1. ON DEATH AND DYING
Sergio Flores | December 3, 2011

2. On Death and Dying
ELISABETH KÜBLER-ROSS, M.D.
ABOUT THE AUTHOR
• Born one of triplets in Zurich, Switzerland, Elisabeth was a
psychiatrist, humanitarian, physician, and hospice pioneer who wrote “On Death and
Dying” in 1969
• She authored 24 books published in 34 languages. Considered to have changed the face of
medicine and one of the most influential people and important minds of the last century
• In 2005 the Elisabeth Kübler-Ross Foundation is formed to further the work and maintain
her legacy
• Provides educational programs that deepen the understanding of those dying and
grieving for the dead
• Develop curricula for those involved in the care of the dying
Butterflies became her symbol, symbolizing the beautiful
transformation that she believed occurred at the time of death.
The logo for her Foundation is the butterfly symbol.
(http://www.ekrfoundation.org/)

3. On Death and Dying
INTERVIEWING THE DYING
• At the Hospital where she worked in New York, Kübler-Ross was appalled by the standard
treatment of dying patients. Unlike her colleagues, she made it a point to sit with
terminally ill patients, listening as they poured out their hearts to her. She began giving
lectures featuring dying patients who talked about what they were going through.
• Impetus for book was conceived by four theological seminary students researching “crisis
in human life”. They considered death as the “biggest crisis people had to face”
• In attempting to understand the needs of the dying, she addresses death in terms of
change, by studying the terminally ill patient’s attittudes, those of their caregivers, and
our cultural attitudes toward death – death as an analogy to change
BOOK QUOTE
”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...help the patient and his family to get „in
tune‟ to each other‟s needs and come to an acceptance of an unavoidable reality...” Kübler-Ross (2011). (p. 151)

4. On Death and Dying
RECURRING CHANGE THEMES
DEATH AS CRISIS RESPECT AND DIGNITY
• Death is the ultimate change • In control of your destiny
• Crisis as a catalyst to change • Manager - Subordinate relationship
• Dehumanizing • Doctor - patient relationship
• Envy of the living • Equanimity
• Job Loss/Retirement – Catastrophic
change
EMPATHY REAWAKINING AND HOPE
• Needs to be understood • Catalyst for renewal
• Perceptions of death (change) will • Collective change
color our ability to deal with it
• Listenting and understanding
• Reassurance
• Trust
• Impact of the messenger

5. On Death and Dying
DEATH AS CRISIS
ENVY OF THE LIVING
• Society has taught us to view death as a taboo
• Feelings or emotions that death invoke in us
• Perception toward death, dehumanizes the patient
• As a society we rather prolong life than diminish human ANACLITIC DEPRESSION
suffering
• Patiens who are informed of their imminent death respond with
anger, detachment, denial and fear
• Losing control of their own destiny
• But death, like change, is inevitable
• Patients express envy of the living
• Avoid death (change) at all costs
• Marasmus of the soul
• LOE
• Catastrophic change
• Job Loss
• Retirement

6. On Death and Dying
CATASTROPHIC CHANGE
RETIREMENT
• Charles Schulz dies weeks after announcing his retirement
• Andy Rooney dies a month after his retirement
• A study of Shell Oil employees shows that those that retire
earlier, die sooner than those who decide to work past their
retiring age
(http://www.webmd.com/healthy-aging/news/20051020/early-retirement-early-death)
"I never dreamed that this would happen to me. I always had the feeling that I
would stay with the strip until I was in my early eighties, or something like
that. But all of sudden it's gone. I did not take it away. This has been taken
away from me.“ – Charles Schulz on The Today Show

7. On Death and Dying
EMPATHY AND UNDERSTANDING
LISTENING AND TRUST
• Patiens who are informed of their imminent death respond with
anger, detachment, denial and fear
• Losing control of their own destiny
• The act of being merciful, provides relief
• Sit, listen, and share
• Change is intensely personal (Jeanie Daniel Duck)
• The sick person has feelings, the right to be heard
• Change is emotional, and evokes real feelings, wounds, our past
(Attachment Theory)
• Patients suffer more not physically, but emotionally
• Communication as a catalyst for reassurance and trust
• More than 75% of those interviewed by Kübler-Ross make a
full recovery
“People have contexts just as organizations do” – Gass, Pascale, and Athos

8. On Death and Dying
RESPECT AND DIGNITY
EQUANIMITY
• Controlling your own destiny
• Doctor‟s learn to judge whether or not a person is ready for the news
, and the manner in which they will be told of death diagnosis - Hope
• Subjective management of individuals
• Achieved only by listening and understanding
• Address those that need to be heard and understood
• “I am alive, don’t forget that. You can hear my voice, I am not dead yet”
Do not apply the mushroom principal to change management:
“ How to grow mushrooms?
Keep'em in the dark, and feed them bulls**t”

9. On Death and Dying
DABDA MODEL
DENIAL
ANGER BARGAINING DEPRESSION
ACCEPTANCE

10. On Death and Dying
DENIAL
Resistance is to be expected/accepted
Who moved my cheese - Hem and Haw DENIAL
This cannot be happening to me
How long will this last? Why me?
Ultimately, can lead to actual death

11. On Death and Dying
ANGER
Strong emotions about change – stems
from desperation
Misderected – alienation of a resistor will
ANGER
often hinder rather than help
Cathartic – Grief includes anger
Should be respected, and understood
“Change is fundemantally about feelings; companies that want their workers to
contribute with their heads and hearts have to accept that emotions are essential to
the new management style” – Jeanie Daniel Duck

12. On Death and Dying
BARGAINING
I‟ve been good, I can be better
What if I don‟t participate? BARGAINING
Can I be the exception?
I‟ve learned my lesson

13. On Death and Dying
DEPRESSION
Loss of hope
Emotional attachment DEPRESSION
Reactive and Preparatory
Sadness , regret, fear, and uncertainty

14. On Death and Dying
ACCEPTANCE
Understanding – no more fear
Resignation ACCEPTANCE
Detachment
Enlightment
“Look not mournfully into the past. It comes not back again. Wisely improve
the present. It is thine. Go forth to meet the shadowy future, without fear.”
- Henry Wadsworth Longfellow (1807 - 1882)

15. On Death and Dying
3-PHASE MODEL
DABDA MODEL OVERLAYED ON KURT LEWIN‟S MODEL
Unfreeze Mobilise Refreeze
• Create the case for • Identify and mobilise • Embed new ways of
change the resources working in the fabric of
• Dissatisfaction with required to effect the organization
the status quo change
DENIAL AND ANGER
BARGAINING ACCEPTANCE
(DEPRESSION)
“Choosing a model is not an arbitrary choice--it is an ideological one. The assumptions we make
about change are also assumptions about the nature of reality and people.”
– Van de Ven & Poole (Theories and Models of Organizational Change)

16. On Death and Dying
DIALETIC CORE PHILOSOPHY
CONSTRADICTION IS A NATURAL STATE
• Change occurs when opposing powers (contradictory values – competing with each
other), gain sufficient power to confront and engage the status quo.
(http://gre.academia.edu/MJReid/Papers/252681/A_brief_review_of_Van_de_Ven_and_Pooles_1995_article_Explaining_develo
pment_and_change_in_organizations_Academy_of_Management_Review_20_3_)
• The DABDA model follows a directly linear representation of this philosophy, but at the
micro, rather than macro, level
(http://changingminds.org/disciplines/change_management/kubler_ross/kubler_ross.htm)
It is inconceivable for our unconscious to imagine an actual ending of our own life here on earth, and if this life of ours has to
end, the ending is always attributed to a malicious intervention from the outside by someone else. In simple terms, in our
unconscious mind we can only be killed; it is inconceivable to die of a natural cause or of old age. Therefore death in itself is
associated with a bad act, a frightening happening, something that in itself calls for retribution and punishment.

17. On Death and Dying
DABDA & ADKAR
KNOWLEDGE REINFORCEMENT
BARGAINING ACCEPTANCE
GROWTH
AWARENESS/DESIRE ABILITY
DENIAL /ANGER DEPRESSION
ENLIGHTMENT

18. On Death and Dying
REAWAKENING AND HOPE
THE ROLE OF HOPE IN ACCOMPLISHING CHANGE
• Even when the situation is most dire, the possibility of hope can
facilitate change
`
Positive Focused Flexible Organized Proactive
- Characteristics of Resilient Individuals (Conner Partners)
Not thinking of dying, but thinking of living Don‟t focus on the negative, focus on the positive

19. On Death and Dying
REAWAKENING AND HOPE
OLD FRAME OF MIND NEW FRAME OF MIND
IMPERSONAL PERSONAL
RIGIDITY SENSITIVITY
QUANTITY OF LIFE QUALITY OF LIFE
ABSOLUTES FLEXIBILITY
LAW ETHICS
POWER IMPACT
CONTENTEDNESS HAPPINESS
VICTORY IN CONFLICTS CONFLICT RESOLUTION
(Hey & Moore, 1998)

20. On Death and Dying
REAWAKENING AND HOPE
How has death changed us as
a society?
• Peresonally?
• Collectively?
The impact on our everyday
lives and decisions
• The collective reality that
has changed our lives so
drastically

21. On Death and Dying
REFERENCES
• Change Management Learning Center - Prosci (1996 – 2011). "ADKAR“- a model for change management : Change
Management Tutorial Series. Retrieved November 5, 2011, from http://www.change-management.com/
• Conner, Daniel (2004). Developing Resilient Teams for Managing Change. Conner Partners website, from
http://www.connerpartners.com
• Duck, Jeanie Daniel (1998). Managing Change: The Art of Balancing. Harvard Business Review on Change
• Goss, Tracy, Pascals, Richard and Athos, Anthony (1998). The Reinvention Roller Coaster: Risking the Present for a
Powerful Future. Harvard Business Review on Change
• Hey, Kenneth R. and Moore, Peter D. (1998). The Caterpillar Doesn‟t Know: How Personal Change is Creating
Organizational Change. New York, NY: The Free Press.
• Kubler-Ross, Elisabeth (2011). On Death and Dying. Simon & Schuster, Inc.. Kindle Edition.

22. On Death and Dying
IMAGE REFERENCES
• http://www.indiesolo.com/files/images/10178_371241.jpg
• http://all-silhouettes.com/silhouetteclipart/
• http://www.serebiiforums.com/showthread.php?t=551694
• http://www.myspace.com/ekrfoundation/photos
• http://peanuts.wikia.com/wiki/Charlie_Brown

23. On Death and Dying
VIDEO AND AUDIO REFERENCES
• http://www.youtube.com/v/aO4xpkH_YMw
• http://youtu.be/CYZJXoyrHnw