Medical tattoos and ethical dilemmas

By Casey Quinlan

Originally published on

I had a dollar for every notification I got on the recent articles in the New England Journal of MedicineThe AtlanticGizmodo, and the Washington Post about a 70-year-old dude with a complex medical history and a ginoromous DNR tattoo on his chest … well, I’d have at least 50 bucks today that I didn’t have two days ago.

Source: Casey Quinlan

Explainer: I myself have a large tattoo (3 inches by 3 inches) on my sternum that’s a QR code with its own embedded link (here’s why I did it). That link, which is password protected with an alphanumeric not visible in the image above, because “not stupid” is a thing in these parts, opens (after aforementioned password input) a page with two PDFs on it.

One is my full medical history: childhood immunizations, illnesses (including cancer), medications historic and current, surgeries, the whole steaming cheese enchilada.

The second is my Advance Directive, which spells out the what-ifs/whens/thens of my wishes for care in circumstances up to and including terminal illness or injury. The Directive includes contact information for my healthcare Power Of Attorney designees, should I not be conscious/competent at the time the issue of my wishes needs to be addressed.

Now, back to the story of the medically-complex 70-year-old dude in the Florida ER, unconscious, with DNR emblazoned, in ink, on his chest.

His case presented a number of issues for the medical professionals trying to assess both treatment options and the patient’s wishes about those options, ’cause dude was out cold, had a cascading set of medical morbidity issues, and a high blood alcohol level on arrival via ambulance.

The medicos whistled up an ethics consult, and there was a bit of a cluster-dance as the hospital crew worked to (a) ID the dude, which then (b) revealed he had a written DNR order on file with them (in the proper “printed on yellow paper” order, according to Florida law). The end result was that the guy was not kept alive against his stated wishes, and he died later that night.

The ethics consult, Ken Goodman, said to The Atlantic, “My view was that someone does not go to the trouble of getting such a tattoo without forethought and mindfulness. As unorthodox as it is, you do get a dramatic view of what this patient would want.”

My tattoo is 90% political statement — about the the total lack of health information exchange in healthcare, with the never-ending risk of getting treatment you either don’t want or can’t have (due to drug allergies, existing medical conditions that aren’t immediately obvious, etc.) in an emergency situation when you’re unconscious and can’t be the Walking Talking Medical History And Wishes Expression Module that’s required in every clinical encounter.

Along with ALL. THOSE. F**KING. FORMS. ON. CLIPBOARDS. But I digress.

I have made clear, repeatedly, that I do not think anyone should have to do this — tattoo one’s wishes on one’s chest — but a weird soup cooked up by Hollywood’s interpretation of the Hippocratic Oath has both the patient/family side and clinical professional side of the medical care encounter convinced that everyone needs ALL. OF. THE. MEDICAL. THINGS. ALL. OF. THE. TIMES. and “DON’T KILL GRANDMA!” on blast.

Which is not the case, even in the majority of times, when someone washes up in an ER with a terminal issue.

So, rather than QRing yourself, or DNRing yourself, via tattoo, I strongly suggest you:

  • Think through what your wishes are in situations that might wind up at “terminal” — some resources there are The Conversation Project and Engage With Grace
  • Find out what the law in your state is about Advance Directive formatting and filing — this link has resources for all 50 US states
  • Identify the person you’ll trust to enact your wishes if you can’t speak for yourself
  • Prepare your Advance Directive forms, and keep a PDF of it on your phone
  • TELL YOUR FAMILY YOU’VE DONE THIS, and provide copies of your Directive to them

Don’t wind up being tortured at the end of your life, unless you’d like to be (if you do, I think you’re weird AF, but I respect your wishes).

And yeah, I saw the story about the guy in the Florida ER with the DNR tattoo.

Casey Quinlan, aka “The Mighty Mouth,” is a speaker, #epatient, writer, rabble-rouser, and member of the Right Care Alliance Steering Committee. Follow her blog at and on Twitter @MightyCasey.