Kubler Ross Outline

Topics: Death, Afterlife, Life Pages: 6 (1922 words) Published: March 3, 2015
On Death & Dying by Elisabeth Kubler-Ross

On the Fear of Death
Death never possible in regard to ourselves
Historically, death less complicated
Ross remembers death of a farmer growing up in Europe
Allowed to die at home upon request
Death accepted more readily as inevitable
No embalming, no pretending
Scientific advancementincreased fear of and denying of reality of death Death today is less certain, more gruesome, more lonely
Dying patient often treated with no opinion/treated like object We don’t readily acknowledge that patients are suffering emotionally, not just physically Attitudes Toward Death and Dying
We strengthen denial by challenging death
Implicit belief in immortality strengthened through defying death (glad it was him, not me) “Suffering has lost its meaning”
people avoid pain at all costs, no perception of reward for suffering people also don’t believe in life after death as muchanxiety to prolong earthly existence, deny its finiteness Denial of deathdestruction of society as we try in fear to prolong and promote our own earthly existence Acceptance of deathpeace (internal and between people, nations) Physicians trained to prolong life, but don’t know much about the definition of life Ultimately we shouldn’t need specialists for dying patients, just better doctors Beginning of Kubler’s study of the dying

Interviewed critical patients without any preconceptions of the topic at hand Doctors resisted idea of addressing topic of death openly with patients The dying as teachers
Kubler believes patients should always be told full truth of their circumstances Physicians should be honest but leave door open for hope
No definitive time frame
Almost all patients knew anyway
Medical staff must accept death themselves in order to help patients come to their own understanding, peace Patients face death based on how they have dealt with hardship in the past Empathy matters a lot: patients pick up loss of interest of doctorsfeelings of isolation First Stage: Denial & Isolation

Temporary defense to be replaced by partial acceptance
Unconsciously, we all believe ourselves to be immortal
Persistent, nurturing therapist who has dealt with his own death complex can help patient overcome denial Patients will simultaneously accept treatment, doctor’s orders while still insisting on denial Second Stage: Anger

Once reality sets in”Why me?”
Anger displaced to environment
Empathy: A patient who is understood will become less angry with time Detached, intolerant caretaker (due to own death complex)defensive, argumentative patient (due to loneliness, fear) Anger often stems from loss of control, especially in those who have led successful lives Hard to accept ultimate equality in death

E.g. nun who helped fellow-patients when she feared not being able to help people anymore (resented nursing staff who she perceived as uncaring) Loss of humanity: e.g. increasing difficulty of maintaining hygiene Third Stage: Bargaining

If I didn’t get my way when I was angry, maybe I should ask more nicely Past experience tells us that good behavior is rewarded
Attempt to postpone through promise making
Promises associated with guilt
Fourth Stage: Depression
Reactive depression
Financial burden and associated guilt
Loss of role as parent
Loss of control
Best treated through assurance
Preparatory depression
Patient prepares to disconnect from everything and everyone in order to facilitate acceptance Treated through implicit understanding
Discrepancy b/w patient’s state of mind (preparing to die) and those around him (hoping for recovery, encouraging optimism)great turmoil in patients Need for resolution of the unresolved is a significant source of grief Fifth stage: Acceptance

Not a happy stage, rather “final rest before long journey” Characterized by extended sleep
Few patients fight until end
Stage of acceptance is difficult for survivors
Patients feel guilty for causing distress
Survivors should...
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