6 Stages Of Death And Dying

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Dardo Hameed

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Aug 4, 2024, 2:56:44 PM8/4/24

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Formany people, death is an unfamiliar process. Terminally ill patients and their caregivers may wonder what to expect during this stage and how to make this time more comfortable. Having a better understanding of what happens during this process can help everyone involved to better prepare for this transition and each of the stages of dying.

There are three main stages of dying: the early stage, the middle stage, and the last stage. These are marked by various changes in responsiveness and functioning. However, it is important to keep in mind that the timing of each stage and the symptoms experienced can vary from person to person. Outlined below is a general look at what to expect during each stage.

The first sign of this stage of dying will be a noticeable drop in interest in food. For many patients, eating becomes more of a burden than a joy at this point. They may also occasionally choke on their fluids and will start to feel full rather quickly.

During this stage, the body starts conserving energy and does not need as much nourishment as it did in the past. Although it may be troubling to witness, it does not cause the patient any pain or suffering. This is a natural process where the body shuts down hunger, and artificial feeding at this time does not prevent death and can even lead to physical distress.

The person will become increasingly less responsive to their surroundings and those around them, to the point where they will eventually become unable to speak or move at all. This is typically seen during the last days of life.

Loved ones should assume the patient can hear everything they say. Experts suggest speaking softly to the patient and touching them gently only if they normally like being touched. This is a good time for prayer or meditation. It is not recommended to ask the patient questions that require answers.

The restlessness noted in this stage is attributed to changes in metabolism, while the kidney and bowel functions are affected by decreasing circulation. Relaxing muscles can lead to incontinence. The slowing of blood circulation to internal organs causes the lungs to lose their power to clear out fluids as well as the relaxation of the throat muscles.

When a patient enters the final stage of dying, it is helpful to talk to them reassuringly. Again, gentle touch is acceptable if the patient likes being touched. Even when they are not responsive, the patient might be able to hear those around them, so it is important to speak respectfully. Although this can be a distressing time for loved ones, it is best to try to stay calm.

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The heart beats a little more slowly, or with a little less force. So, blood is moved around the body more slowly. This means the brain and the other organs receive less oxygen than they need, and do not function as well.

In the days before their death, a person's control over their breathing starts to fail. They may breathe more slowly for a while, then more quickly, and so their breathing becomes quite unpredictable.

Someone who is close to death will spend most of the time asleep. They may not be able to communicate when they are awake because their senses are failing. However, they may still be able to hear, so speak to them normally.

Death is a normal part of the life cycle. As a health worker or professional, it should be viewed as an honour and privilege to be part of the care provided to a person who is dying, and their loved ones. When caring for someone at the end of their life, it is important to know what to expect.

A tool to guide quality end-of-life (terminal) care. An end-of-life care pathway is a tool which outlines what is recognised as best practice for a holistic, person-centred approach to end-of-life care and dying

Providing care at the end of life. The Australian Commission on Safety and Quality in Health Care defines dying as 'the terminal phase of life, where death is imminent and likely to occur within hours or days, or occasionally weeks.'

Healthdirect Australia acknowledges the Traditional Owners of Country throughout Australia and their continuing connection to land, sea and community. We pay our respects to the Traditional Owners and to Elders both past and present.

Medical professionals will work with dying patients in all disciplines, and the process is difficult as care shifts from eliminating or mitigating illness to preparing for death. This is a difficult transition for patients, their loved ones, and healthcare providers to undergo. This activity provides paradigms for the process of moving toward death as well as a discussion of how they should and should not be applied, supporting the interprofessional team to address the unique needs of their patients and guide them and their loved ones through the process.

Objectives:Describe the five stages of death, as outlined by Elisabeth Kubler-Ross.Describe alternative paradigms for experiencing death and grief, in addition to those introduced by Kubler-Ross.Explain the potential underlying process generating these outwardly demonstrated stages to provide a context for supporting patients, families, caregivers, and healthcare providers experiencing death.Outline interprofessional team strategies for improving care coordination and communication in a dying patient.Access free multiple choice questions on this topic.

Medical professionals in all disciplines work with dying patients, and doing so effectively can be difficult. In the context of death and dying, patients, their loved ones, and the health care team must shift their goals. Where treating acute and chronic illness usually involves finding a tolerable path to eliminating or preventing the progression of a condition, treating terminal illness must involve preparing for death as well as efforts to mitigate symptoms.[1] Understanding the experience of dying and grief allows providers to support the unique needs of patients, their loved ones, and other healthcare team members.[2][3][4]

Dr. Elizabeth Kubler-Ross introduced the most commonly taught model for understanding the psychological reaction to imminent death in her 1969 book, On Death and Dying. The book explored the experience of dying through interviews with terminally ill patients and outlined the five stages of dying: denial, anger, bargaining, depression, and acceptance (DABDA). This work is historically significant as it marked a cultural shift in the approach to conversations regarding death and dying. Prior to her work, the subject of death was somewhat taboo, often talked around or avoided altogether. Dying patients were not always given a voice or choices in their care plan. Some were not even explicitly told about their terminal diagnosis. Her work was popular in both the medical and lay cultures and shifted the nature of conversations around death and dying by emphasizing the experience of the dying patient.[4][5] This led to new approaches to working with patients through the final phase of life. She highlighted the importance of listening to and supporting their unique experiences and needs and spurred new perspectives on ways practitioners can support terminally ill patients and their family members in adjusting to the reality of impending death.[6]

Kubler-Ross and others subsequently applied her model to the experience of loss in many contexts, including grief and other significant life changes. Though the stages are frequently interpreted strictly, with an expectation that patients pass through each in sequence, Kubler-Ross noted that this was not her contention and that individual patients could manifest each stage differently, if at all. The model, which resulted from a qualitative and experiential study, was purposely personal and subjective and should not be interpreted as natural law. Rather, the stages provide a heuristic for patterns of thought, emotions, and behavior, common in the setting of terminal illness, which may otherwise seem atypical.[7] Facility with these patterns can help health care providers provide empathy and understanding to patients, families, and team members for whom these patterns may cause confusion and frustration.[6]

Denial is a common defense mechanism used to protect oneself from the hardship of considering an upsetting reality. Kubler-Ross noted that patients would often reject the reality of the new information after the initial shock of receiving a terminal diagnosis. Patients may directly deny the diagnosis, attribute it to faulty tests or an unqualified physician, or simply avoid the topic in conversation. While persistent denial may be deleterious, a period of denial is quite normal in the context of terminal illness and could be important for processing difficult information. In some contexts, it can be challenging to distinguish denial from a lack of understanding, and this is one of many reasons that upsetting news should always be delivered clearly and directly. However, unless there is adequate reason to believe the patient truly misunderstands, providers do not need to repeatedly reeducate patients about the truth of their diagnosis, though recognizing the potential confusion can help balance a patient's right to be informed with their freedom to reconcile that information without interference.

Anger is commonly experienced and expressed by patients as they concede the reality of a terminal illness. It may be directed at blaming medical providers for inadequately preventing the illness, family members for contributing to risks or not being sufficiently supportive, or spiritual providers or higher powers for the diagnosis' injustice. The anger may also be generalized and undirected, manifesting as a shorter temper or a loss of patience. Recognizing anger as a natural response can help health care providers and loved ones tolerate what might otherwise feel like hurtful accusations. However, they must take care not to disregard criticism that may be warranted by attributing them solely to an emotional stage.[8]