Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

reminded him of his promise to retire soon, to move to Arizona perhaps, to have a few more good 
years .... 
 
He talked with much warmth and affection about his daughter, twenty-one years old, who came to 
visit him on a leave from college, and who was shocked to see him in this condition. He mentioned 
all these things, as if he was to be blamed for disappointing his family, for not living up to their 
expectations. 
 
I mentioned that to him and he nodded. He talked about all the regrets he had. He spent the first 
years of his marriage accumulating material goods for his family, trying to "make them a good 
home," and by doing so spent most of his time away from home and family. After the occurrence of 
cancer he spared every moment to be with them, but by then, it seemed to be too late. His daughter 
was away at school and had her own friends. When she was small and needed and wanted him, he 
was too busy making money. 
 
Talking about his present condition he said, "Sleep is the only relief. Every moment of awakening 
is anguish, pure anguish. There is no relief. I am thinking in envy of two men I saw executed. I sat 
right in front of the first man. I felt nothing. Now, I think, he was a lucky guy. He deserved to die. 
He had no anguish, it was fast and painless. Here I lie in bed, every hour, every day is agony." 
 
Mr. P. was not so much concerned about pain and physical discomfort as he was tortured by regrets 
for not being able to fulfill his family's expectations, for being "a failure." He was tortured by his 
tremendous need to "let go and sleep, sleep, sleep" and the continuous flow of expectations from 
his environment. "The nurses come in and say I have to eat or I get too weak, the doctors come in 
and tell me about the new treatment they started, and expect me to be happy about it; my wife 
comes and tells me about the work I am supposed to do when I get out of here, and my daughter 
just looks at me and says `You have to get well'-how can a man die in peace this way?" 
 
For a brief moment he smiled and said, "I will take this treatment and go home once more. I will 
return to work the next day and make a bit more money. My insurance will pay for my daughter's 
education anyway, but she still needs a father for a while. But you know and I know, I just cannot 
do it. Maybe they have to learn to face it. It would make dying so much easier!" 
 
Mr. P. showed as well as Mrs. W. (in Chapter VII) how difficult it is for patients to face impending 
and anticipated death when the family is not ready to "let go" and implicitly or explicitly prevents 
them from separating themselves from the involvements here on earth. Mrs. W.'s husband just 
stood at her bedside, reminding her of their happy marriage which should not end and pleading 
with the doctors to do everything humanly possible to prevent her from dying. Mr. P.'s wife 
reminded him of unfulfilled promises and undone tasks, thus communicating the same needs to him, 
namely, to have him around for many more years to come. I cannot say that both these partners 
used denial. Both of them knew the reality of the condition of their spouses. Yet both, because of 
their own needs, looked away from this reality. They faced it when talking with other people but 
denied it in front of the patients. And it was the patients who needed to hear that they too were 
aware of the seriousness of their condition and were able to accept this reality. Without this 
knowledge "every moment of awakening is pure anguish," in Mr. P.'s words. Our interview ended 
with the expression of hope that the important people in his environment would learn to face the 
reality of his dying rather than expressing hope for a prolonging of his life. 

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(P156) 
 
This man was ready to separate himself from this world. He was ready to enter the final stage when 
the end is more promising or there is not enough strength left to live. One might argue whether an 
all-out medical effort is appropriate in such circumstances. With enough infusions and transfusions, 
vitamins, energizers, and antidepressant medication, with psychotherapy and symptomatic 
treatment, many such patients may be given an additional "lease on life." I have heard more curses 
than words of appreciation for the gained time, and I repeat my conviction that a patient has a right 
to die in peace and dignity. He should not be used to fulfill our own needs when his own wishes are 
in opposition to ours. I am referring to patients who have a physical illness but who are sane and 
capable enough to make decisions for themselves. Their wishes and opinions should be respected, 
they should be listened to and consulted. If the patient's wishes are contrary to our beliefs or 
convictions, we should express this conflict openly and leave the decisions up to the patient in 
respect to further interventions or treatments. In the many terminally ill patients I have so far 
interviewed, I have not seen any irrational behavior or unacceptable requests, and this includes the 
two psychotic women earlier described, who followed through with their treatment, one of them in 
spite of her otherwise almost complete denial of her illness. 
 
The Family After Death Has Occurred 
 
Once the patient dies, I find it cruel and inappropriate to speak of the love of God. When we lose 
someone, especially when we have had little if any time to prepare ourselves, we are enraged, 
angry, in despair; we should be allowed to express these feelings. The family members are often 
left alone as soon as they have given their consent for autopsy. Bitter, angry, or just numb, they 
walk through the corridors of the hospital, unable often to face the brutal reality. The first few days 
may be filled with busywork, with arrangements and visiting relatives. The void and emptiness is 
felt after the funeral, after the departure of the relatives. It is at this time that family members feel 
most grateful to have someone to talk to, especially if it is someone who had recent contact with the 
deceased and who can share anecdotes of some good moments towards the end of the deceased's 
life. This helps the relative over the shock and the initial grief and prepares him for a gradual 
acceptance. 
 
Many relatives are preoccupied by memories and ruminate in fantasies, often even talk to the 
deceased as if he was still alive. They not only isolate themselves from the living but make it harder 
for themselves to face the reality of the person's death. For some, however, this is the only way they 
can cope with the loss, and it would be cruel indeed to ridicule them or to confront them daily with 
the unacceptable reality. It would b e more helpful to understand this need and to help them 
separate themselves by taking them out of their isolation gradually. I have seen this behavior 
mainly in young widows who had lost their husbands at an early age and were rather unprepared. It 
may be more frequently encountered in the days of war where death of a young person occurs 
elsewhere, though I believe a war always makes relatives more aware of the possibility of no return. 
They are therefore more prepared for that death than, for example, for the unexpected death of a 
young man through a rapidly progressing illness. 
 
A last word should be mentioned about the children. They are often the forgotten ones. Not so 
much that nobody cares; the opposite is often true. But few people feel comfortable talking to a 

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