Kübler-Ross identified the following “stages” of dying:
- Denial and isolation: In this stage, the person denies that death is really going to take place. This reaction is commonly associated with any kind of terminal illness. However, denial is usually only a temporary defence and is eventually replaced with increased awareness when the person is confronted with such matters as financial considerations, unfinished business and worry about surviving family members.
- Anger: The dying person realises that denial can no longer be maintained, and very often, feelings of anger, resentment, rage and envy follow. In this stage, the dying person wonders “why” he has to die. It can be difficult to care for a person in this stage since the anger can be displaced and projected onto the nurses, social worker, doctor, family member, etc. or even God. The realisation of loss becomes great, and those who symbolise life, energy, and competent functioning are especially salient targets of the dying person’s resentment and jealousy.
- Bargaining: In this phase, the dying person develops the hope that death can somehow be postponed or delayed. Some persons enter into a bargaining or negotiation - often with God - as they try to delay their death. Psychologically the person is saying “Yes me, but...”. In exchange for a few more days, weeks, or months of life, the person promises to lead a reformed life dedicated to God or to the service of others.
- Depression: Here the dying person comes to accept the certainty of death. This can be evident in several ways. The dying person may become silent, may refuse visitors, and may spend much of the time crying or grieving. This behaviour should be perceived as normal in these circumstances and is actually an effort to disconnect the self from all love objects. Efforts to cheer up the dying person at this stage should be discouraged, because the dying person has a need to contemplate impending death.
- Acceptance: The dying person develops a sense of peace; an acceptance of one’s fate; and, in many cases, a desire to be left alone. In this stage, feelings and physical pain may be virtually absent. Kübler-Ross sees this stage as the end of the dying struggle, the final resting stage before death.
Kübler-Ross never intended the stages to be an invariant sequence of steps toward death, and individual variation should be recognised.