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States worse than death

Hillman, Kena,b; Athari, Fakhria,b; Forero, Robertoa

Current Opinion in Critical Care: October 2018 - Volume 24 - Issue 5 - p 415–420
doi: 10.1097/MCC.0000000000000529
CRITICAL CARE OUTCOMES: Edited by Ognjen Gajic

Purpose of review This review aims to discuss situations where patients would prefer to consider dying rather than survive, particularly in the context of choosing whether to be subjected to active medical management aimed at increasing their life span.

Recent findings Obviously, there are no randomized trials on evaluating whether patients would choose death rather than life. Moreover, the topic of the review is rarely addressed in a conventional scientific way. Instead, we review the suffering that people may go through when receiving futile care in both the short and long-term in acute hospitals and how this may influence people's decisions about their own Goals of Care.

Summary The review describes the failure of acute hospitals to recognize people at the end of life until very late and, when they are recognized, the failure to manage the dying process well. The inference is that if patients were genuinely aware of the potential short and long-term suffering involved in futile care, they would consider those states worse, may be worse than death, especially when death is almost certainly inevitable with or without conventional treatment.

aThe Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales Sydney, Ingham Institute for Applied Medical Research, Liverpool, Kensington

bIntensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia

Correspondence to Ken Hillman, AO, MD, Intensive Care Unit, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW 1871, Australia. Tel: +61 2 8738 3585; e-mail:

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