Life or death: Doctors think tattooing 'Do not resuscitate' is a bad idea
Consumers are often told: "Put it in writing." But in the case of a hospitalised Florida, US, man facing death, displaying his wish by having it tattooed on his chest wasn't good enough.
And other doctors agree that publishing your resuscitation preference via a simple tattoo is not the best idea compared to having a living will or healthcare directive readily available.
The 70-year-old had "Do Not Resuscitate" on his chest - complete with an apparent signature and the word "not" underlined.
But that failed to convince doctors to withhold treatment after he was brought to Miami's Jackson Memorial Hospital drunk, dying and unconscious.
A tattoo might seem like a clear way to make your wishes known and doctors themselves often joke about inking "DNR" on their chests.
In this case: "When the guy comes in, we looked at the tattoo and we said: 'We've always talked about this, but we've never seen one.' And then it struck us. We had to think about whether this was real or not," said Dr Gregory Holt, co-author of the case report in The New England Journal of Medicine.
The problem with a tattoo: it's a little too permanent. Sometimes patients change their minds about what kind of treatment they're willing to endure in a health crisis, Holt said.
For example: "When something happens and people can't breathe, they just want to breathe well.
"So a lot of times people want to reverse their code status," he said.
Holt's other concern was whether the tattoo was done when the patient was drunk or acting on a whim.
Dr Lori Cooper came face to face with the problem as a chief resident at California Pacific Medical Centre in San Francisco. A 59-year-old patient with "D.N.R." tattooed on his chest told her he wanted to be resuscitated if he developed cardiac or respiratory arrest.
His tattoo was there because he lost a bet playing poker. He declined the suggestion to have it removed, saying he didn't think anyone would take it seriously. Cooper reported the case in 2012 in the Journal of General Internal Medicine.
"We deal with code status so much and everyone says: 'I'm just going to tattoo it on myself.' But that creates a lot of confusion," she told Reuters Health.
"It can change with the person's health at the time, or their age and you have to ask if it reflects their wishes down the road.
"It's not a great idea," she said.