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Comment by Cass | Hacker News Reader

To everyone considering a "NO CODE" tattoo after reading this story: Don't. If you're really that serious about not wanting to be resuscitated under any circumstances, wear some kind of bracelet or necklace with those words on it, and, just as importantly, a recent date, and contact info for a person who knows your exact wishes. Make sure to update the date regularly.

Medicine changes, and so do your life circumstances. If you're presenting an EMT with a ten-year-old, faded tattoo, you're placing them in an awkward position due to the lack of context. Is this a decision you made ten years ago and got stuck with, or are these your current wishes? They might end up disregarding your wishes just to be safe. A bracelet with a recent date will be much less ambiguous.

And remember, with all medical decisions, you want the ability to change your mind when medical advances are made or your circumstances change. Tattoo removal sucks.

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Not to mention that at least where I'm from a tattoo will not and cannot be accepted by EMS personnel as a valid order. Here is the relevant part from our Medical Control treatment protocols on what can be accepted as a valid do not resuscitate order:

"Patient is wearing a do-not-resuscitate identification bracelet which is clearly imprinted wit the words “Do-Not-Resuscitate Order”, name and address of declarant, and the name and telephone number of declarant’s attending physician, if any OR

The EMS provider is provided with a do-not-resuscitate order from the patient. Such an order form shall be in substantially the form outlined in Annex 1 or 2 and shall be dated and signed by all parties."

Anything else and we are required to follow all the regular resuscitation efforts.

How bizarre that they'll accept 'do not resuscitate' on jewellry, but not tattooed across the chest.

"Do we think he really meant it? Nah, he just got the tattoo - if he really meant it, he'd be wearing one of those constantly annoying bracelets"

What if "NO CODE" is the name of a band?

You're asking someone to make a quick life-or-death decision on ambiguous data when there is a clearly known and socially agreed upon way to express the sentiment.

Having it on an annoying bracelet that is explicitly used to signal medical intent sounds pretty good to me.

So what if "NO CODE" is the name of a band? I'm talking about "Do not resuscitate" - and if you tattoo that on your chest because it's a cool band name, you're an utter fuckwit. 'No Code' is stupid anyway because not everywhere uses that jargon, while 'do not rescuscitate' is clear, plain English.

As for the bracelet, I hate jewellery and anything from my elbows down catches on anything that I'm working on with my hands, and I'm not alone - and unlike the tattoo which is only 'present' at parts of the day, a bracelet is always 'present'. Not to mention that there's all sorts of medical accoutrements that infirm people are supposed to carry with them but don't because they're annoying (prime example being the 'help, I've fallen' pagers).

Of course, "do not resuscitate" across the chest is pretty clear of your intentions when you get it. But I don't think you realize how hard it can be to have that power over someone's life and make that call. I think the point about old tattoos is much more relevant than a band named that; if there are former neo-nazis with ultra racist/symbolic tattoos that regret them, there could be people that just got a "Do Not Resuscitate" tattoo because they thought it was hardcore when they were younger but now regret it. I know this isn't always the case but when you're deciding whether or not to give someone another shot at life, or to let them die, a RECENT bracelet would be more definitive with all the thoughts racing through your head.

Also, if getting a tattoo is less annoying than wearing a bracelet you probably have some of them already and it can become even less clear.

getting a tattoo isn't less annoying than a bracelet, but having a tattoo is much less annoying.

In any case - where is the rash of young people with 'do not rescusitate' tattoos? Everyone I've seen that is supposed to have had one is a greyhair, well out of the young-and-dumb age. And even if you do 'later regret' the tatt and don't want to stump for tatt removal, just tatt a couple of lines through it or tatt something over it.

And then there's the young people who genuinely do not want to be rescusitated - what about them? Stigma enough carrying a medical bracelet amongst the young to begin with. I just don't see this supposed grey area of young people tattooing themselves with a mythical band name.

EDIT: To put it another way, this mythical youth tattooing himself errantly is such a vanishingly tiny fringe minority. Plenty of laws exist allowing for people to freely express themselves to death. The more stringent US states have a maximum blood alcohol content of .08 for drivers, which is higher than the level at which measurable cognitive effects occur on your co-ordination and attention. If we're really concerned about 'free expression' deaths, bring that number right down. There are tons of laws like it. There is no reason not to make it another social norm to say "tattoo 'do not resus' on your chest, and you won't be resuscitated". There's no need to pander to base idiots.

I would prefer we avoid shooting the messengers. Even if there's an argument that EMTs should honor indelible express wishes, we can't have this debate with all of them simultaneously. We are being informed that many of the ones out there today will not, which never would have occurred to me, and knowing that has some value.

Hey "Do Not Resuscitate" could be a good band name too.

The bracelet is an official state issued thing for people with terminal diseases. Obtaining one requires a doctor's order.

A tattoo (or any other non-official marking) could be anyone, like a depressed person who is going to attempt suicide.

Something related to this actually happened where I live last week. A 30 year old afghanistan vet wrote "do not resuscitate" on his arm with a sharpie and then shot himself in the chest in a hospital parking lot.

I suspect he meant it, too.

So then why do it in a hospital parking lot? Sounds more like a really excessive cry for help to me.

Perhaps he was thinking of the convenience of the morgue workers.

It depends on the particulars of the story. Perhaps he was hospital-bound. Perhaps he had to visit the hospital so frequently that one day on the way in, he just couldn't handle it anymore.

If I were a doctor, I think I would be more prone to recognize a "NO CODE" bracelet over a tattoo. A tattoo is a decision you made on a single day. Wearing a bracelet is a decision you make every day of your life.

(Of course, you could say that leaving the tattoo in place is a decision you make every day, but it's much easier to remove a bracelet if you change your mind, vs. a tattoo.)

Opt-in/Opt-out, as it were. Considering the consequences, I agree with the reasoning.

This was drilled into our heads in EMT school--without a valid DNR per protocols, we continue CPR. The exact rules vary from county to county and from state to state, but the point is to ensure that the DNR is well and truly valid before denying potentially lifesaving care to a patient (and to legally protect the first responders, who can lose their license/possibly go to jail for recklessly failing to provide appropriate care).

You can read San Francisco's EMS protocol for DNRs--it's more complicated than just saying (or wearing) "NO CODE."

http://www.sfdem.org/Modules/ShowDocument.aspx?documentid=76... (warning: pdf)

Note that the bracelet/necklace frequently has a phone # that the first responders can call to verify the DNR.

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