(di´ing)  a stage of life; a process that from a medical point of view begins when a person has a disorder that is untreatable and inevitably ends in "death" DEATH, or the final stages of a fatal disease. Dying is a process, whereas death is an event. The essential task of the dying person is to work through psychologic responses toward the reality of approaching death to a final and peaceful acceptance of that reality. 

STAGES OF DYING. In the early 1960s Dr. Elisabeth Kübler-Ross, a psychiatrist, proposed a stage theory of dying. These stages represent the adaptive strategies of a dying person who is trying to come to grips with the finality of his or her terminal illness. Not every dying person proceeds through these stages in accordance with the proposed sequence. Many patients alternate between one stage and another. 
Sometimes a patient will appear to have moved toward acceptance only to regress toward denial in response to some event. 

Dying is unique to the individual. No two people have the same life experiences or the same inner resources to deal with the vagaries of life and its inevitable end. However, being aware of what people who confront death have in common can be of benefit to those who care for them throughout the dying process. 

The stages proposed by Dr. Kübler-Ross are not limited to adaptation to dying. They are familiar to anyone who has tried to deal with profound, unwanted change. Every change involves some loss, the end of something familiar and the beginning of something new. Unhappiness with the change can trigger denial and other psychologic responses that delay acceptance. 

In 1964 Dr. George Engel proposed the theory that grief over the loss of a loved one brings about psychologic responses not too different from those exhibited by persons who are themselves dying.  Moreover, it has been noted that severely handicapped and disabled persons who must change their lifestyle to accommodate the effects of illness or injury might also go through a process in which they move toward acceptance of a new self and a new way of life. 

Stages of Death and also used for explaining the process of grieving  "DABDA"

Denial and disbelief are the initial responses to the knowledge that one is dying. It often is only a holding action until the person is ready to move forward to the next stage. It can be useful if the period is used to find a way to deal with death. During this stage the caregiver should neither agree with and reinforce the patient's denial nor attempt to force progress toward acceptance. 

Anger is a typical response to frustration and loss of control over one's life. The anger might be misplaced and directed toward the caregivers or relatives and significant others rather than on events and circumstances over which the dying person has no control and against which there is a feeling of helplessness. Caregivers should not take patients' expressions of anger and frustration personally. It is appropriate to allow angry patients opportunities to express their anger and feelings of helplessness in a nonjudgmental and accepting environment. 

Bargaining is the stage in which dying persons begin to try making some arrangement whereby they give up something in return for an extension of life. The bargaining often is with God or a Supreme Being who the patient feels has the power to prolong life. 

Depression is the stage during which dying persons grieve over all that they know will soon be lost. When terminally ill patients have the courage to admit their loss and face its reality, they have earned the right to mourn. At this point there may be withdrawal from others and expressions of a desire to be left alone. Although it is best to respect the wishes of patients in this matter, caregivers remain in touch and ready to offer companionship and consolation when appropriate. 

Acceptance is the final stage during which patients accept their loss and find some degree of peace within themselves. It is not the same as resignation or resentful giving in to the forces of fate. In accepting the inevitable these patients are not happy, but at least they have won their struggle with fear and grief. They are willing to stop resisting death and to rest and prepare for the long journey. During this time it is important that loved ones and others whom the patient wants to be with are available to provide times of togetherness. 

Those who have been with patients during this stage of the dying process often are told by the patients that it is one of the most meaningful periods of their entire lives. One of the greatest fears of dying persons is that of loneliness and abandonment. 

Concern for Dying is an educational council that provides programs tailored to meet the needs of laypersons and professional caregivers coping with the problems of terminal care. It also is the source of the Living Will and addresses legal and medical issues related to death and dying. Its address is Concern for Dying, 250 W. 57th St., New York, NY 10107, (212) 246-6962.

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