Merck Manual

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Acceptance of Death and Dying


Elizabeth L. Cobbs

, MD, George Washington University;

Karen Blackstone

, MD, George Washington University;

Joanne Lynn

, MD, MA, MS, The George Washington University Medical Center

Reviewed/Revised Oct 2021 | Modified Sep 2022

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.

  • Dying people and their family members can often achieve a deep sense of peace with the help of family, friends, and sometimes clergy.

  • Grieving often progresses through five emotional stages: denial, anger, bargaining, depression, and acceptance.

The prospect of dying raises questions about the nature and meaning of life and the reasons for suffering and dying. No easy answers to these fundamental questions exist. In their pursuit of answers, seriously ill people and their families can use or turn to their own resources, religion, counselors, friends, and research. They can talk, participate in religious or family rituals, or engage in meaningful activities. The most effective antidote to despair is often feeling cherished by another person. The torrents of medical diagnoses and treatments should not be allowed to obliterate larger questions, meaningful experiences, and the importance of human relationships.

Grieving is a normal process that usually begins before an anticipated death. According to Elisabeth Kübler-Ross, a pioneer in death and dying studies, dying people often experience five emotional stages:

  • Denial

  • Anger

  • Bargaining

  • Depression

  • Acceptance

These stages are typically experienced in roughly sequential order. However, these stages can occur in any order. People in denial may act, talk, or think as though they are not dying. Denial is usually a temporary response to overwhelming fears about loss of control, separation from loved ones, an uncertain future, and suffering. Talking to a doctor or other health care practitioner can help dying people understand that they can remain in control and can count on being comfortable and comforted. 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 dying people realize 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 and providing for loved ones, dying people and their family members often achieve a profound sense of peace.

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