On Death and Dying

On Death and Dying is a 1969 psychological study by Elisabeth Kübler-Ross. It is best known in popular culture for introducing the five stages of grief: denial, anger, bargaining, depression, and acceptance. Kübler-Ross’s work with terminally ill patients inspired the model. She wrote the study as a response to the lack of instruction in medical schools about how to handle the topic of death. It was the very first book written by Kübler-Ross in her illustrious career, and became a standard text for health care professionals, therapists, chaplains, psychologists, and all those who wish to gain more knowledge of what it means to die and to care for the dying.

This study guide references the 2019 Scribner paperback edition entitled On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy, and Their Own Families.

Summary

Kübler-Ross begins by discussing how many people in modern society are afraid of death and seek to prolong their lives through medical intervention at any cost. Death is treated as something shameful that adults hide from children, and at their funerals, dead bodies are made to look as alive as possible. Kübler-Ross suggests that paying more attention to the feelings of the dying patient might help rid them of some fear.

Kübler-Ross talks about the way doctors are trained to prolong life even after it has become painful and intolerable for a terminal patient. She wonders whether fear of death leads to the continuation of warfare around the world, as people wage war in an explicit attempt to defy death by causing it in others.

The main body of Kübler-Ross’s book comprises information she gathered from interviews with many terminally ill and dying patients. She worked closely with theology students and doctors to help open communication between the patients and their health care providers about what they could expect from the process of dying.

The first stage most people experience when they receive a terminal illness diagnosis is denial. They assume that there must have been a mistake made in their diagnosis, or that alternative medicine can cure them. Some patients continue to experience denial right up until their deaths. Kübler-Ross advises support givers to allow patients to experience denial and not to continually try to prove them wrong or argue with them about their prospects.

Denial is followed by anger, as the patient lashes out at loved ones and hospital staff. This stems from a realization that the patient will not be able to finish what he or she started and that plans must be cut short by the impending death. Kübler-Ross advises allowing patients in this phase as much control as possible so that they can begin to feel that they are in charge of their remaining life.

The next stage is bargaining. Patients may try to bargain with a higher power, or with their doctors to prolong their lives. According to Kübler-Ross, this bargaining generally stems from a sense of guilt; patients should be listened to closely in order to help them find closure and to have a sense of what is really bothering them.

Next, patients experience depression. This depression may stem from something the patient has already lost, such as quality of life, or it may be a preparatory depression as the patient realizes that death is now likely inevitable. Caretakers can try to cheer up the patient and this may be effective, but this approach should be balanced with allowing the patient to open up about his or her real fears and anxieties.

Finally, after passing through the other stages, the patient accepts his or her fate. This may be followed with a retreat or withdrawal, but not one born from depression. Caretakers should keep the lines of communication open and encourage the patient to talk about his or her feelings. Patients who do this tend to die with more dignity and more at peace than those who keep their feelings bottled up inside.

Keeping the family in the loop at all times was found to be absolutely essential and proved to be a vital part of the grieving process in both patients and loved ones. In almost all instances, Kübler-Ross felt that her attempts to speak with patients for the benefit of the seminar were met with great resistance by their physicians. Most doctors were fearful of death themselves and expressed anger at the attempt of outsiders to understand the dying process; the author determined that in many instances what was at work was a fear and pride that would resolve in the wake of seeing the great benefit in the patients’ experiences. Nurses and hospital chaplains were much more receptive to the aims of the seminar, and provided invaluable help and encouragement.

Great experience and maturity are required for those who work with the terminally ill, and keeping the lines of communication open between patients, loved ones, and care providers is one of the key aspects of any successfully navigated death.