32 pages • 1-hour read
On Death and Dying
A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Themes
Persistence of Hope
As the author asserts: “The one thing that usually persists through all these stages is hope” (148). Hope appears as soon as denial has shifted to anger. In every case, “even the most accepting, the most realistic patients left the possibility open for some cure” (148). The evidence is overwhelming that hope is intrinsic to the human spirit and necessary for the continued fight through illness until the very end.
Hope is also necessary for the health care personnel charged with caring for the dying patient. Even a doctor with all the evidence could still possess “the hope that something unforeseen may happen, that [the patient] may have a remission, that they will live longer than is expected” (149). Conflicts arise with family and loved ones, either because the family refuses to acknowledge the seriousness of the situation, or because the patient feels that everyone has given up on them. Hope is the means by which the inevitability of death and the pain and suffering which accompany them can be faced head-on with positivity and strength.
Obstacles in the face of death would not be so grave if death could be seen as a natural part of the human experience: “If we, as members of the helping professions, can help the patient and his family to get ‘in tune’ to each other’s needs and come to an acceptance of an unavoidable reality together, we can help to avoid much unnecessary agony and suffering on the part of the dying and even more so on the part of the family that is left behind” (151).
Necessity of Communication
The purpose of On Death and Dying is to facilitate communication and allow patients and their families to navigate the dying process together: “If this book serves no other purpose but to sensitize family members of terminally ill patients and hospital personnel to the implicit communications of dying patients, then it has fulfilled its task” (151). Kübler-Ross relates the story of a married couple who knew the true, terminal nature of the husband’s illness, and yet were unable to communicate the reality to the other: “She knew and he knew, but neither had the courage to share it” (168). The couple’s inability to communicate was directly due to their fear and desire to protect each other’s feelings. Their communication was necessary if for no other reason than to assure the other that they cared.
In death, the patient’s suffering ends, but not for the family and friends left behind. Communication should be encouraged before death, ideally while the patient is still lucid. When a patient dies without healthy communication, survivors can be traumatized. As the author notes, survivors can experience unprocessed guilt due to lack of communication and will seek help for “somatic symptoms as a result of the failure to work through their grief and guilt” (169).
The Five Stages of Grief
Five of the 12 chapters in the book detail the classically defined stages of grief: denial, anger, bargaining, depression, and acceptance. After being diagnosed with a terminal illness, the patient almost always slips into denial. A random attack on one’s body seems inconceivable. As Kübler-Ross notes, denial is not usually permanent, but acts “as a buffer after unexpected shocking news, allows the patient to collect himself and, with time, mobilize other, less radical defenses” (52). The second stage is anger at the realization that something grave and harmful has entered one’s life; the “next question becomes: ‘Why me?’” (63). In essence, these first two stages are the manifestation of the human fight-or-flight response. At first flight is chosen—denial, or flight from reality. Then fight kicks in—anger and lashing out in an attempt to beat back the inevitable.
The third stage is bargaining: trading something valuable to get something in return. In the case of a terminal illness, this comes in the form of making promises, often to God: “If God has decided to take us from this earth and he did not respond to my angry pleas, he may be more favorable if I ask nicely” (93). The fourth stage is depression. Once the patient has vented their rage and their attempts at manipulating the universe or changing God’s mind have failed, the result can be overwhelming sorrow and lethargy. The patient’s “numbness or stoicism, his anger and rage will soon be replaced with a sense of great loss” (97). This is a natural and understandable reaction; the patient is “in the process of losing everything and everybody he loves” (99).
The fifth stage is acceptance, where the patient internalizes the inevitability of their death. They accept their diagnosis in order to make the most of what time they have left. When the various stages have been worked through—and they may not all occur, or even in straightforward order—the patient will reflect on death with “quiet expectation” (123-24). Acceptance is not happiness or contentment, but often simply a “void of feelings” (124). In the final days of the illness leading up to death, acceptance will shift into decathexis, the process of total and final detachment from the world.
Unlock every key theme and why it matters
Get in-depth breakdowns of the book’s main ideas and how they connect and evolve.
- Explore how themes develop throughout the text
- Connect themes to characters, events, and symbols
- Support essays and discussions with thematic evidence