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Published: Sunday, 8/29/2004

Dealing with death

Perhaps the most enduring tribute that can be paid to Elisabeth Kubler-Ross is that she brought the subject of death and dying out of the dark closet of fear in which it had been ensconced by society for so many years.

The author of the 1969 international best-seller, Death and Dying, the Swiss-born psychiatrist pioneered the modern view that death is an integral part of life and that the terminally ill are best served in their final days with dignity and respect.

Dr. Kubler-Ross, 78, died last Tuesday in a Scottsdale, Ariz., nursing home while receiving hospice care, which has exploded in scope in the United States over the past 35 years under the influence of her ideas.

Dr. Kubler-Ross theorized that the terminally ill go through five stages of grief - denial, anger, bargaining, depression, and acceptance - as they near death. Understanding the process, she reasoned, eases life's final journey, both for the dying and those around them.

Before her breakthrough book, which was based on interviews with more than 500 dying patients, the medical community typically treated the terminally ill with something like an embarrassed reserve, almost as a failure of their craft. The dying often were told little about their condition, which spoke almost as much to the fear and anxiety of the doctor as that of the patient.

"We live in a very particular death-denying society," she told a U.S. Senate committee in 1972. "We isolate both the dying and the old, and it serves a purpose. They are reminders of our own mortality. We should not institutionalize people. We can give families more help with home care and visiting nurses, giving the families and patients the spiritual, emotional, and financial help in order to facilitate the final care at home."

Although hospice care did not become a permanent benefit for the elderly under Medicare until 1986, Dr. Kubler-Ross' words helped open the door for healthy public discussion and action.

Hospice care, little known in the United States for more than a decade after she broached the subject, has soared in the years since. In addition to care at home, there are now at least 3,300 hospice facilities, and the number of patients served climbed steadily from about 185,000 in 1985 to 885,000 in 2002.

Dr. Kubler-Ross's reputation in the scientific community suffered greatly after she became involved in experiments with so-called out-of-body experiences and channeling spirits, but those controversies pale in comparison to the worldwide impact of her ground-breaking work.

In breaking down the old taboos about death, she helped us all confront our mortality in an honest and healthy manner.

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