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Comment & Response
April 2017

States Worse Than Death—Reply

Author Affiliations
  • 1Pulmonary, Allergy and Critical Care Division, University of Pennsylvania, Philadelphia
  • 2Fostering Improvement in End-of-Life Decision Science Program, University of Pennsylvania, Philadelphia
JAMA Intern Med. 2017;177(4):593-594. doi:10.1001/jamainternmed.2016.9666

In Reply I appreciate the thoughtful response by Nothelle and Finucane to our Research Letter regarding states worse than death in hospitalized patients with serious illnesses.1

As we mentioned in our Research Letter1 and Nothelle and Finucane highlight in their response, people have difficulty forecasting how they would react in hypothetical situations and frequently adapt to previously unimaginable states of debility and dependence that accompany aging or illness. For this and many other reasons, the data presented in our Research Letter1 should not be taken literally to mean that a significant number of patients would actually choose to die rather than go on living if they were, for example, to become incontinent.

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