stages of dying [OFr, estage, stage; ME, dyen, to lose life] , the five emotional and behavioral stages that may occur after a person or family first learns of approaching death. The stages, identified and described by Elisabeth Kübler-Ross, are denial and shock, anger, bargaining, depression, and acceptance. The stages may occur in sequence or they may recur, as the person moves forward and backward—especially among denial, anger, and bargaining. Caring for a dying person requires sensitivity to the signs of each stage. At first, shock may be accompanied by signs of panic. The person may refuse care and deny the diagnosis and prognosis. Denial serves as a defense against the shock. Anger often follows this stage. It is characterized by abusive language, refusal to perform basic self-care responsibilities, negative criticism of anyone who wants to help, and other kinds of angry behavior. The third stage, bargaining, reflects the need of the person for time to accept the situation. A common observation of this period is the patient’s attempt to make a bargain, “If I could live until Christmas …” Commonly, the person goes back and forth from anger to bargaining: sometimes silent, sometimes grieving, and sometimes apathetic, depressed, insomniac, and distant. The fourth stage is a time of depression in which the person goes through a period of grieving before death, mourning over past experiences and anticipating impending losses. The final stage, acceptance, is one of inner peace and resolution that death is a certainty. The person may show his or her acceptance by being uninterested in present or future events, being preoccupied with past events, preferring to have few visitors, and wanting quiet and solitude. Nursing care includes administering adequate pain relief, ensuring privacy and dignity, and giving sensitive, honest emotional support to both patient and family. See also emotional care of the dying patient, hospice.
