The document discusses the history and development of hospice care. It originated from the work of Cicely Saunders in 1948 who sought to relieve the anxiety of dying patients. Today, hospice organizations provide palliative care to ensure patients can die with dignity. The document also examines the stages of death proposed by Kubler-Ross and how families experience similar stages of grief. It notes sitting with a dying loved one can be agonizing as their ability to communicate is lost. The grieving process has no timeline and is impacted by one's relationship with the deceased and mode of their death.

1. Death and Bereavement 1
Running head: DEATH AND BEREAVEMENT
Death and Bereavement
Lisa L. Woodward

2. Death and Bereavement
“A dying man needs to die as a sleepy man needs to sleep, and there comes a time
when it is wrong, as well as useless to resist” (Stewart Alsop, 1973).
Modern hospice care stems from a concept created by a young social worker named
Cicely Saunders in England in 1948. The organization has morphed numerous times and crossed
an ocean but still adheres to the same principle, “you matter to the last moment of your life. . .”
(Bjorkland, 2008, p. 346). Saunders was introduced to a young Polish man dying of cancer,
alone in a foreign hospital with no friends or relatives; he was experiencing anxiety and fear.
Saunders made her way to his room each day, she would sit and let her new friend speak of his
family, he’d share stories and experiences, and in doing so Saunders found his anxiety was
relieved.
After the young man’s death Saunders became a physician and specialized in the
treatment of dying patients. Today hospice organizations around the world exist to ensure
members of all societies can be ministered to, receive palliative care, and offer hope that no one
will die alone. Compiling research on the process of death and dying, developing the ability to
identify stages of death, and knowledge of these stages helps to educate those who provide
medical and respite care. Grief education also benefits family members preparing for the loss of
a loved one or those already in the process of grieving (NHO, 1996).
Elisabeth Kubler-Ross (1969), wrote a book called On Death and Dying, the stages of
death explained by Kubler-Ross are taught in every hospice training program in the United
States. The following excerpt offers a brief explanation of each stage of death as presented by
Bjorkland (2008, p. 328).
Denial. A constructive first defense upon learning of a terminal diagnosis.

3. Anger. Persistent questioning either in self talk or to family, nurses, and doctors “why
me?” Outbursts and lashing out is a common occurrence in the anger stage.
Bargaining. Patients will sometimes try to make a deal with doctors or with God, “if I
don’t tell anyone then it’s not going to happen.” Trying to make more time to see
children grow up or attend important events.
Depression. As the body declines in physical health and the disease takes over, a type of
mourning begins for the loss of one’s own life and for the loss of relationships.
Acceptance. An understanding and readiness for death accompanied by a quiet,
withdrawn reality of impending death.
Kubler-Ross was clear, these stages except for acceptance do not occur in sequential
order and some may be omitted altogether. Bjorkland (2008, p. 328) included a quote from
Stewart Alsop, which explains beautifully the acceptance stage of death, “A dying man needs to
die as a sleepy man needs to sleep, and there comes a time when it is wrong, as well as useless to
resist.”
As the patient experiences the stages of death, family and loved ones go through many of
the same stages. Often just as the dying patient reaches the psychological acceptance stage of a
terminal illness, the physical act of dying nears the end. Palliative care is provided to make the
patient comfortable and manage pain. For family, medical professionals, hospice staff and
volunteers the process is often agonizing. An article published in the New York Times penned
by Robin Marantz Henig, (2005). Will We Ever Arrive At The Good Death? As the ability to
communicate with the dying patient is lost there in an onset of new trials for those closest to
them. Henig (2005) reports:

4. The death rattle is what’s so unnerving. People who sit beside someone who is close to
death, someone in a stage the experts call “active dying”: might hear a sound that’s not quite a
snore, not quite a gurgle, not quite a rasp. It doesn’t hurt; it probably isn’t something the dying
person is even aware of. But it sounds terrible. Once the so-called death rattle starts, that’s
usually an indication that the person is not coming back. The sound, made with each intake of
breath, is merely air moving across phlegm “Healthy people can cough it up or spit it out or
swallow it, but a dying person is just not strong enough, so the secretions collect in the upper
airways. As they breathe in and out, it makes that sound - - that sound that we have learned to
fear. To those watching, the person seems to be gasping for breath, asking to be saved.
Sitting, waiting and helplessly watching while a loved one goes through the process of
dying is as overwhelming as it is as painful. When death does occur and the process of grief and
bereavement begin there is no timetable to feeling “normal” again. The Hospice Consortium
created a list for the determinants of grief. A major factor to be considered is “Who the person
was “or rather, who was the person to you? The loss of a distant cousin will be handled
differently from the loss of child. A spouse may be grieved differently than the loss of a parent.
Intensity of attachment is determined by the intensity of love. Security of the attachment
and how much the survivor needed the person for self esteem or “okayness” will be relevant to
the amount of grief experienced. Mode of death is another prominent factor in the grieving
process. Survivors of suicidal deaths have the most difficult time handling their grief, obviously
the accidental death of a child may be more difficult than that the natural death of an elderly
person.
In addition there are four tasks of mourning taught by the Hospice Consortium:
Task 1: TO ACCEPT THE REALITY OF THE LOSS

5. Task 2: TO EXPERINCE THE PAIN OF GRIEF
Task 3: TO ADJUST TO AN ENVIRONMENT IN WHICH THE DECEASED IS
MISSING
Task 4: TO WITHDRAW EMOTIONAL ENERGY AND REINVEST IT IN
ANOTHER RELATIONSHIP
In particular Task #2 deals with the ways individuals and society try to avoid the painful
feelings of loss, the point hospice tries to stress is that there simply is no adaptive way of
avoiding it by moving away, keeping busy, or strengthening resolve. Recalling and relating
memories of the deceased can be unpleasant and painful. Joining groups and arming oneself
with knowledge in regard to feelings of anger, guilt, loneliness, anxiety and depression and
understanding these are normal feelings and the majority not the minority go through the same
process in their personal experiences with loss.
One important idea to grasp is the distinction between grief and mourning. “Grief is the
internal meaning given to the experience of bereavement.” Mourning entails expressing sorrow
outside of oneself or “grief gone public.” Unfortunately, many people in our society grieve but
do not mourn. Often advice is offered in a cliché’ “carry on” or “keep your chin up.” When
survivors aren’t allowed to mourn, internalized and trapped feelings can cause isolation. Hospice
suggests, “don’t just grieve, mourn too, and be proud of your capacity to do so.” Mourning can
be the catalyst for the healing process (Wolfelt, 2000).
Though countless books have been published on death and grief there is no laundry list to
be checked off or magic wand to wave over a person in the process of death or those near to
them. Education and knowledge are key components and though it may be of little comfort these
stages and feelings are age old and kindred to everyone who was, is, and is yet

6. References
Bjorkland, B. and Bee, B. (2008). The Journey of Adulthood 6th
Edition. Upper Saddle River,
New Jersey: Pearson Education, Inc.
Henig, R. August 7, 2005. Will We Ever Arrive At The Good Death? Retrieved from
NYTimes.com on September 15, 2006.
National Hospice Organization. (1996). Hospice: A Better Way to care for the Dying.
Arlington, VA: National hospice Organization (NHO).
Wolfelt, A. (2000). 5 Dispelling Common Myths About Grief. Retrieved from Centerforloss.com
on February 12, 2010.

7. References
Bjorkland, B. and Bee, B. (2008). The Journey of Adulthood 6th
Edition. Upper Saddle River,
New Jersey: Pearson Education, Inc.
Henig, R. August 7, 2005. Will We Ever Arrive At The Good Death? Retrieved from
NYTimes.com on September 15, 2006.
National Hospice Organization. (1996). Hospice: A Better Way to care for the Dying.
Arlington, VA: National hospice Organization (NHO).
Wolfelt, A. (2000). 5 Dispelling Common Myths About Grief. Retrieved from Centerforloss.com
on February 12, 2010.