 ¿Un tatuaje como orden médica? El dilema de los tatuajes DNR y su validez legal y clínica en 2025 🧬 IntroducciónEl tatuaje que reza "Do Not Resuscitate" (No reanimar o DNR, por sus siglas en inglés) en el pecho de un paciente genera un potente conflicto entre la ética médica, la legalidad y el respeto por la autonomía del individuo. ¿Tiene valor legal un tatuaje que solicita no ser reanimado? ¿Debe el personal sanitario cumplirlo? Este debate, ya planteado en estudios como el del New England Journal of Medicine y analizado en múltiples escenarios, sigue siendo fuente de dilemas éticos y legales en medicina de emergencias. En este artículo se analiza la situación en 2025 con evidencia actualizada y comparativa internacional, utilizando fuentes como EMS Solutions International y EMS1. 🔍 ¿Qué es un tatuaje DNR?Un tatuaje DNR consiste en la inscripción permanente sobre la piel de frases como “Do Not Resuscitate”, con la intención de comunicar al personal médico que el portador no desea maniobras de resucitación cardiopulmonar (RCP), desfibrilación o intubación en caso de paro cardiorrespiratorio. Ejemplo emblemático: En 2017, un hombre inconsciente en Miami presentaba un tatuaje que decía “Do Not Resuscitate” con su firma. El equipo de emergencias decidió no iniciar RCP, pero consultó al comité de ética. Posteriormente se encontró una orden DNR válida y documentada. (NEJM, 2017) 📜 ¿Es legal un tatuaje como directiva anticipada?❌ NO. Un tatuaje, por sí solo, no constituye un documento legal válido en ningún país del mundo en 2025.Según EMS Solutions International (2019) y el artículo de EMS1 actualizado, los tatuajes no sustituyen una directiva anticipada escrita, firmada, fechada y validada por el marco legal de cada país. Posibles problemas:
🌍 SITUACIÓN LEGAL INTERNACIONAL (2025)🇺🇸 Estados Unidos
🔹 Referencia oficial: 🇬🇧 Reino Unido
🇪🇺 Unión Europea
🇪🇸 España
🇲🇽 México
🇩🇴 República Dominicana
🇧🇷 Brasil
🇯🇵 Japón
🇷🇺 Rusia
⚖️ ORGANISMOS INTERNACIONALES Y LEGISLACIÓN RELACIONADA
💡 Recomendaciones clínicas actualizadas 2025
🧾 ConclusiónAunque los tatuajes DNR son una manifestación fuerte de voluntad personal, no sustituyen a los documentos legales exigidos por los marcos jurídicos internacionales . El personal de salud debe actuar conforme a la legislación vigente, siempre respetando los principios de autonomía, beneficencia, no maleficencia y justicia. La clave es combinar rigor legal, juicio clínico y humanidad , sin dejarse llevar por interpretaciones visuales sin respaldo documental. 🔗 Fuentes y lecturas recomendadas:
📌 DrRamonReyesMD |
¿Es legal no resucitar un tatuaje? |
P: ¿La adicción a las drogas es una opción o una enfermedad?
R: Son ambas, inicia como una opción y se convierte en una enfermedad de dependencia debido al sistema de recompensa del cerebro y la liberación de dopamina.
P: ¿Si un adicto con un tatuaje de "DNR" (do not resuscitate) y la sobredosis es intencional, honramos el tatuaje?
R: No, un tatuaje no es un documento legal, el documento legal de DNR, debe estar firmado por un médico.
P: ¿Incapacidad mental?
R: En EUA, en la mayoría de los estados tenemos documento legal que nos permite llevar un paciente al hospital en contra de su voluntad cuando hacen comentarios o atentados encontra de su vida o otros. (En Massachusetts es el MGL parte I, título XVII, capitulo 123, sección 12)
por Christian Goring, NREMT-P
El tatuaje de "No resucitar" de un hombre deja a los médicos debatiendo si salvarle la vida
POR ASHLEY WELCH
ACTUALIZADO EL: 4 DE DICIEMBRE DE 2017 / 15:50 / CBS NEWS
Los médicos de un hospital de Florida enfrentaron un dilema ético cuando un hombre inconsciente llegó a la sala de emergencias con un tatuaje que decía "No resucitar" estampado en su pecho.
El paciente, de 70 años, presentaba una glucemia elevada y antecedentes de enfermedad pulmonar obstructiva crónica (EPOC), diabetes y fibrilación auricular. Unas horas después, su presión arterial descendió a un nivel anormalmente bajo.
El hombre había llegado sin identificación y sin familiares ni amigos.
Su tatuaje, que incluía una firma y tenía la palabra "No" subrayada, dejó a los médicos sin saber qué hacer a continuación.
¿Era el tatuaje una clara representación de los deseos del paciente? ¿Debían respetarlo y evitar cualquier esfuerzo heroico para salvarle la vida? ¿Estaban obligados a hacerlo legalmente?
Los médicos detallaron el caso y las decisiones que tomaron en un informe publicado en el New England Journal of Medicine.
Al principio, decidieron no honrar el tatuaje, "invocando el principio de no elegir un camino irreversible ante la incertidumbre", escribieron.
Sin embargo, esta decisión dejó al equipo médico en conflicto , y llamaron a un comité de ética para que consultara sobre el asunto más a fondo.
Después de revisar el caso, el comité recomendó a los médicos respetar el tatuaje del DNR.
"Sugirieron que lo más razonable era inferir que el tatuaje expresaba una preferencia auténtica", escribieron los médicos.
Lo que los médicos y los pacientes quieren al final de la vida
Al mismo tiempo, el departamento de trabajo social del hospital había logrado obtener una copia de la orden DNR "fuera del hospital" del paciente emitida por el Departamento de Salud de Florida, y el equipo médico confirmó que era consistente con el mensaje de su tatuaje.
La condición del hombre se deterioró y murió sin ninguna intervención médica adicional.
The doctors write that they were "relieved" to find the patient's official written DNR request in the state files, as the "tattoo produced more confusion than clarity." They cited one other case, found in a review of the scientific literature, involving a person with a DNR tattoo — but that patient's tattoo no longer reflected his current wishes.
They also mentioned being concerned about the potential unknown circumstances in which a person might get such a tattoo. What if the patient had done it while under the influence of drugs or alcohol?
Medical ethicist Dr. Arthur Caplan, Ph.D., said that legally, DNR tattoos are not binding.
"There's no law that says you have to respect or recognize a tattoo," Caplan told CBS News. "But morally, it carries a lot of weight."
Caplan, the founding head of the Division of Medical Ethics at NYU School of Medicine, was not involved in the patient's case.
He said the first step for doctors treating such a patient would be to contact next of kin or seek a written DNR order.
"If that's not available and there are no family or friends around to verify the patients' wishes, would I not resuscitate him just on the basis of the tattoo? Probably not, because I wouldn't know if I could trust it," he said. "I wouldn't know whether it was 10 years old or five minutes old. I wouldn't know if maybe he had changed his mind. There's too much uncertainty."
Caplan advises that if people want to have a DNR tattoo or bracelet to call attention to their end-of-life medical wishes, they should also carry a copy of a living will or advanced directive in their wallet.
"At the end of the day, tattoos are not substitutes," he said. "They're also not substitutes for having conversations with your family and friends or with your doctor about your wishes."
First published on December 4, 2017
© 2017 CBS Interactive Inc. All Rights Reserved. https://www.cbsnews.com/news/do-not-resuscitate-dnr-tattoo-leaves-doctors-debating-whether-to-save-his-life/
Do-Not-Resuscitate Tattoos: Are They Valid?
By Laura Vearrier, MD, MA | on April 10, 2018
A recent New England Journal of Medicine article presented a case in which a “Do Not Resuscitate” (DNR) tattoo (see Figure 1) created an ethical dilemma for the emergency and critical care physicians caring for the patient, who were guided by a questionable recommendation from their ethics consultants.1 The unknown patient presented to the emergency department unconscious and in critical condition. “Do Not Resuscitate” was tattooed across his anterior chest wall, accompanied by his presumed signature.
Without the guidance of next of kin or advanced directive paperwork, the health care team initially decided not to honor the DNR tattoo. However, they later reversed their decision and honored the tattoo after an ethics consultation. The ethics consultants concluded that the tattoo could be presumed to represent the patient’s authentic preferences and that the “law is sometimes not nimble enough to support patient-centered care and respect for patients’ best interest.” The conclusion of the ethics consultants should not set a precedent for future similar cases, as the DNR tattoo was neither legally nor ethically sufficient to guide medical care.
Before delving into the specific insufficiencies of the tattoo, it is useful to review advance care planning (ACP). There are two main forms of ACP documents: advance directives (AD) and physician orders for life sustaining treatment (POLST). ADs are legal documents that can be completed at any time in life to guide future care and/or appoint a surrogate decision maker. ADs must be completed by the person (him/herself) and require either a witness or notary, depending on the state. POLST forms are physician orders for end-of-life (EOL) care designed to be transferred among health care institutions. They are for patients who are seriously ill or frail who are near the EOL and can be completed with the assistance of a surrogate. Table 1 summarizes the differences between ADs and POLST.
The “Do Not Resuscitate” tattoo in the article is neither legally nor ethically sufficient to guide medical care for the following reasons:
Tattoos are not legal ADs nor POLST, which are the two ACP documents transferrable among institutions in the United States. The tattoo cannot be considered a wearable AD, as it does not include a witness or notary to complete the legal documentation.
Informed decision-making cannot be presumed. Studies have reported that patients have a poor understanding of EOL care terminology, and only about half of emergency department patients surveyed had a correct understanding of the term “Do Not Resuscitate.”2 There is no evidence that the tattoo indicates a clear understanding of a DNR status.
The tattoo contains insufficient information to guide medical treatment. Does the patient mean no chest compressions, no intubation, no vasopressors? ADs and POLSTs clarify preferences so that providers can better interpret patient wishes, although confusion may still arise as to whether specific interventions are desired.
EOL care preferences are dynamic. Depending on factors such as age, health status, prognosis, and advancement of medical technology, a person’s EOL preferences may change.3 In contrast to a tattoo, ADs and POLST forms may be easily amended to reflect a patient’s current wishes.
Tattoo regret is common. More than 50 percent of individuals later regret their tattoos.4 The most frequent motivation for tattoo removal is poor decision making, often the result of intoxication, leading to subsequent regret. A case report of a DNR tattoo that did not represent a patient’s current wishes has previously been reported.5
An important ethical principle for emergency physicians to consider is that withholding and withdrawing life-sustaining treatment are considered ethically equivalent. Therefore, when faced with ambiguity regarding a patient’s wishes, emergency physicians should proceed with life-saving interventions. When further information is obtained, the patient’s care can be appropriately de-escalated in accordance with their preferences.
default to proceeding with life-sustaining measures does not mean that tattoos or other non-standard means of communicating preferences should be ignored. The tattoo, an alternative form of communication, should be used as piece of information in the decision-making process. A major limitation of AD and POLST documents is that in most states they must physically accompany the patient and are often not available when providers are making key decisions.
Some states, such as Oregon and California, have electronic databases that providers can access, but the lack of this type of accessible database may cause patients to be concerned that their wishes may not be known. In our era of smartphones, patients should be encouraged to enter “ICE” (In Case of Emergency) data into their phones, which can include medical information and emergency contacts. Emergency providers should also be encouraged to routinely search for available ICE data on the phones of incapacitated patients.
Dr. VearrierDr. Vearrier is clinical assistant professor in the department of emergency medicine at Drexel University College of Medicine in Philadelphia.
References
Holt GE, Sarmento B, Kett D, et al. An unconscious patient with a DNR tattoo. N Eng J Med. 2017;377:2192-2193.
Marco C, Savory EA, Treuhaft K. End-of-life terminology: the ED patients’ perspective. AJOB Prim Res. 2010;1:22-37.
Vearrier L. Failure of the current advance care planning paradigm: Advocating for a communications-based approach. HEC Forum. 2016:28(4):339-354.
Burris K, Kim K. Tattoo removal. Clin Dermatol. 2007;25:388-392.
Cooper L, Aronowitz P. DNR tattoos: a cautionary tale. J Gen Intern Med. 2012;27(10):1383.
Here are some hard questions:
Is drug addiction a choice or a disease? If an addict has DNR tattooed on him and the OD was presumed intentional, what are our ethical responsibilities for resuscitation? Could the same be applied to any suicide? Or do we assume mental incapacity to non-addicts who attempt to take their lives?
Have a safe week everyone.
Respectfully,
DanSun
DO NOT RESUSCITATE TATTOO that is legal? ¿Tatuaje no resucitar es legal?
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