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I found a very good article by Daniel Sokol published in the BMJ about this topic. He takes us through a particular ethical scenario of where a patient has a DNR tattoo but there is no record of DNR in their formal medical notes. In the UK and North America, patients are legally entitled to refuse medical treatment, even if it will result in death. However, this patient was unconscious - as many potential DNR patients would be- so how do you infer whether to take the tattoo seriously? Sokol writes that we cannot know the validity of this tattoo: "Was the tattoo done several years ago during a bout of acute depression? Was it done as a joke or a dare? Or was it inscribed during a moment of lucidity?"
"So what are this patient’s autonomous preferences? The answer must be that we do not know. The criminal standard of proof, “beyond reasonable doubt,” is more appropriate in this context than the much lower civil standard of “on the balance of probabilities.” A patient’s life is at stake, and the risk of getting it wrong—of failing to resuscitate contrary to the patient’s true wishes—is too high, the consequences too grave, to warrant the