Certain wounds have long been recognized as heralding death. However, contemporary sources rarely agree on the terminology for and identification of these wounds. In the nineteenth century, Charcot described the decubitus ominosus,1 a concept later revived and expanded with the Kennedy Terminal Ulcer (KTU),2 the Trombley-Brennan Terminal Tissue Injury (TBTTI),3 and Skin Changes at Life’s End (SCALE).4
Advancement of medical science and development of critical care technology has altered end-of-life trajectories and impacted the epidemiology of wounds.5 A recent review6 demonstrated that various terms referencing end-of-life wounds overlap in meaning and have limited research support; in addition, nomenclature that incorporates verbiage such as terminal or end-of-life can be ambiguous and potentially subject to bias.
Because the terms terminal and end-of-life conflate concepts regarding diagnosis and prognosis, it is unclear whether the wound is predicting death, resulting from the dying process, or both. The association with end-of-life is intrinsically problematic because this period of time is complex, often prolonged, and difficult to define. This commentary reflects on terminal ulcer terminology in the context of today’s health care system by examining inherent uncertainties, bias, and health care system evolution. I ultimately propose that use of said terminology should be limited to clinical situations where the health care team (including patient and family) agree the patient is actively dying according to the definition cited by Hui et al7 (ie, the hours or days preceding imminent death during which time the patient’s physiologic functions wane). Otherwise, I recommend clinicians employ nomenclature grounded in accepted concepts of physiology shared with other organ systems, such as skin failure.