Nonstandard Advance Health Care Directives in Emergency Departments: Ethical and Legal Dilemma or Reality: A Narrative Review
Abstract
People have tattooed themselves for thousands of years, and it remains popular with various groups across mainstream society. Although many people choose tattoos that express their life philosophy, epic events in their life, or their personal mantra, the use of tattooing in medicine such as a "do not resuscitate" tattoo is increasingly becoming more common (; ). As these tattoos do not meet the legal requirements for an advance health directive, they are at best a guide to the person's wishes and at worst a useless, painful exercise. New technology such as "talking tattoos" or implantable microchips could conceivably be used to record either an audible advance health directive or directions for emergency responders to access an individual's advance health directive. This article discusses the ethical and legal implications of nonstandard advance health directive tattoos in emergency treatment situations.
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Evidence from two systematic reviews suggests that the use of advance directives is associated with reductions in emergency room visits, hospital admissions, health care costs, and more preference for comfort care as opposed to life-sustaining treatments.
“Evidence from two systematic reviews suggests that the use of advance directives is associated with reductions in emergency room visits, hospital admissions, health care costs, and more preference for comfort care as opposed to life-sustaining treatments. 4,8”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [8]
Evidence from 13 RCTs and from 8 nonrandomised studies included in 3 systematic reviews suggests associations of communication interventions with an increased frequency of DNACPR orders.
“Evidence from 13 RCTs and from 8 nonrandomised studies included in 3 systematic reviews suggests associations of communication interventions with an increased frequency of DNACPR orders. 4,7,8,10”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [8]
Data from eight RCTs included in three systematic reviews indicated that communication interventions aiding the completion of advance directives had no significant effect on patient/family satisfaction with end-of-life care.
“Data from eight RCTs included in three systematic reviews indicated that communication interventions aiding the completion of advance directives had no significant effect on patient/family satisfaction with end-of-life care. 4,7,8”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [8]
Another 4 RCTs included in one of these reviews reported an increase in patient/family satisfaction with care associated with a communication intervention.
“However, another 4 RCTs included in one of these reviews, reported an increase in patient/family satisfaction with care associated with a communication intervention. 8”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [8]
Cites
Quality of Life and Cost of Care at the End of Life: The Role of Advance Directives
Garrido, M. M., Balboni, T. A., Maciejewski, P. K., Bao, Y., & Prigerson, H. G. (2015) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2014.09.015 · Cited by 126 · see citing works
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European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions
Mentzelopoulos, S. D., Couper, K., Voorde, P. V. D., Druwé, P., Blom, M., Perkins, G. D., Lulic, I., Djakow, J., Raffay, V., Lilja, G., et al. (2021) · Resuscitation · doi:10.1016/j.resuscitation.2021.02.017 · Cited by 246 · see citing works
- Authors
- Gilbert, J., & Boag, J.
- Affiliations
- Federation University (AU)
- Venue
- Advanced Emergency Nursing Journal
- Published
- 2018-10
- Volume
- 40
- Issue
- 4
- Pages
- 324-327
- ISSN
- 1931-4485 (ISSN-L)
- OpenAlex
- W2992896000
- Cited by
- 6
- References
- 1
- Citations by year
- 2026: 1 · 2025: 1 · 2021: 3 · 2020: 1
- FWCI
- 0.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Advanced Emergency Nursing Journal (publishedVersion)
- PubMed (publishedVersion)
- FedUni ResearchOnline (Federation University Australia) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Medical and Health Sciences Research
- Keywords
- advance directives, emergency department, ethical implications, implantable microchips, patient autonomy
- MeSH terms
- Emergency Service, Hospital, Humans, Tattooing, Advance Directives
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