On Death and Dying

"For It Is Appointed Unto Every Man to Die, and After This the Judgment." - Hebrews 9:27

By Bp. Joseph (Ancient Church of the West)

“On Death and Dying” is one of the most important books ever written on the subject of death and grief, and is still considered the bench-mark in the palliative care of the dying. It became an immediate bestseller, and Life magazine called it "a profound lesson for the living." This companion volume consists of the questions that are most frequently asked of Dr. Kübler-Ross and her compassionate answers. She discusses accepting the end of life, suicide, terminal illness, euthanasia, how to tell a patient he or she is critically ill, and how to deal with all the special difficulties surrounding death. Questions and Answers on Death and Dying is a vital resource for doctors, nurses, members of the clergy, social workers, and lay people dealing with death and dying.

A classic in the study of death, dying and grief, this first effort by Elisabeth Kubler-Ross provides the first glimpse at the true feelings and experiences of people in the process of dying. Written in 1969, Kubler-Ross uses material gathered from her many seminars and interviews with terminally ill hospital patients and in a groundbreaking gesture, suggests to the reader that instead of ignoring, avoiding or isolating the dying patient, it is important to understand the stages of grief and to allow the patient to talk openly and honestly about his situation. In earlier times, death was not a subject to be discussed aloud, and was such an uncomfortable topic, that a dying patient was not free to share his feelings, anxieties, anger and transitions with even his loved ones. Kubler-Ross presents some new possibilities, that perhaps a dying patient feels lonely and isolated, and the awkward non-communicative way we treat the dying can be transformed to help the patient feel a sense of completion, comfort and peace at the end of his life.

With the help of four theology students, Elisabeth Kubler-Ross undertook a project that involved providing seminars at hospitals to help people with the process of death and dying. In addition, the group provided one-on-one interviews with patients and their families in an attempt to help them spell out their worries, frustrations, fears and undelivered communication. They found simply listening to the patients discuss openly and frankly the prospect of their own deaths was quite calming for the patients and perhaps, helped them to move on to the preparatory stage of grief, which coincides with the final stage of acceptance.

Death is a topic difficult for even the strongest people to discuss when it affects them personally. Often, terminally ill patients are avoided by their families, isolated and lonely, because it is too difficult for relatives to communicate openly about the situation. Kubler-Ross found patients are often eager to talk about what has happened to them, and the issues among their family members that may otherwise be left unresolved. Moreover, terminally ill patients wish their doctors would be forthright with them, and express their sadness and anger over the occasionally lax treatment they receive at the hands of nurses and other hospital staff.

The author's now-famous five stages of dying or grief, have been incorporated into hospice studies and, although they are perhaps presented too rigidly, they are based on the Kubler-Ross's extensive work with many terminally ill patients. Kubler-Ross wants us to know that, although there is no set, proper way to die, the stages of grief are fairly common, and apply not only to the dying patient, but the family as well. 

The thrust of her message with this book is to encourage us to talk to the dying and listen to the dying patient, giving them whatever help they need to express their feelings and wishes, and helping them to resolve the final issues that are keeping them alive or in discomfort. Perhaps more importantly, we should not avoid a dying person, but sit with them, hold their hands, and just be a source of silent strength that will allow them to complete their process with dignity and in peace.

The Stages of Grief According to Kubler-Ross’ Famous Study

Further Reflections on Clinical Notes on Death and Dying 

Elizabeth Kubler-Ross’ 1964 monumental work, "On Death and Dying”, was followed up by a short manual of questions and answers in 1969 entitled “Questions on Death and Dying”. This book was made up of the most frequently asked and representative question from health and service professionals. The general ethos of the book is one of simple, grounded helpfulness, concern for dying patient and grieving family, and a recognition of the reality of suffering and the necessity of mourning. 

Unlike other books of its time, or the popular trend amongst the religious, death is to be seen for what it is, a tragic, often unbearable, and irreversible state of loss. Pius platitudes about the goodness of God or of the love that He has for mankind are to be avoided. Instead of focusing on the abstract qualities of faith and Scripture, Dr. Kubler-Ross reminds us to be present, to be sympathetic and to resist the temptation to react, to judge, or to try to make our own job easier by denying others grief or the time necessary to work through losses in public space. 

In Dr. Ross’ vision of end-of-life care, patients are to be made comfortable, supported as they go through the necessary stages of grief, and family members are to be treated with patience, kindness and an understanding sobriety. Family, especially when the patient is the victim of sudden trauma or suicide, are to be supported through a long, painful process that mirrors that of the slowly dying, as they deny, bargain, get angry, become depressed, and finally come to a sense of peace and purpose through the whole experience. Caregivers are encouraged to think first about practical issues of pain-eleveation and communication, and then add such vital human touches as patience with irrational anger, permission to scream and wail, and a respect for the need for quiet and a sympathetic face. 

Dr. Ross’ vision of death with dignity complement Christian views of death, in that we see the moral imperative to embrace life as God-given and good, and the time of death as out of our control, completely rejecting the illegitimate siren call of “Euthanasia”. As Dr. Kubler-Ross points out, “Euthanasia” is used as a euphemism for “Assisted Suicide” or “Mercy Killings”, but originally it means “Good Death”. Mercy killing is anything but good because it robs the person of his or her vital humanity and attempts to “play God”, limiting the time and suffering that the patient has on this earth. Rather, a “Good Death” should be everyone’s goal, found in faith, relationships, calm and detachment, where meaning is found and where people can physically see and grieve their losses.

Even after nearly 50 years of helpful advice from Dr. Kubler-Ross’ works, the process of death is still an inhumane, hurried and often feared affair within the church and hospital system. Her call was always for proper time, silence and friendship in these contexts as people work through the most difficult times of their lives. "Questions on Death and Dying” reminds us of the importance of reality and of empathy, silence and willingness to suffer with others. It is a sober call to health professionals and chaplains to deal with people as people, not as projects or principles, and not to shut out or ignore the process because of our own discomfort with death. Practicality and honesty are key, as is patience and a fair amount of experience, which often allows us to guess or intuit the needs and thoughts of others, so that we can facilitate the natural process of dying with strength, goodness and dignity.