Christopher Ryan: Trouble with tatts

THE Minister for Mental Health and Ageing Mark Butler last year told of witnessing a man rip off his shirt to expose a “Do Not Resuscitate” tattoo emblazoned across his chest.

He said a woman in Darwin had boasted of the same tattoo, similarly placed, who claimed that on her back was tattooed “PTO”.

It seems the increasing penetration of tattoos into mainstream society has thrown up an unexpected option patients may want to discuss with their doctors — medical tattoos.

Medically motivated body art seems to come in two flavours — alerts and advance directives.

Those who have them laud tattooed alerts as a never-to-be-lost alternative to the traditional medical alert bracelet.

While they won’t be for everyone, I suppose they are at least an option if a patient’s condition is likely to have them fall unconscious and their care could be aided by treating doctors knowing about it early.

In the Diabetes Queensland newsletter it was argued that a medical tattoo was at least worth thinking about. It seems a logical solution for a young person with diabetes prone to hypoglycaemic attacks.

However, anyone seriously considering such a tatt would need to give careful thought to its placement and design. While a medical bracelet is likely to be noticed, a faded, stylised allergy warning, even if placed on the wrist, could easily go unheeded in the hubbub of resuscitation.

On balance, I’d stick with the locket and chain.

Tattooed advance directives probably aren’t a good idea either.

While there is no doubt that finding “DO NOT DEFRIBRILLATE” printed between the nipples in 40 point copperplate would give any early responder cause for hesitation, script like that cannot and should not be seen as an actual advance directive.

Many states stipulate forms on which advance directives must be made and common law demands that while an advance directive must be respected, it also must be “clear and unambiguous”.

This was the ruling in a NSW Supreme Court case involving an unconscious man who had an advance care directive. “If an advance care directive is made by a capable adult, and is clear and unambiguous, and extends to the situation at hand, it must be respected”, the judgment said.

An inked DNR may be clear and unambiguous but there will usually be reasonable doubt about its relevance depending on the situation a patient might find themselves in.

Unless your patient is prepared to give up most of their epidermis to a lengthy indelible document detailing their future desires, I’d suggest a better move would be a bracelet directing medical personnel to a written document.

There are still many drawbacks to using body art as a medical instruction.

Dr Christopher Ryan is the director of consultation-liaison psychiatry at Sydney’s Westmead Hospital and an honorary associate of the University of Sydney’s Centre for Values, Ethics and Law in Medicine, where he is the program director of the mental health and psychiatry stream.

Posted 11 March 2013