For persons with AIDS, current health status does not necessarily affect their desire to be revived if their heart stops, according to a study supported by the Agency for Health Care Policy and Research (HS06239).
About 65% of terminally ill AIDS patients in this study, mostly young homosexual and bisexual men, wanted to be revived if their heart stopped. Overall, those who considered themselves to be in the best health were more likely to want to be revived. However, over half of those who considered their health to be the very worst (the lowest quartile) also wanted to be resuscitated.
A key finding was that the relationship between health status and desire for resuscitation does not hold up for all patients. For the third of patients who expressed the most reluctance to give up life, by saying that they wanted life extension even if it meant living in some undesirable state (such as being blind or fed by a tube), current health status was unrelated to desire for resuscitation.
These results suggest limits to the validity of assessing how a patient values his or her current health status by asking questions that involve loss or risk of life, such as "standard gambles" (for example, what risk the patient is willing to take of dying in surgery to cure a health problem) and time trade-off questions (for example, how many years of later life a person is willing to give up for better life now). A general reluctance to give up life may confound how patients answer such questions, notes Arnold Epstein, md, of Harvard Medical School. These findings are based on interviews of 291 patients with AIDS who participated in the Boston Health Study during 1990 and 1991.
For more information, see "The Role of Reluctance to Give Up Life in the Measurement of the Values of Health States," by Floyd J. Fowler, Jr., phd, Paul D. Cleary, phd, Michael P. Massagli, phd, et al in Medical Decision Making [15(3):195-200, 1995].
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
