Ethics and Religion Talk: Should I tattoo a do not resuscitate order on my body?

The 70-year-old man was taken earlier this year to Jackson Memorial Hospital, where doctors made their startling discovery: a chest tattoo that seemed to convey the patient's end-of-life wishes. The word ‘Not’ was underlined, and the tattoo included a signature. Should such a tattoo be a valid medical order?”

The Reverend Colleen Squires, minister at All Souls Community Church of West Michigan, a Unitarian Universalist Congregation, responds:

“As a general rule, hospitals have Ethics Committees to help handle such difficult questions. There are also legal standards and laws that aid in the decision making process of such a case so my response is purely from an ethics and religion point of view.  

“If the treating physician were Unitarian Universalist her religious obligation would be to uphold the request of the patient regardless of her own personal opinion. Whether the patient has a tattoo, medical bracelet, or DNR legal documents ultimately our faith believes the patient’s wishes are to be respected over the physician’s religious beliefs. Having read the details in the article I believe the doctors acted correctly in honoring the patients ‘Do Not Resuscitate’ tattoo.”

Rev. Ray Lanning, a retired minister of the Reformed Presbyterian Church of North America, responds:

“This may be a question for lawyers to answer, but it seems to me that If the signature is authentic, what would invalidate the order? The signature and/or seal authenticates a document, not the paper it is printed on. In this case it seems that the patient chose the most indelible way possible to express and record his wishes. To mark his body this way with no serious intent would be very foolish, and no one could be blamed for taking him at his word.

“Since by current standards of medical practice, the request is not unreasonable, immoral or illegal, the doctors should respect the man’s wishes. Hopefully he was prepared to die and ready to meet his Maker, but that is a matter between him and God. Nothing in the law of God requires anyone to undergo or undertake 'heroic measures' in such ​circumstances.”

Fred Stella, the Pracharak (Outreach Minister) for the West Michigan Hindu Temple, responds:

“It astounds me that this situation even came up. Tattoos are, if nothing else, a statement of dedicated commitment. It we can leave aside for a moment the exceptional situation of a misguided decision made at 3AM, under the influence, to immortalize a Led Zeppelin lyric, such an epidermically solidified request as this demands that ‘attention must be paid.’ I suspect that the hospital personal were thinking much more in terms of legality more than morality. Recent surveys show that physicians are more likely than anyone to have rather severe advance directives in place. They, more than anyone else, know the futility of wallowing in a diminished state while being kept alive artificially.”

Doug Van Doren, the pastor of Plymouth United Church of Christ, responds:

“It seems there is no end to the dilemma’s we humans can create for one another. I understand that a tattoo in Florida (or likely anywhere else) doesn’t constitute a legal document. I understand, in our litigious society, doctors wanting to be absolutely certain when not taking action that might save a person’s life. I think, however, the ethicists that advised the doctors in this case to follow the tattoo’s dictate, got it right.

“First, I believe that a person does have the right to refuse medical treatment that might prolong life. It appears that this person was adamant about that request being honored and you have to admire his clever solution. It is likely that he either did not trust the legal documents would be found in time, or that he had someone to convey his wishes. Yes, there is the concern that a tattoo is quite permanent and makes it difficult to change if a person changes his or her mind. However, with laser technology a key word could be removed. Or a tattoo artist could certainly alter it. Or he could have just add, ‘J. K.!’ ”

My response:

First, I should mention that as a general rule, Jews and others who adhere to the restrictions of the Hebrew Bible should not get tattoos. For those who do: a DNR chest tattoo may be effective in a very narrow sense of conveying one’s wishes not to be receive chest compressions or artificial ventilation or other major interventions, but a fully written advance directive (including assigning a durable power of attorney for health care) covers a wider and more nuanced range of treatment (or non-treatment) options. They are also easier, cheaper, and less painful to change if one changes one’s mind later on.

This column answers questions of Ethics and Religion by submitting them to a multi-faith panel of spiritual leaders in the Grand Rapids area. We’d love to hear about the ordinary ethical questions that come up on the course of your day as well as any questions of religion that you’ve wondered about. Tell us how you resolved an ethical dilemma and see how members of the Ethics and Religion Talk panel would have handled the same situation. Please send your questions to [email protected].