Patients' and families' preferences for medical intensive care

JAMA. 1988 Aug 12;260(6):797-802.


Medical ethics suggest that life-sustaining treatment decisions should be made with consideration for patients' preferences and quality of life. Patients were interviewed who were at least 55 years old and had experienced medical intensive care at a university hospital during a one-year period to determine their preferences regarding intensive care; family members were interviewed if the patient had died (n = 160). Seventy percent of patients and families were 100% willing to undergo intensive care again to achieve even one month of survival; 8% were completely unwilling to undergo intensive care to achieve any prolongation of survival. Preferences were poorly correlated with functional status or quality of life and were not altered by life expectancy for 82% of respondents. Age, severity of critical illness, length of stay, and charges for intensive care did not influence willingness to undergo intensive care. These data suggest that personal preferences may conflict with any health policy that limits the allocation of intensive care based on age, function, or quality of life.

KIE: Patients over age 54 who had been cared for in the intensive care unit (ICU) of a university hospital or the families of such patients who had died were interviewed to determine their attitudes toward intensive care. Only 8% of the 160 people interviewed would reject intensive care to achieve any prolongation of life, while 70% would accept such care for even an additional month's survival. Choices were poorly correlated with functional status, quality of life, or life expectancy. Age, severity of illness, length of stay, or charges for the ICU did not influence the choice. The authors conclude that their data and similar studies on preferences for resuscitation suggest that, except in cases of extremely poor quality of life or prognosis, patient and family choices may pit self determination and individual wishes against a public policy to maximize general medical care by limiting costly services.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Consumer Behavior
  • Critical Care / economics
  • Critical Care / psychology*
  • Family
  • Female
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Patient Selection*
  • Personal Autonomy
  • Quality of Life
  • Resource Allocation
  • Socioeconomic Factors
  • United States
  • Withholding Treatment