Death and Dying

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Although all people die, everyone's dying process is unique. Many people think of dying as merely a physical process, but dying is an experience of the whole person and is influenced by a combination of physical, psychological, social, cultural, and spiritual factors. There are as many ways to die as there are to live, so in order to better understand how people who are dying experience the process, researchers and clinicians have developed different models or theories that attempt to account for how people cope with dying. THEORIES/MODELS OF DYING

Elisabeth Kubler-Ross's Stage Theory of Dying

The general public is most likely to be familiar with Kubler-Ross's theory of dying. In 1969, she published a book titled On Death and Dying, which was based on interviews collected from 200 dying patients. In the book, Kubler-Ross discerned five stages that dying people experience. The five stages, which reflect different reactions to dying, are denial, anger, bargaining, depression, and acceptance.

Denial is the "No, not me!" stage where the person is in shock or denial and cannot believe that they are going to die. Denial is self-protective and gives the person time to adjust psychologically to the news that he or she is going to die. Anger is the "Why me?" stage and may involve, in addition to anger, resentment, rage, and envy at God, doctors, nurses, family members, or anyone who is not dying. Bargaining is the "Yes me, but. . ." stage and often involves bargaining with God and attempts to postpone the inevitable ("Yes, I am going to die, but if only I could live long enough to see my child graduate," etc.). Depression involves mourning for current and past losses (reactive depression) and anticipated losses (preparatory depression and grief). Finally, acceptance emerges. Acceptance is not a happy stage, but rather is characterized by an absence of feeling, a giving up or resignation, or even a sense of peace that occurs as the person realizes that death is imminent and cannot be avoided. Although not a stage of dying, hope is an important aspect of all five stages and can persist throughout all of them.

In spite of its general popularity, Kubler-Ross's theory has been criticized on several points. Two of those criticisms are that there is really no evidence that stages are present in coping with death, and there is also no clear evidence that people who are dying actually move through the five stages that Kubler-Ross identified. Many people have also taken the stages as a prescription that dying persons must experience, rather than acknowledging that dying persons react and cope in different ways and may not want to or need to go through the five stages of dying.

Regardless of these criticisms and others, Kubler-Ross taught us important lessons about the dying process. First, she shed light on the much avoided topic of dying and was the catalyst for continued discussion and research on the issue. She also brought to light the challenges of dying and taught that dying people are still living and have needs and desires that need to be understood and supported throughout their dying process.

Task-Based Models of Dying

Task-based models of dying differ from Kubler-Ross's stage theory in several ways. First, they focus less exclusively on the ways that people cope emotionally with dying and instead take a more holistic approach by considering the ways that dying persons actively cope with a variety of potential challenges across numerous dimensions of life. They also do not explicitly or implicitly imply an order or sequence, which offers a more flexible, less prescriptive perspective from which to view the challenges of both dying patients and their loved ones.

Charles A. Corr's Task-Based Model of Dying

Charles Corr has presented one popular task-based model of dying that describes four areas of task work (physical, psychological, social, and spiritual) and basic types of tasks related to coping with...
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