Book Review: On Death & Dying

“Finally we may achieve peace — our own inner peace as well as peace between nations — by facing and accepting the reality of our own death.” - Elisabeth Kübler-Ross

In her first and most famous book, On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy & Their Own Families, Elisabeth Kübler-Ross accomplished some groundbreaking feats. First, she asked dying patients about their impending death and their thoughts and concerns about life. She challenged the medical community to shift their approach to communicating with their dying patients and their families. She also developed the five stages of grief that have since become part of our everyday language of loss: denial and isolation, anger, bargaining, depression, and acceptance.

Kübler-Ross attributed the disconnect in dying to modern medicine. She observed that dying patients often were not included in the decisions about their own care. They were “protected” from information about the severity of their conditions. They were treated more like objects and problems to be solved than like people. In her early practice of medicine Kübler-Ross had fewer technological advancements at her disposal. People more often died at home, surrounded by family and friends (including children). She observed that older doctors and brand new medical students were better at speaking with dying patients because they had not been indoctrinated by new approaches. When she first asked her colleagues about speaking to their patients, she faced strong resistance and sometimes direct hostility.

If we #payattention, resistance will show us exactly what we need to confront.

The medical community showed resistance in a few different ways. They did not want Kübler-Ross and her team to speak with their patients. They did not want to speak of the possibility of the death of their patients and some went so far as to deny that they had any terminally ill patients. They wanted to protect their patients from the knowledge of their own death. They did not want to hear that their patients’ wishes opposed the medical interventions that would prolong life. Out of this work grew the hospice movement and other patient-centered approaches to end-of-life care.

Of course, resistance showed up for the patients and their families as well. Resistance to our own death is how we survive. Denial, anger, bargaining, and depression clearly show our desire to live. And, as Kübler-Ross points out, even in acceptance we have hope that something miraculous will come along to give us more time. Beyond the resistance to our own death, the resistance that comes up through the stages of grief can show us what is unresolved in our life. When people were given a chance to share their authentic feelings, the release often resulted in insight. For example, one man was depressed because he felt he had not lived up to his wife’s expectations of him as a husband and a father. When he was able to express this to her, she was able to tell him all the ways he had been a blessing in her life.

Patients were often eager to speak with the team, which was no small feat because the discussions often took place in front of a large group of students. Kübler-Ross believes the conversations offered several benefits to the patients:

  • They had a voice.

  • They were able to be of service to others.

  • They were able to show their strength in the dying process.

  • They were able to leave a legacy.

  • They were not alone.

“We are talking about death — the subject of social repression — in a frank, uncomplicated manner, thus opening the door for a wide variety of discussion, allowing the complete denial if this seems to be necessary or open talk about the patient’s fears and concerns if the patient chooses. The fact that we don’t use denial, that we are willing to use the words death and dying, is perhaps the most welcomed communication for many of our patients.” - Elisabeth Kübler-Ross

On Death and Dying was published in 1969. In 50 years, many important changes have been made but there remains the opportunity for us to open up the discussion of death and dying even more. What if we could all speak about our deepest concerns and move through resistance openly with our family, friends, and medical professionals. What if on the other side of that resistance we found our voice, our service to others, our strength through vulnerability, our legacy, and a connection to others? That seems like the definition of a great life.

To open up the conversation in your family check out Let's Have Dinner and Talk About Death.

Also, The Great Blue Song Project addresses all the benefits Kübler-Ross found through her work interviewing patients. If you, or someone you know, are sick or dying, please reach out and schedule an exploration call.

Please share, ask questions, leave comments, suggest topics, and tell stories! I want to hear about your moments of magic, miracles, and synchronicity.

Dare to be immortal.


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