The Legal and Ethical Issues with DNR Tattoos

Is a tattoo a legally binding document?

Doctors in Miami had to grapple with this question when an unconscious man was brought into their hospital, suffering from organ failure. While this is clearly a situation that calls for prompt medical attention, the doctors faced a strange setback. The man had a tattoo across his chest that read “do not resuscitate,” with a signature below it.

What is a DNR Order?

A do-not-resuscitate (DNR) order is a medical order that tells first responders not to provide life-saving measures if the patient’s heart stops beating or if they stop breathing. If a patient does not have a DNR order, doctors and other responders will do everything they can to save the patient. This might include chest compressions or rescue breathing, and the use of electric shock or breathing tubes.

There are many reasons why someone might consider a DNR order. Resuscitation efforts can be very intense, leading to injuries like broken ribs, internal damage, and upper airway complications. If a patient feels that these potential injuries might seriously affect their health, they might prefer to avoid resuscitation efforts. Resuscitation efforts can also be very expensive, particularly if a patient requires long-term care to stay alive. And finally, some people simply don’t like the idea of being reliant on doctors or machines to stay alive.

Once someone decides to get a formal DNR order, they can get a form from their doctor. They can clarify their specific requests, including situations where they would want to be resuscitated. The form is then signed and notarized, and placed in the person’s medical charts. Since a DNR order is a complex and tough decision, many people consult with a will and estates attorney to make sure the process goes smoothly.

Are DNR Tattoos a Good Idea?

When someone gets a DNR order, avoiding resuscitation is clearly something they care deeply about. This is why some people get DNR tattoos. But by getting this kind of tattoo, they might actually be complicating their own desires. According to research by the National Center for Biotechnology Information, DNR tattoos are legally and ethically tricky for a few big reasons:

  • If the tattoo simply reads DNR, there is no way to tell what that stands for. While its meaning might seem obvious, medical decisions should never be made by guessing or inferring alone. Because the letters could stand for something else, medical professional cannot be 100% sure that DNR means “do not resuscitate.”
  • Even if the patient’s desires are obvious, the tattoo cannot show the patient’s true intent. Maybe they got the tattoo years ago, but have since changed their feelings on resuscitation. While a legal document shows nuances— for example, if the patient would want to receive chest compressions, but not the insertion of a breathing tube — a tattoo cannot show this. Without an actual document, medical professionals cannot understand the full meaning of the DNR order.
  • Oftentimes, DNR tattoos are not accompanied by a signature, and are therefore not legally binding. Even if there is a  signature, there is no way to tell if the signing was witnessed, making it a true legal contract.

Ethical Issues

Because of these complications, many medical professionals will not honor a DNR tattoo without the accompanying legal paperwork. Doctors have a duty to prevent harm, so if there is no valid implication that a patient wants to forego critical care, doctors will generally act. In the case of the patient in Miami, doctors initially began treatment. However, they later decided to honor the man’s DNR tattoo after consulting with an ethics specialist. The ethics specialist found that:

“it was most reasonable to infer that the tattoo expressed an authentic preference, that what might be seen as caution could also be seen as standing on ceremony, and that the law is sometimes not nimble enough to support patient-centered care and respect for patients’ best interests.”

In this case, the patient died a few days later, and the hospital was able to track down his paperwork. It included a formal DNR order. But while this case points to their validity, there are still ethical dangers of assuming a tattoo shows the full situation.

Ultimately, a DNR tattoo can complicate the situation, and may even have the opposite result than a patient intended. A binding legal document is always the safest bet, particularly in a life-or-death situation.


The attorneys at Perenich, Caulfield, Avril & Noyes represent those involved in car accidents, motorcycle accidents, bicycle accidents, pedestrian accidents, and other types of personal injury matters. Our firm is one of the oldest personal injury law firms in Tampa Bay. There are no attorneys’ fees or costs unless we prevail for you. Call our office 24 hours a day at 727-796-8282 or simply click here to schedule a free case consultation.

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