Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Is a tattoo the answer?
- Richard Harding (5 November 2001)
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Sole Searching
- Hazel Hambidge (6 November 2001)
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A tatoo may not be effective
- Steven Zeitzew (8 November 2001)
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Is a tattoo the answer?
- Johan H A Janssen (18 December 2001)
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Richard Harding, Retired GP
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Dear Editor, Dr Polack's grandmother is clearly a lady of spirit, and we should celebrate her pioneering method of ensuring her wishes are known. More and more elderly people appear to be clear about their wishes at the end of life. An advance directive is not going to serve patients' needs all the time as it is unlikely to be immediately avaialble, as your grandmother has appreciated. I wonder why MedicAlert is unable to engrave an advance directive on a bracelet? A tattoo does seem a very drastic measure at 83, and I hope any paramedic or other health worker seeing her instructions emblazoned across her chest will be sensitive to her wish, though I think it unlikely. You and she should be congratulated on drawing attention to a growing trend which needs discussion and evenytually, I hope, formal recognition. Yours sincerely, Dr Richard Harding, Payhembury, Devon |
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Hazel Hambidge, wife of Consultant Psychiatrist Home
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What a problem for all of us to consider as we get older. I have to admire Clare's grandmother and fully support her in her worries. Is our response to squirm at such an idea because the thought of tattooing her chest seems barbaric to us? I realise that this topic will be around for many years before an acceptable proceedure is adopted, and will require much consideration. I would like to suggest, how about a tattoo on the sole of the foot? Though maybe the relevent legislation with also require the request to be in a specific font to be complied with. |
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Steven Zeitzew, Chief, Orthopaedic Surgery West Los Angeles Veterans Administration Healthcare Center
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As it happens I saw an older man with a prominent "Do Not Resuscitate" tattoo on his right forearm yesterday. He was in the weight machine room of a health club where I was exercising. A radiologist friend and I (an orthopaedic surgeon) later debated what our response might be if he had collapsed. We concluded that in America one would be legally liable for whatever action (or inaction) we would have taken, and hoped he would stay healthy enough to continue his exercise program without incident. |
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Johan H A Janssen, Registrar General Medicine Kalgoorlie Regional Hospital, Kalgoorlie Western Australia 6433
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Editor- The questions raised by Clare Polack (1) are well beyond having a tattoo. It addresses the fear of the elderly generation about how they will be looked after when they turn ill. It also demonstrates Clare’s fear of the elderly not being taken seriously when they express their wish not to be resuscitated. Recent studies have shown that more physicians are willing to investigate the possibilities for satisfactory relief of symptoms and improvement of quality of life in the elderly. The TIME study, published in the Lancet advocates an aggressive approach in elderly patients with chronic symptomatic coronary-artery disease (2) . The mean age in this study was 80 (SD3.7) years. More importantly even, finally it seems elderly patients are being taken seriously. A recent study in the BMJ investigated “ Should elderly patients be told they have cancer?” (3). In this study the mean age was 79.9 (SD 8.3) years. So it seems Clare Polack’s grandmother has a fair chance that if she falls ill, the medical profession will be “aggressive” enough to ensure a good outcome and if this, despite their efforts, is not achievable, to tell her so. In Kalgoorlie – Western Australia’s Goldfields capital of approximately 30.000 people- ‘everybody’ has a tattoo. As for Clare Polack’s question: “Is a tattoo the answer?” my advice here would be yes- but only when she also carries one on her back reading ‘please see reverse site..’ Dr Johan HA Janssen
(1)Polack C. Is tattoo the answer? BMJ 2001;323:1063 (2)The TIME Investigators. Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary-artery disease (TIME): a ramdomised trial. Lancet 2001: 358: 951-957 (3)Ajaj A, Singh MP, Abdulla AJ. Should elderly patients be told they have cancer? Questionnaire survey of older people. BMJ 2001; 323:1160 |
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