Paramedics in the United States have just opened up a debate as to whether tattoos should be seen as stupid drunken decisions or genuine requests to end a person's life.
This contentious ethical dilemma follows a decision taken by emergency responders in Florida to allow a man to die after it was found he had a tattoo on his chest which read: "Do Not Resuscitate".
In a statement published in the New England Journal of Medicine, a representative for the medics said that although they were "conflicted", the team "initially decided not to honour the tattoo."
"He was placed on empirical antibiotics, received intravenous fluid resuscitation and vasopressors, and was treated with bilevel positive airway pressure," the report reads.
But after reviewing the patient's case, ethics consultants advised the responders to honour the tattoo – allowing the man to pass on without undergoing any further medical procedures.
The consultation came to the conclusion it was "most reasonable to infer that the tattoo expressed an authentic preference," the report states.
In defence of the decision, their written statement also explains how US laws are often "not nimble enough to support patient-centered care and respect for patients' best interests."
The 70-year-old man was taken to the emergency room at Miami University Hospital with high blood-alcohol level, but without any form of identification, the journal reports.
Doctors later found that the "unconscious" man had no next of kin, a history of chronic obstructive pulmonary disease, diabetes and had already made an official request not to be revived.
His "Do Not Resuscitate" tattoo, accompanied by his presumed signature, however, "produced more confusion than clarity," the team admit:
"Given concerns about its legality and likely unfounded beliefs tattoos might represent permanent reminders of regretted decisions made while the person was intoxicated."
In 2002, doctors found that a patient under their care had a "Do not resuscitate" tattoo on his chest that did not reflect his end-of-life wishes, but the result of a lost bet on a drunken night out.