The Will to Live
August 15, 1999 3 minutes read
The Will to Live
Abstract & Commentary
Synopsis: A survey of 51 persons with HIV infection found that most were satisfied with their lives. In response to a hypothetical question, nearly half were unwilling to sacrifice any remaining life expectancy for better health.
Source: Tsevat J, et al. The will to live among HIV-infected patients. Ann Intern Med 1999;131:194-198.
If you were ill with a chronically disabling disease, would you be willing to trade longevity for a shorter but healthier life? This intriguing question was posed to 51 HIV-infected patients with varying levels of disease progression, along with questions regarding their health status, quality of life, life satisfaction, as well as attitudes toward family, friends, and religion.
Surprisingly, 71% of the patients were delighted, pleased, or satisfied with their lives. Only 6% were dissatisfied or unhappy—and none indicated that they thought their lives were terrible. While 47% felt their life was getting better, 41% felt it was stable. The remaining 12% thought it was getting worse or did not know. Women were much more likely to be satisfied with their life, as were persons who were at "peace with God and the universe," as well as those who had stopped using injection drugs. When asked whether their life was better than before they knew they were infected with HIV, 74% of women responded "yes" vs. 39% of men (P = 0.034). There was no association between life improvement following a diagnosis of HIV and the number of years of diagnosis, stage of disease, or use of protease inhibitor therapy.
Most surprisingly, 47% of patients were unwilling to sacrifice any years of life for better health. At most, patients were willing to consider a trade-off of 5% of their remaining life expectancy for excellent health. Persons who felt better, had less fatigue, or less advanced disease were at peace with the universe, and those with children, as well as men, were less willing to sacrifice longevity. In something called a "standard-gamble score," patients were, on average, willing to risk a 20% chance of death for perfect health. There was a wide range of response to this question, however; 41% of patients were unwilling to accept more than a 1 in 200 chance of death in exchange for perfect health.
Comment by Carol A. Kemper, MD, facp
Tsevat and associates suggest that their data show that patients with HIV strongly prefer quantity to quality of life. On closer inspection, however, it appears that factors other than health may be more important to the sense of life satisfaction and the will to live. Directing attention to other areas of these patients’ lives, such as improved living conditions, encouraging drug and alcohol treatment, and addressing psychological and spiritual issues, may have as much or greater effect on the quality of life than medical care alone. In addition, these data suggest that women may have entirely different coping mechanisms for dealing with poor health that deserve further examination in the context of HIV. There is something inspirational in these data—that many patients with HIV, despite being faced with poor health, social ostracism, and declining economic station, nevertheless have found a way to treasure life.
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