Deny your death

The five stages of dying

The educational talk about dying sets a sequence of chains of thought, memories and insights in motion, which everyone experiences individually, but which in most cases follows certain patterns.

It is important for family members to be aware of these patterns so that typical misunderstandings can be avoided. We owe our knowledge of these patterns to the Thanatology or death customer. As a “doctrine of death”, it deals scientifically with dying and is a research area of ​​philosophers, psychologists, theologians, physicians and sociologists. Elisabeth Kübler-Ross, a doctor who was born in Zurich in 1926 and who later became famous in the USA, is considered to be the founder. From her comes the concept of the five phases of the dying process in which dying typically takes place.

Dont want to believe it. In the first phase, many dying people deny their condition because it seems unbearable to them. The fact that this state of affairs leads inexorably to death is not accepted by them and is therefore suppressed. Often the dying isolate themselves in this phase and do not want to think about their situation. They are neither able to talk about it nor can they weigh the possible consequences. The shock prevails.

Anger, anger, aggression and resistance mark the second phase. These feelings are often directed against relatives, doctors, and caregivers. You will be held responsible for the fate of the person concerned and their situation. But also aggression towards their own "incompetent" body and suicidal thoughts torment those affected.

Caregivers should know that the dying person's anger is not directed against them; Rather, it consists in the fact that the person concerned sees no possibility of getting out of this hopeless situation. Reactions should therefore be understanding, but not compassionate.

Negotiate with fate. The dying negotiates with doctors, nurses and, in the case of believing patients, also with his God. The affected person clings to everything that could promise a possible cure and tries by all means to escape the danger of death. He expresses important projects and wishes. As far as the condition of the person concerned allows this, the projects should be planned together and his wishes realized.

Looking back and deep sorrow about the fact that one's own life is finally coming to an end characterize the fourth phase. Fear, anxiety and the worry of an excruciating end with thoughts of active euthanasia also preoccupy the dying in this phase. Caregivers should listen and share this sadness. It is important to perceive worries and fears and to plan in advance protective possibilities of palliative care to alleviate the suffering.

Accept what is. In the final phase of acceptance and consent, the dying person accepts the facts without any ifs or buts. He is calm about his fate and takes care of final affairs. Conversations are possible during this time and are often desired by the patient. The dying person's instructions and wishes should be taken very seriously. If people can die in this phase, their death is often a gentle fall asleep and "letting go" after saying goodbye to their caregivers.

Not every dying person goes through all dying phases, they last different lengths and are different intensities for each individual. Unfortunately, many people do not reach the phase of acceptance, so that they die without having said goodbye to life and their loved ones in peace.

Authors

Dipl.-Pflegew. (FH) Carmen Happe, Ruth Mamerow, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 15:21