Fates worse than death: the role of valued life activities in health-state evaluations.

One hundred eight college students (Study 1) and 109 elderly adults (Study 2) rated 28 health impairments for the quality of life perceived to be possible in that state, the extent to which the state was perceived as a fate better or worse than death, and the extent to which the state was perceived to interfere with the ability to engage in the activities each individual valued most in life. States perceived most negatively were those perceived to interfere most with valued life activities. For any given health state, evaluations were more negative the more the state was perceived by individuals as likely to interfere with engagement in their valued life activities. Implications of these results for end-of-life medical decision making in general and the use of advance medical directives in particular are discussed.