doctors to take the tattoo seriously. The man got sicker and sicker overnight. They didn't do CPR. The man died. And it turned out the man had an out-of-hospital form on file with the Florida Department of Health that backed up his tattoo. So DNR tattoos¹⁰ have a couple of things going for them. They are hard for doctors to miss. And they're basically impossible to lose. But they're not a good solution because they're not reliable. To understand why, take another example - this one from 2012.

ALEX SMITH: A person who presented with a DNR tattoo at a local hospital here in San Francisco.

HERSHER: Alex Smith is a palliative medicine doctor at the University of California, San Francisco. This man was 59 years old, in the hospital for surgery. The letters DNR were tattooed in red below his heart. His doctors asked him, is that real?

SMITH: And in that case, the DNR tattoo in the person's chest was the result of a poorly conceived drinking game.

HERSHER: Specifically, a poker¹¹ bet with colleagues from - I kid you not - the hospital where he worked at the time. He said he actually wanted to be resuscitated¹². So, yeah, DNR tattoos - not reliable. Doctors and ethicists say what would really be helpful for them is an easy way to access official forms from everywhere. Ideally, EMTs and ER docs would both know instantly what care an unconscious person actually wants.

GOODMAN: Imagine an ordinary patient who has a preference never to be resuscitated and that were in her record. Why, then that ought to be something you could easily call up anywhere.

HERSHER: With the Internet, the cloud, it seems like something that should be possible. In fact, two states do have electronic registries for end-of-life forms. Two others are considering it. And since California's pilot registry began, doctors there say they're seeing fewer patients who choose to wear their preferences on their bodies - etched in bracelets¹³, mostly, not tattooed on their skin. Rebecca Hersher, NPR News.