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Comment & Response
April 2017

States Worse Than Death

Author Affiliations
  • 1Johns Hopkins Bayview Medical Center, Baltimore, Maryland
JAMA Intern Med. 2017;177(4):593. doi:10.1001/jamainternmed.2016.9604

To the Editor In their Research Letter in a recent issue of JAMA Internal Medicine, Rubin and colleagues1 discuss why “hospitalized patients with serious illnesses may receive care aimed at prolonging life when they are living in states they have deemed to be the same as or worse than death.”1(p1558) We are geriatricians and care daily for patients who have incontinence, need 24-hour care, cannot get out of bed, have dementia, and/or are confused all the time. Quality of life is always a central consideration. Rubin et al1 found that for each of these states, over 40% of respondents deemed them worse than death. Yet it is vanishingly rare that a patient reports to us a preference to be dead.

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