Five Stages of Dying

Chronic illnesses evolve over time, usually exacerbating as you age. Often, this means switching medications, making more lifestyle modifications or seeing additional specialists. But sometimes as an illness goes through its natural course, it no longer responds to curative care. This is when the illness transitions from chronic to terminal.

It’s daunting to be faced with a terminal illness. Most patients experience pain and suffering and begin pondering their mortality. It can be quite stressful. But there might be some comfort in knowing that there’s a process terminally ill patients go through to find inner peace. If you or a loved one is dealing with this, here are the stages of dying as defined by renowned psychiatrist, Elisabeth Kübler-Ross, MD.

Five Stages of Dying

1. Denial 
   A terminal diagnosis is hard to accept. We know we’re not invincible, but it’s still difficult to wrap our heads around dying. And since many terminal patients feel ill, but not as though they’re dying, the prognosis can seem unreal. During this phase patients describe feeling numb and don’t want to discuss their prognosis. They tend to isolate themselves from family and friends. They may even skip palliative care treatments. For most people, the phase is short-lived, but some people take longer to get through it. Once a patient is through the phase, they resume their relationships and treatments, realizing their time is limited.   

       

2. Anger
   Next comes understandable questions – “Why me?” or “Why now?” or “What’s going to happen to my loved ones?” They may also question God. A life cut short is frustrating – hopes are gone, dreams are dashed and plans won’t be realized. This leads to anger and an outpouring of emotions such as yelling and fits of rage. Like denial, many patients move through this phase rather quickly once they realize that anger is not helping their situation.     

    

3. Bargaining 
   This leads to bargaining, usually with God, but it can be with a doctor or even the illness. Patients offer good behavior, acts of kindness and charitable donations in exchange for more time. As part of the negotiation, patients agree to not ask for anything else if their prayer is answered. However, patients quickly learn that this tactic doesn’t work and move through this stage.

    

4. Depression 
   As this point, patients usually feel quite ill and may need more palliative care. They are less active and social and mourn the loss of their old life, becoming depressed as they look back on their life and relive memories. Kübler-Ross defines this period as reactive depression.  There’s a good chance this happens after patients had to give up roles in their life, including their job. The financial strain of care may force major lifestyle changes such as downgrading a home. These losses also trigger depression. Patients also understand they’re not going to heal, grieving the loss of their future, which Kübler-Ross refers to as preparatory depression. This stage can take a while for a patient to navigate through and it’s common for patients to progress and regress during this stage.  

    

5. Acceptance
   The goal of the terminally ill patient is reaching this stage. At this point, patient has reflected on their life, expressed emotions and lamented their losses. They’re ready to make amends with loved ones and say their goodbyes. They use the time they have left to mentally prepare for their final moments and die in peace.

To learn more about the death and dying process, talk to your primary care doctor; they can usually help with resources for people who are terminally ill. If you don’t have a primary care doctor, consider joining with an MDVIP-affiliated practice. Find an MDVIP affiliate near you and begin your partnership in health »