Life-sustaining treatments during terminal illness: who wants what?

J Gen Intern Med. 1993 Jul;8(7):361-8. doi: 10.1007/BF02600073.


Objective: To determine patient characteristics associated with the desire for life-sustaining treatments in the event of terminal illness.

Design: In-person survey from October 1986 to June 1988.

Setting: 13 internal medicine and family practices in North Carolina.

Patients: 2,536 patients (46% of those eligible) aged 65 years and older who were continuing care patients of participating practices, enrolled in Medicare. The patients were slightly older than the 65+ general population, 61% female, and 69% white, and most had one or more chronic illnesses.

Measurements and main results: The authors asked the patients whether they would want each of six different treatments (hospitalization, intensive care, cardiopulmonary resuscitation, surgery, artificial ventilation, or tube feeding) if they were to have a terminal illness. The authors combined responses into three categories ranging from the desire for more treatment to the desire for less treatment. After adjustment for other factors, 53% of women chose less treatment compared with 43% of men; 35% of blacks vs 15% of whites and 23% of the less well educated vs 15% of the better educated expressed the desire for more treatment. High depression scores also were associated with the desire for more treatment (26% for depressed vs 18% for others).

Conclusion: Patients' choices for care in the event of terminal illness relate to an intricate set of demographic, educational, and cultural factors. These results should not be used as a shortcut to determine patient preferences for care, but may provide new insights into the basis for patients' preferences. In discussing choices for future life-sustaining care, physicians need to explore with each individual the basis for his or her choices.

Publication types

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

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Life Support Care / psychology
  • Life Support Care / statistics & numerical data*
  • Male
  • Medicare / statistics & numerical data
  • North Carolina
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Patient Participation*
  • Socioeconomic Factors
  • Terminal Care / psychology
  • Terminal Care / statistics & numerical data*
  • United States
  • Withholding Treatment*