Understanding the Stages of Dying in Hospice Care

stages of dying

Saul Ebema, D.Min.

In continuation to my article on “knowledge of death as a crisis in hospice care”, I will attempt to dive into what follows next after the knowledge or awareness of death.  According to Kubler- Rose, “There are five stages of dying that someone diagnosed with terminal illness will most likely experience.”[1] She said that the first common reaction to death and dying is denial. Throughout my experience as a hospice chaplain, I have come to notice the same pattern. Denial is the most likely reaction to a diagnosis of terminal illness. “No not me, that can’t be true,” This reaction is typical because, no one expects to be confronted by death in such a random way without preparation. Therefore, denial functions as a shock absorber to help deal with shocking news. Denial allows the person confronted with a diagnosis of terminal illness to recollect themselves and begin preparing for the reality of the illness. To some patients, this is a normally temporal reaction, while others main retain this state of denial until they die. Each patient is different.

The second stage is Anger. One of my patients consistently asked me why this happened to him. He would look at his eighty five year old grandfather and complain why it didn’t happen to his grandfather rather than him. This stage of anger is often very difficult to deal with because this anger is displaced in all directions. Anger may be projected by the patient at the environment, their family members, themselves or at the medical staff.

The third stage is bargaining. One of my patients often asked me to pray for God to heal him. He said if God healed him, he would donate to charity, work for God and help the homeless. Some patients with a diagnosis of a terminal illness believe there is a slim chance they can make a deal with God.  The deal is usually a life dedicated to God or a life in the service of their local churches. Such promises to God for healing may be associated with an issue of personal guilt. Such remarks by terminally ill patients are not just brushed aside but attended to through careful listening.

The fourth stage is Depression.When the terminally ill patient can no longer deny his/her illness, when he/she is forced to undergo more surgery, or hospitalization, when he/she begins to have more symptoms or becomes weaker and thinner, he/she cannot smile it off anymore. His/her anger and rage will soon be replaced with a great sense of loss and depression.[2]This depression is often heightened by the reality that there is nothing the patient can do to stop the death from happening.

The fifth stage of death is acceptance. I visited a patient one day who had just reached this stage of acceptance. He said, “I have had a good life and I am ready to go meet my God.” All the anger, denial and depression he had before this stage had gone. He had come to terms with his death and was ready.  This stage is often void of feelings as the patient begins to prepare for his or her death. It is important to note that, there will always be a few patients who will struggle and keep hope for healing alive until they die.

Resources

[1] Elizabeth Kubler- Rose, On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy and Their Own Families 2nd ed. (New York: Scribner 2014), 31.

[2] Larry A. Bugen, Death and Dying: Theory/Research/practice (Dubuque, IO: Wm. C. Brown Company. 1979), 122.

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