We present the case of a person whose presumed code-status preference led him to tattoo “Do Not Resuscitate” on his chest. Paramedics brought an unconscious 70-year-old man with a history of chronic obstructive pulmonary disease, diabetes mellitus, and atrial fibrillation to the emergency department, where he was found to have an elevated blood alcohol level. The staff of the medical intensive care unit evaluated him several hours later when hypotension and an anion-gap metabolic acidosis with a pH of 6.81 developed. His anterior chest had a tattoo that read “Do Not Resuscitate,” accompanied by his presumed signature (Figure 1). Because he presented without identification or family, the social work department was called to assist in contacting next of kin. All efforts at treating reversible causes of his decreased level of consciousness failed to produce a mental status adequate for discussing goals of care.
We initially decided not to honor the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty. This decision left us conflicted owing to the patient’s extraordinary effort to make his presumed advance directive known; therefore, an ethics consultation was requested. He was placed on empirical antibiotics, received intravenous fluid resuscitation and vasopressors, and was treated with bilevel positive airway pressure.
After reviewing the patient’s case, the ethics consultants advised us to honor the patient’s do not resuscitate (DNR) tattoo. They suggested 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. A DNR order was written. Subsequently, the social work department obtained a copy of his Florida Department of Health “out-of-hospital” DNR order, which was consistent with the tattoo. The patient’s clinical status deteriorated throughout the night, and he died without undergoing cardiopulmonary respiration or advanced airway management.
This patient’s tattooed DNR request produced more confusion than clarity, given concerns about its legality and likely unfounded beliefs1that tattoos might represent permanent reminders of regretted decisions made while the person was intoxicated. We were relieved to find his written DNR request, especially because a review of the literature identified a case report of a person whose DNR tattoo did not reflect his current wishes.2 Despite the well-known difficulties that patients have in making their end-of-life wishes known,3–5 this case report neither supports nor opposes the use of tattoos to express end-of-life wishes when the person is incapacitated.
Write a 1,250-1,500 word paper in which you explore decision making methods that can be used to resolve an ethical dilemma using the scenario provided in the assigned reading, "An Unconscious Patient With a DNR Tattoo." Describe how to use the principles of ethical decision making (reviewed in this topic) to help resolve this ethical dilemma. Address the scenario to generate your conclusions about how you would proceed.
Principles:
According to this scenario methods to be used:
potential organisational policies:
We present the case of a person whose presumed code-status preference led him to tattoo “Do...
Read the case and answer the below question. Note All the question are related to the case i cannot separate them Mrs. Doe is a 33 year old paramedic who has discussed end-of-life decisions including the importance of Do Not Resuscitate orders with her husband. Mrs. Doe (having lost her brother years earlier) expressed to her husband that she never wanted to be kept alive by machines. She also expressed a desire to sign a DNR order but had not...
read the below case and answer all the question Mrs. Doe is a 33 year old paramedic who has discussed end-of-life decisions including the importance of Do Not Resuscitate orders with her husband. Mrs. Doe (having lost her brother years earlier) expressed to her husband that she never wanted to be kept alive by machines. She also expressed a desire to sign a DNR order but had not done so yet. Eighteen weeks (4 ½ months) into her second pregnancy,...
please read the case in the top part and answer the question below Mrs. Doe is a 33 year old paramedic who has discussed end-of-lite decisions including the importance of Do Not Resuscitate orders with her husband. Mrs. Doe (having lost her brother years earlier) expressed to her husband that she never wanted to be kept alive by machines. She also expressed a desire to sign a DNR order but had not done so yet. Eighteen weeks (4 % months)...
Case Study: Nursing homework A 70-year-old man with a history of hypertension, hyperlipidemia, appendectomy, initially presented to his primary care physician with occasional bloody stools and dull right upper quadrant pain. Blood was sometimes mixed into his stools but was more often seen on the toilet paper after wiping. He attributed his symptoms to hemorrhoids and did not undergo the colonoscopy recommended by his primary care doctor. His pain and hematochezia were improved for some time, but they began to...
Case #1 History of Present Illness: The patient is 42 year old Caucasian male with no prior cardiac history. He presented to the emergency room at Green River Hospital complaining of chest pain. This morning he notices some numbness and pain in his left arm. Later in the day he developed pressure in the chest. This gradually worsened throughout the morning until shortly before lunch when he was rating the pain at 8/10 in severity and decided to go to...
A page to the Ethics on-call consultant came at 4 PM on a Monday afternoon. The consult order had been placed by the new attending during the third week of hospitalization for an incapacitated and unresponsive patient in the medical ICU. The requestor’s reason for consulting ethics: “Assistance requested in complex case of anoxic brain injury patient with unreliable DPOA and potential conflict regarding goals of care.” “Patti” was a 52-year old woman with history of asthma, chronic pulmonary obstructive...
Case Study 1 Introduction Bob, a 53-year-old caucasian man, arrives at the emergency department accompanied by his friend, complaining of increasing difficulty breathing and productive cough with green sputum. His friend says he dropped in to visit Bob, who lives alone, and found him sitting up on the edge of his bed, unable to breathe and seemed quite confused. When he last saw Bob 4 days ago, he says he had a cough and a temperature for which he has...
How can we assess whether a project is a success or a failure? This case presents two phases of a large business transformation project involving the implementation of an ERP system with the aim of creating an integrated company. The case illustrates some of the challenges associated with integration. It also presents the obstacles facing companies that undertake projects involving large information technology projects. Bombardier and Its Environment Joseph-Armand Bombardier was 15 years old when he built his first snowmobile...
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Using the book, write another paragraph or two: write 170 words: Q: Compare the assumptions of physician-centered and collaborative communication. How is the caregiver’s role different in each model? How is the patient’s role different? Answer: Physical-centered communication involves the specialists taking control of the conversation. They decide on the topics of discussion and when to end the process. The patient responds to the issues raised by the caregiver and acts accordingly. On the other hand, Collaborative communication involves a...