Abstract
Example 1
Henceforth, the medical team initiates the process of reviewing her code status. The patient does not have an heir or a next of kin. She has been living independently and has no medical records of physician visits for innumerable years. She may have an attorney, but the initiated efforts to find the law firm becomes time consuming. The process of legal guardianship is initiated to come to the decision regarding her code status. The concerted decision to change code status to “comfort measures only” is made by the legal guardian after weighing the benefits and risks of continuing life support, and subsequently, the patient does not receive any chest compressions during the next episode of pulseless electrical activity, and dies peacefully.
The only dilemma that lingers with the medical team is that it would have been more comforting to have had some method of knowing the patient's wishes. Had the patient's wishes been known, the medical team would not have had to rely on the legal opinion of the neutral third party of legal guardianship, although supposedly intended as congruent to patient's wishes in the worst case scenario.
Example 2
Suppose the same patient walks into the supermarket for weekly grocery shopping. While dining in the in-house restaurant, she chokes on the buffalo wings. The emergency medical services are activated. In the meantime, the young waitress who has the basic skills in the Heimlich maneuver tries to make her cough out the choking food particle. However, the patient becomes unconscious and when the paramedic team removes the shirt of the patient to initiate chest compressions, they observe a do-not-resuscitate tattoo in the sternal area, indicating the wishes of the patient. Now the dilemma of the emergency paramedic team is whether to initiate cardiopulmonary resuscitation for this acute salvageable critical event or to respect the patient's wishes as obscurely reflected by the tattoo with no clear indications for the medical conditions when her wish for do not resuscitate has to be fulfilled.
These two conflicting clinical scenarios with the ethical dilemmas for the caregiver team to respect the patient's autonomy puts forth a difficult question and the author suggests the henceforth solution. Institute a tattoo flash that can be copyrighted by the American Academy of Hospice and Palliative Medicine and emblematized as “Consider do not resuscitate” so that the person is not denied cardiopulmonary resuscitation in acute and salvageable events. Essentially, the consideration of do not resuscitate as patient's documented wish as reflected by the tattoo flash will be an additional tool for supplementing the living will in people (41% Americans) who have been aware and vigilant enough to have the living will prepared in their lifetime, 1 and complementing the living wills that were never prepared though the people were aware enough of documentation of their wishes in forms that are more conducive to their sensibilities like having a tattoo (14% Americans). 2 Moreover, the addition of the word “consider” in the verbatim will swing the weight from withholding life support to withdrawing life support, as the withdrawal of life support is performed under more controlled and less obscure ethical scenarios than the acute and critical clinical scenario of withholding life support that demands the immediate decision regarding the knowledge of code status of the person in question. Hence, the tattoo flash will be a cost effective, easily accessible, comprehensible, and always executable tool for fulfilling the personal wishes of the people to die respectfully as the tattoo flash will be the patient's participation in the time-out before the withdrawal of life support indicating it loud and clear, “Consider do not resuscitate: I concur to the guided and educated decision of my medical team for medical futility in my present clinical scenario.”
Footnotes
Acknowledgment
The author is sincerely thankful to Dr. Michael Stellini, M.D., M.S., Assistant Professor of Medicine and Chief, Section of Palliative Medicine, Wayne State University, and Dr. Harold Michael Marsh, MBBS, Chair and Professor of Anesthesiology, Wayne State University, for their able support and encouragement for the manuscript.