Doctors at a Florida hospital faced an ethical dilemma when an unconscious man arrived in the emergency room with a tattoo that read "Do Not Resuscitate" emblazoned on his chest.

The patient, who was 70 years old, had an elevated blood alcohol level and had a history of chronic obstructive pulmonary disease (COPD), diabetes and atrial fibrillation. A few hours later, his blood pressure dropped to an abnormally low level.

The man had arrived with no identification and no family or friends.

His tattoo, which included a signature and had the word "Not" underlined, left doctors unsure of what to do next.

Was the tattoo a clear representation of the patient's wishes? Should they honor it and avoid any heroic efforts to save his life? Were they required to, legally?

Doctors detailed the case and the decisions they made in a report published in the New England Journal of Medicine.

At first, they decided not to honor the tattoo, "invoking the principle of not choosing an irreversible path when faced with uncertainty," they wrote.

However, this decision left the medical team conflicted, and they brought in an ethics committee to consult on it further.

After reviewing the case, the committee advised the doctors to honor the DNR tattoo.

"They suggested that it was most reasonable to infer that the tattoo expressed an authentic preference," the doctors wrote.

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