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The Merck Manual--Second Home Edition logo
 
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Chapter 8. Death and Dying
Topics: Introduction | Time Course of Dying | Making Health Care Choices | Symptoms During a Fatal Illness | Financial Concerns | Legal and Ethical Concerns | Coming to Terms | When Death Is Near | When Death Occurs
 
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Coming to Terms

Preparing for death often means finishing a life's work, setting things right with family and friends, and making peace with the inevitable. Spiritual and religious issues are important to many dying people and their families. Members of the clergy are part of the care team in some hospice and hospital facilities, and professional caregivers can help people and their families find appropriate spiritual assistance if they do not have a relationship with a minister or other spiritual leader.

Grieving is a normal process that usually begins before an anticipated death. According to Elisabeth Kubler-Ross, a pioneer in death and dying, the dying person typically experiences five emotional stages, often in the following order: denial, anger, bargaining, depression, and acceptance. A person in denial may act as if, talk as if, or think that he is not dying. Denial is caused by fears about loss of control, separation from loved ones, an uncertain future, and suffering. Talking to a doctor or other health care member can help the dying person understand that he can remain in control and that his pain and other symptoms will be controlled. Anger may be expressed as a sense of injustice: "Why me?". Bargaining can be a sign of reasoning with death, that is, seeking more time. When the person realizes that bargaining and other strategies are not working, depression may develop. Acceptance, sometimes described as facing the inevitable, may come after discussions with family, friends, and care providers.

Preparing for death is hard work, with many emotional ups and downs. However, for most people, it is a time of new understanding and growth. By dealing with past hurts and mending relationships, a dying person and family members can achieve a profound sense of peace.

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