About Stages of Death and Dying

Anyone who has lost or is losing a loved one to a fatal illness knows the illness does not just affect only the physiology, but also the emotions and
disposition of the dying person.
Understanding the stages a person may pass through helps those who are assisting the dying person to allow each person involved to experience their emotions in an open environment.
Internal medicine professionals look at the physical aspects of dying and how to aid the dying patient in the transition from life to death.
A group of doctors, nurses, chaplains and other professionals working in focus groups came up with a list of factors associated with a good death.

History

Elisabeth Kubler-Ross was a survivor of the Holocaust internment camps of WWII. She witnessed some of the atrocities which took place in the camp. It has also been suggested her father was very stern with her.
She became a doctor against her father's wishes.
She became interested in the grief exhibited by Holocaust survivors. Her studies led her to publish a book on the cycles of grief in 1969, "On Death And Dying."
She spent most of the last years of her life presenting seminars on death and dying to anyone who wanted to attend.
Her five cycles of grief have become a standard by which others have written similar books. Although she never intended for anyone to assume the cycles were a rigid pattern, she did spend a great deal of time trying to dispel that assumption. People grieve differently and experience the five cycles or stages in different orders.
Another important study was done by a group of internists and other medical personnel at a symposium. In this study the group came up with a group of factors which were meant to give medical caregivers a standard of needs a dying patient will have as they face the inevitable. However, these same factors would be true for most people who do caregiving.

Expert Insight

When Elisabeth Kubler-Ross wrote her book, she described five cycles of grief. The cycles she discussed were denial, anger,bargaining, depression and acceptance. Each of these stages are an important part of the transition through the grief process but also the dying person. The stages occur in each individual and in a different order for each person.

Denial is often the first stage. Here, the person goes on as if nothing has changed. They may not want to discuss the diagnosis and may even put off seeing the doctor. They may not wish to discuss their diagnosis with their loved ones.

Anger is the stage when the truth of the situation hits them. They may lash out at loved ones. A teenager may lash out at her younger siblings because she knows they will continue to live when she is gone. A husband may turn away from his wife. This may be the stage where unresolved issues come to the forefront and become big issues to resolve.

Bargaining is the stage when a person pleads with their higher being for an extension to her life. She may have a list of things she wishes to accomplish and believes she won't die until the list is done. She may become very religious or she may turn her back completely on any religious affiliations she once had.

Depression is when the person realizes death cannot be put off or bargained away. He becomes sad and may cry. He may withdraw.

Acceptance is when the person realizes death is imminent. A peace overcomes him. He may wish to say his good-byes. He is now neither sad nor joyous.

Types

In the internist study, the factors dealt more with the physical act of dying and the needs the patient had to have met before moving towards a peaceful death. These factors were deemed important for the medical practitioners to know about in order to help the patient. Although their study was meant for medical personnel, it is also pertinent to family and friends who may attend to the dying person.

Pain and symptom management is important to patients so they can remain able to take care of themselves and to use their mental faculties.

Clear decision making is important so patients can make decisions regarding their own care. Most patients want to remain mentally alert as long as possible.

Preparation for death is a time when the patient may be making preparations. This can include finishing up unfinished projects, making peace with people they have been at odds with over time, cleaning out their personal effects, deciding to whom personal belongings will go to and even making preparations for her own funeral.

Contributing to others is allowing patients to do for others the things they can and wish to do. This may be giving some advice, checking on the well-being of a visitor's family or talking to friends who live far away. Caregivers must allow the person to contribute as long as he feels able.

Affirmation of the whole person allows the person to feel he is still a part of the world. It is important for all caregivers and visitors to give this final important gift to the dying person. This means simply allowing them to discuss the things they have always been interested in, sharing common likes and dislikes with the person, allowing for laughter, jokes and
lively discussions. Not constantly talking about their critical illness is a relief. They want to be treated just like you have always treated them.

The symposium concluded if caregivers could do all of these things it would result in a peaceful death. As a loving friend or family member your goal should also be to allow your loved one to have a peaceful death.

Effects

When dealing with a loved one who is dying, often the caregiver feels as if they are all alone. There are several ways to make the care-giving burden lighter.
When the doctor declares a person has little or no chance of recovery and sets the time limit, often the family can request hospice care. Hospice sends out nurses to deal with medications, aids to help in the day to day care, bathing and feeding.
If you request it, they may also send an appropriate religious person to help counsel the dying person. They may also send people who come to read or visit and those who wish to help others make it through the process of dying.

As a friend or family member, you may also be of assistance by offering to come in for a few hours to give the care giver relief. Things still need to be done to keep the family going such as paying bills, grocery shopping, and school or church activities. Friends can offer to stay with the dying person so the family members can continue with their normal activities.

Remember the family is going through a very difficult time. You can make things easier for them which will make the dying process easier for the dying person.

Benefits

As active, healthy people, we are often afraid to visit with dying friends. The fear is less a palpable heart-racing fear than it us an uneasiness because we are as close as we can come to facing our own death when a loved one is dying.
The process of another dying person may impress upon us things we want to do if and when we are faced with a lingering death.

Potential

The experience of aiding another person to have a peaceful death will be rewarding in two important ways. First, we will discover death is not as frightening a prospect as we first believed, and second we will know those things we wish to do if we are faced with a lingering death. Training ourselves to face death as a stage of living will enable us to be a better person, a better friend to friends who may be dying, and a better family member.

Resources

• Information about Elisabeth Kubler-Ross
• Annals of Internal Medicine
• List of articles on Death and Dying