An Ethical Dilemma

I recently read an article in the Student BMJ which I found very interesting. The article describes a woman who was admitted to A&E with an overdose and had perviously been admitted for self harm at an earlier date. After her treatment for the overdose (whilst still on hospital grounds) she covered herself in lighter fluid and set herself alight however the paramedics spotted her and she was readmitted. It was in theatre during the scrubbing of the burnt skin before a surgical tracheostomy took place that the dilemma arose.

The theatre team spotted a tattoo which read: DNR Do Not Resuscitate

The team proceeded to initiate further resuscitative treatment as they believed it was in the patients "best interests" and failure to do so immediately would have led to deterioration, there was no time to seek advice from an ethicist.

The article describes a method which can be used to analyse ethical issues using four broad topics:
"Medical indications, patient preferences, quality of life and contextual features. The approach is also entirely compatible with the widely used four principles of medical ethics (respect for autonomy, beneficence, non-maleficence and justice)"

(Briefly applied to the case described) With regards to medical indications the proposed treatment would prolong life along with a high probability of success. Patient preferences are made clear by the tattoo although the message may not have represented her current wishes. Failure to resuscitate would lead to grave consequences and no risks could be taken. Quality of life again presents problems, would the patient be grateful for another chance at life or would she be devastated and feel her wishes been contradicted? Finally contextual features considers legal factors, in terms of the tattoo, it was not a legally binding contract.

"The patient continued to be depressed after recovery. She did not complain or display any anger about the intervention; nor did she express any gratitude."

The complexity and difficulties surrounding the case made it very interesting to read but imagine if you had been in the theatre team, what would you have done?