Stages of DyingStages of Dying

Test Review• Cause of most fear• How to face fear – how related

to Thanatology• 4 Categories of Fear• 3 of 4 things that dealing with

death can teach us• 3 of 5 reasons why North

American’s can more easily deny death

• Euphemisms• Cryonics movement• Grief – definition in own words• 3 Steps to “Grief Work”

Process• 3 Ways to Prepare for Grief

• 3 of 5 Emotions associated with Grief

• Neurotic Guilt = guilt feelings out of proportion to the cause

• Existential Guilt = Sense of human inadequacy in face of death

• Abnormal Grief• 5 Stages of Dying

– Where else the stages apply– Rules of stages

• 3 Reasons why people NOT in denial may not talk with us personally

• Know 6 of 14 points for “Dealing with the Dying”

Elisabeth Kübler-RossElisabeth Kübler-RossThe The five stagesfive stages, -- first introduced , -- first introduced

by by Elisabeth Elisabeth KüblerKübler-Ross-Ross In the late 1960’sIn the late 1960’s

5 Stages 5 Stages a process by which a process by which people deal with a terminal illnesspeople deal with a terminal illnessBring death and dying into the Bring death and dying into the

mainstream.mainstream.

5 stages can also apply to:5 stages can also apply to:1.1. Catastrophic lossCatastrophic loss. .

(job, income, freedom). (job, income, freedom). 2.2. Significant life eventsSignificant life events

a)a) The death of a loved oneThe death of a loved oneb)b) DivorceDivorcec)c) Drug addictionDrug addictiond)d) Infertility diagnosis, Infertility diagnosis, e)e) As well as many tragedies As well as many tragedies

& disasters.& disasters.

Characteristics of the “Stages”

1. Stages not necessarily in the order given

2. All stages not experienced by all patients usually a person will always experience at least two.

3. Often, people will experience several stages in a "roller coaster" effect switching between two or more stages, returning to one or more several times before working through it.

Hint for the caregiverHint for the caregiverDon’t try to “rush the process” to Don’t try to “rush the process” to reach acceptance.reach acceptance.

– Realize that: Some people fight death Realize that: Some people fight death until the end. until the end.

a)a) The harder a person fights death, the more likely they are The harder a person fights death, the more likely they are to stay in the denial stage.to stay in the denial stage.

b)b) The ill person will have more difficulty dying in a dignified The ill person will have more difficulty dying in a dignified way.way.

c)c) Some may adapt better with this approach.Some may adapt better with this approach.

Stages of Dying

Stage 1• Denial 

– "I feel fine."; "This can't be happening, not to me."

a. Denial is usually only a temporary defense for the individual.

b. Person may need this for a time to transition to later acceptance. (cushion)

Stage 2Stage 2 AngerAnger  

"Why me? It's not fair!"; "Why me? It's not fair!"; "How can this happen to "How can this happen to me?"; "Who is to blame?"me?"; "Who is to blame?"

a. The individual recognizes a. The individual recognizes that denial cannot continue.that denial cannot continue.

b.b. The person is very difficult The person is very difficult to care for due to misplaced to care for due to misplaced feelings of rage and envy. feelings of rage and envy. Healthy people are Healthy people are resented!resented!

Stage 3Bargaining – "Just let me live to see my children

graduate."; "I'll do anything for a few more years."; "I will give my life savings if..."

• Person hopes that they can somehow postpone or delay death.– Deal with God: “I’ll live a better life if you

just give me more life.”

Stage 4• DEPRESSIONDEPRESSION

– "I'm so sad, why bother with anything?"; "I'm going to die... What's the point?“

a. The dying person begins to understand the certainty of death.

b. The individual may become silent, refuse visitors and spend much of the time crying and grieving. (Allows person to disconnect). • It is not recommended to attempt to cheer up an

individual who is in this stage. It is an important time for grieving that must be processed.

Stage 5• ACCEPTANCE

– "It's going to be okay."; "I can't fight it, I may as –well prepare for it."

a. This final stage comes with peace and understanding of the death that is approaching.b. Person will want to be left alone.c. Feelings and physical pain may be non-existent.

Dealing With the DyingDealing With the Dying1. We need to be willing to talk2. Don’t be afraid of upsetting them – they are already

upset!3. Never say: “I know what you’re going through.”

YOU DON’T!4. Allow the dying to give you a clue

(They may be afraid to upset YOU).5. Remember: Not everyone wants to discuss it.

(Some still in denial and you can’t “break through it.”)6. Those not in denial may not talk because:

a. They are considering your feelingsb. They are afraid they will have no visitorsc. They may talk better with certain people.

7. Don’t be afraid to show your feelings. (doctors may be an exception).

8. Children may visit – but use judgment– Which will “frighten” them more?

9. Families often suffer from a misguided compassion:– They don’t want to face it so they assume the patient

doesn’t want to face it!10. Patients often “know” even if they haven’t been

told.11, “Active Listening” – Respond to patients hints and

don’t be afraid to address their concerns.12. Dying are often considered “untouchables” so

don’t be afraid of a hug, hold their hand, etc.13. Regulate visits: “A visit is a ‘medication’, regulate

the dose, don’t become ‘toxic!’”14. REMEMBER: They are still LIVING – they are the

same person, the difference is often in us!