PART THREE: DYING

Core Concepts
Dying is a special situation in living, not the whole of life Death is the outcome of dying, not its equivalent

Key Questions
How does someone cope with dying? How can we help persons who are coping with dying? How has our society responded to the needs of dying persons?

Dying persons are What is involved in living human beings dying?

Corr & Corr, Death & Dying, Life & Living, 7th edition

Coping with Dying

Corr & Corr, Death & Dying, Life & Living, 7th edition

Coping
A definition:
Constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person.
(Lazarus & Folkman, 1984)

Corr & Corr, Death & Dying, Life & Living, 7th edition

3 Categories of Coping Skills

1. Appraisal-focused Coping
How do I understand or make sense of the situation?

2. Problem-focused Coping
What will I do about the situation?

3. Reaction-focused Coping (Emotionfocused Coping)

What will I do about my reactions to the situation?

Corr & Corr, Death & Dying, Life & Living, 7th edition

Coping as Learned & Dynamic Behavior

Questions to Consider:
What does the individual perceive as stressful? How is the individual coping with that stress? Why is the individual coping in this particular way? Is the individuals coping style flexible enough to adapt to challenges encountered?

We are born with the ability to adapt to change, but we all must learn how to cope with loss.
(Davidson ,1975)

Corr & Corr, Death & Dying, Life & Living, 7th edition

Coping with Dying: Who Is Coping?

Coping with dying is multifaceted & involves more than one:
Person Set of perceptions Set of motivations

Empathetic Listening is necessary to:

Identify each person involved Listen carefully to what his or her coping reveals Understand what coping means for each person in each situation
Corr & Corr, Death & Dying, Life & Living, 7th edition

Coping with Dying: Kbler-Ross Stage Model

Stages Denial Anger Bargaining Depression
Reactive

Typical Expression Not me! Why me? Yes me, but Responding to:
Past & present losses

Preparatory

Anticipating future losses

Acceptance

A stage almost void of feelings

The one thing that usually persists throughout all these stages is hope.

Corr & Corr, Death & Dying, Life & Living, 7th edition

five stages of grief - elisabeth kbler ross

EKR stage

Interpretation Denial is a conscious or unconscious refusal to accept facts, information, reality, etc., relating to the situation concerned. It's a defence mechanism and perfectly natural. Some people

1 - Denial

can become locked in this stage when dealing with a traumatic change that can be ignored. Death of course is not particularly easy to avoid or evade indefinitely. Anger can manifest in different ways. People dealing with emotional upset can be angry with themselves, and/or with others, especially those close to them. Knowing this helps keep detached and non-judgemental when experiencing the anger of someone who is very upset. Traditionally the bargaining stage for people facing death can involve attempting to bargain with whatever God the person believes in. People facing less serious trauma can bargain or seek to negotiate a compromise. For example "Can we still be friends?.." when facing a break-up. Bargaining rarely provides a sustainable solution, especially if it's a matter of life or death. Also referred to as preparatory grieving. In a way it's the dress rehearsal or the practice run for the 'aftermath' although this stage means different things depending on whom it involves. It's a sort of acceptance with emotional attachment. It's natural to feel sadness and regret, fear, uncertainty, etc. It shows that the person has at least begun to accept the reality. Again this stage definitely varies according to the person's situation, although broadly it is an indication that there is some emotional detachment and objectivity. People dying can enter this stage a long time before the people they leave behind, who must necessarily pass through their own individual stages of dealing with the grief.

2 - Anger

3 - Bargaining

4 - Depression

5 - Acceptance

(Based on the Grief Cycle model first published in On Death & Dying, Elisabeth KblerRoss, 1969. Interpretation by Alan Chapman 2006-2009.)

Kbler-Ross Stage Model

Critique
Existence of these stages has not been demonstrated No evidence has been presented that people actually do move from stage 1 through stage 5 Limitations of the method have not been acknowledged The line is blurred between description & prescription The totality of the persons life is neglected The resources, pressures, & characteristics of the immediate environment are not taken into account. The model suggests that ways in which all human persons respond to the stress of dying are independent of any social or cultural influence.
Corr & Corr, Death & Dying, Life & Living, 7th edition

Three Lessons to Learn from the Legacy of Elisabeth Kbler-Ross

1. Individuals who are coping with dying are still alive & often have unfinished business that they want & need to address 2. We cannot be effective providers of care unless we listen actively to those we seek to serve & identify with them their own tasks & needs 3. We need to learn from those who are coping with dying in order to come to know ourselves better

Corr & Corr, Death & Dying, Life & Living, 7th edition