There are five stages of the dying process as reported by Kubler-Ross. These stages are defined as: denial, anger, bargaining, depression, and acceptance. Please note that all patients do not experience each stage as outlined by Kubler-Ross in any specific order. The dying process is unique and very subjective to each individual and their caregivers through the dying process. The process of dying is specific to each individual and no two individuals are the same.

DENIAL

Patients initially have difficulty believing they are dying or that this is really happening to them. There is an analogy between denial and shock in that both denial and shock protect the individual and are a normal reaction to a stressful event. This normal reaction allows the emotive component to be experienced over a period of time. This buffering is beneficial for the individual and their family. Some patients may never resolve this stage and may continue to deny their prognosis until the day they die.

ANGER

Patients often feel angry that they are dying and at times may abuse those who are closest to them as they are the most vulnerable. This could include those who are performing volunteer work to assist them or their family. At times the expression of anger may appear irrational and may be directed at others not involved with their care. This is a normal reaction from the patient. Their caregivers (family) are the most vulnerable not only due to the proximity and the amount of hours they are exposed to the patient, but also because they are familiar with their family. An outward expression of anger should be viewed as a healthy sign that the patient is facing the reality of their situation.

BARGAINING

Once the anger phase is over the patient may enter the bargaining stage. This stage is characterized by attempts on the patient's part to bargain for further time. Some may see their illness as punishment which they can mitigate if they make a commitment to eat right or live a better life. They hope to postpone the inevitable outcome of their condition. Some patients even hope for a last minute reprieve provided by medical science. It should be noted here that some patients do live longer than expected. The motivation seems to derive not from the result of their bargaining, but from a strong desire to experience a life event such as the birth of a grandchild.

DEPRESSION

When all else has failed, the patient may resign themselves to what they see as inevitable and become depressed. Depression is a serious condition that can lead to other serious physical and mental problems. When the patient faces the reality of their death they may feel they have no control over themselves. They may no longer take their medications and may feel completely lost. By supporting the patient during this phase, the caregiver reassures the patient that they are not dead yet and that the individual will not be abandoned. They can also be depressed over the impending loss of the relationships they have or the rituals they have participated in.

ACCEPTANCE

The final stage is acceptance. It is during this stage that the patient faces their demise and prepares themselves for the inevitable. As they may come to peace with themselves, they finalize any remaining issues they need to take care of. The patient's area of interest becomes smaller and they may attempt to withdraw from the family. Some family members may see this withdrawal and become concerned. This withdrawal allows the patient and family to become less involved and eases the transition from life to death. Some family members never reach the acceptance stage which places an additional burden on the patient to seek resolution prior to their death.