During the course of progressive heart failure, patients must make many decisions regarding medical treatments. One aggressive treatment option that can prolong life for advanced heart failure patients is the destination therapy left ventricular assist device (DT LVAD). Patients are asked to determine which treatments to pursue, like whether or not to receive a DT LVAD, yet little research has examined the factors that influence these decisions. One area of determinants that has been entirely overlooked is existential factors. When diagnosed with a life-limiting illness, patients' salience of death increases, and they often experience end of life fears. According to Terror Management Theory (TMT), when faced with death, one establishes cultural worldviews that give life meaning and provide an illusion of immortality. This meaning, in a sense, protects one from death anxiety. However, death anxiety and meaning in life have yet to be studied in terms of medical decision making. Therefore, the objective of this study was to examine how death anxiety and meaning in life influence the decision to receive a DT LVAD among patients with advanced heart failure using vignette methodology. The primary hypotheses of this study were that (a) death anxiety and meaning would be inversely related in that higher meaning would relate to lower death anxiety, and (b) both death anxiety and meaning would predict the likelihood of deciding to receive a DT LVAD in patients with advanced heart failure. Results from the current study indicate that meaning in life and death anxiety were not significantly related to each other, yet this lack of significance aligns well with TMT, which states that humans essentially suppress death anxiety and do so by focusing instead on what gives their life. These existential factors did not predict the decision to receive a DT LVAD, yet it is likely that basic methodological issues were present, namely the use of hypothetical vignettes, thus impacting the results. Further research is needed to fully understand how existential factors impact patients and their medical decisions, ideally with longitudinal designs to examine both prospective and actual medical decisions.