Stability of choices about life-sustaining treatments

Ann Intern Med. 1994 Apr 1;120(7):567-73. doi: 10.7326/0003-4819-120-7-199404010-00006.


Objective: To examine the stability of patients' choices for life-sustaining treatments.

Design: A longitudinal cohort study.

Setting: Primary care practices in central North Carolina.

Patients: Medicare recipients (n = 2536).

Intervention: Participants were asked about demographic characteristics, health status, well-being, depression, social support, use of a living will, and desire for life-sustaining treatment if they were to become terminally ill. These questions were repeated 2 years later (n = 2073, 82% follow-up).

Results: The population tended to choose to forego one more treatment at follow-up than they did at baseline. A choice to forego treatment was twice as stable as a choice to receive treatment. Patients with a living will were less likely to change their wishes (14%) than those without a living will (41%). Persons were more likely to want increased treatment at a later time if they had been hospitalized (23% compared with 18%), had had an accident (29% compared with 19%), had become more immobile (23% compared with 19%), had become more depressed (25% compared with 15%), or had less social support (25% compared with 14%).

Conclusions: Most patients (85%) who had chosen to forego life-sustaining treatments did not change their choices. Nonetheless, these data suggest that it is important to review patients' preferences for life-sustaining treatments rather than to assume the stability of their choices.

Publication types

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

MeSH terms

  • Advance Directive Adherence
  • Advance Directives / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Choice Behavior
  • Depression / psychology
  • Female
  • Follow-Up Studies
  • Health Status
  • Humans
  • Life Support Care / psychology*
  • Life Support Care / statistics & numerical data
  • Living Wills
  • Logistic Models
  • Male
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Social Support
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • United States
  • Withholding Treatment