Cohort studies and randomized trials among hospitalized patients with acute and serious illnesses commonly use mortality as the primary or key secondary outcome measure. Death is a patient-centered outcome because nearly everyone wishes to avoid it. Despite this general preference, however, studies among healthy outpatients and those with serious illnesses show that a significant minority, and sometimes a majority, rate states such as severe dementia as worse than death.

To our knowledge, there is no evidence as to whether patients with acute illnesses requiring hospitalization also consider certain states of debility as worse than death. This distinction is important because some evidence suggests that as death nears, people may choose more aggressive treatment options in an attempt to prevent it. We therefore sought to understand how hospitalized patients with serious illnesses would evaluate states of cognitive or functional debility relative to death.