Is There Really A Fate Worse Than Death?

Is there such a thing as a fate worse than death? According to a new survey, there are, or at least there are some things patients with serious illnesses consider scarier than dying. Because death isn't the only terrible thing that can happen to you — and for some people, it might not even be the worst.

In a new survey published as a research letter in the journal JAMA Internal Medicine, researchers looked at patients with serious illnesses to see if there were outcomes they considered to be even less desirable than death. Researchers asked patients, who were all age 60 or older, to rank 10 different health states on a five point scale. They found that although death is obviously not something that many people look forward to, for a substantial number of patients, death is not the thing they fear most.

More than half of all patients said that bowel or bladder incontinence, relying on a breathing machine, or being unable to ever get out of bed to be worse than death. The majority of patients also felt the same about mental states such as dementia.

On the other hand, most patients ranked being in a wheelchair, living in a nursing home, or being in constant but moderate pain to be better than dying.

These results probably wouldn't be true for everyone, of course. For one thing, all of the patients in the trial are at least 60; it's likely that patients who are much younger might have a very different perspective on what sorts of things they'd prefer to death. And for another thing, the underlying message of this study is that it's not safe to assume what outcomes a patient will prefer, and that those preferences are likely unique to each individual.

"Death is a patient-centered outcome because nearly everyone wishes to avoid it," the researchers explain in the study. "Despite this general preference, however, studies among healthy outpatients and those with serious illnesses show that a significant minority, and sometimes a majority, rate [other states] as worse than death."

The overall message, these researchers feel, is that doctors shouldn't assume that the goal with any given patient should be to avoid death at any and all costs. Today, hospitals tend to assume they know what's best for a patient, when in reality, patients might have different ideas about which outcomes they prefer. And patients should be allowed and encouraged to express those feelings and choose treatments that are in line with their wishes.

In other words, whether or not there is a such a thing as a fate worse than death — and what that fate might be — probably depends on who you are.

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