This study evaluates the effect of complete traumatic tetraplegia on the life satisfaction and well-being of 87 individuals, 42 of whom are ventilator supported, 2 years or more postinjury. Standard psychosocial instruments were used. The relative distress comparing ventilator dependence with loss of extremity function was also evaluated. The ventilator assisted individuals with tetraplegia (VAITs) were significantly more satisfied with their housing, family life, and employment when applicable, than were the autonomously breathing individuals with tetraplegia (ABITs). The VAITs' life satisfaction and other well-being and quality of life indicators were generally positive, and were significantly underestimated by a control group of health care professionals. Only 23.8% of the VAITs expressed general dissatisfaction with their lives compared with 35.6% of the ABITs. The ABITs and the control group significantly overestimated the distress which the VAITs associated with ventilator use by comparison with loss of upper extremity function. We conclude that long-term life satisfaction and well-being are considered to be positive by the majority of both ABITs and VAITs, are at least as high in the latter as in the former, correlate best with family and social interaction, and are severely underestimated for both ABITs and VAITs by health care professionals.